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Stroke Treatment in India

What is a Stroke?

A condition that occurs when a burst or clogged artery interrupts flow of blood to the brain. This deprives the brain of food and oxygen and as a result, brain cells begin to die. These dead brain cells cause loss of the functions in different parts of the body. Loss of feeling, reasoning problems, language problems, problems in vision and visual perception, speech problems, coma, difficulty swallowing, muscle weakness and paralysis can be caused by a stroke. A stroke requires prompt treatment in order to minimize the damage caused to the brain and to avoid the potential complications.

Types of Stroke

A stroke can be categorized into two types –

Hemorrhagic Strokes: This type of stroke occurs when a blood vessel bleeds and burst in the brain. The accumulated blood compresses the nearby tissues of the brain. This could be caused due to

  • A blood vessel on the brain surface, which starts bleeding in between the skull and the brain.
  • A blood vessel bleeding or bursting inside the brain
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Hemorrhagic strokes has two main types –

  • Subarachnoid hemorrhage: In this situation there is bleeding in the area between the brain and the thin tissues covering it.
  • Intracerebral hemorrhage: The most common type of hemorrhagic stroke. It occurs when an artery bursts inside the brain and results in flooding of nearby blood tissues.

Ischemic Stroke: This occurs when something causes a blockage in an artery carrying blood to the brain. Potential ischemic strokes could occur–

  • When there is a blockage in the small blood vessels within the brain
  • When a blood clot develops in one of the main arteries to the brain
  • When an air bubble, a blood clot or fat globule develops in a blood vessel and is carried to the brain.

There are two common types of ischemic stroke –

  • Embolic Stroke: This stroke occurs when debris or blood clots develops away from the brain. This mostly occurs in the heart and is then swept in the bloodstream to the narrow brain arteries. This kind of blood clot is known as an embolus.
  • Thrombotic Stroke: This occurs when a thrombus (a blood clot) develops in one of the arteries that supplies blood to the brain. The clot may occur due to accumulation of plaque (fatty deposits) in arteries that results in decreased blood flow.

A mini stroke or a transient ischaemic attack (TIA) happens when there is temporary blockage in blood supply to the brain and commonly associated with it is a stroke like feeling, which lasts for a little time. This is an indication that a part of the brain is not getting sufficient blood & may result in a severe stroke in the future.

Symptoms of a Stroke

There are many signs indicating occurrence of a stroke, which is largely dependant on what part of the brain is being affected. The symptoms include –

  • Headache with unknown cause
  • Trouble in seeing
  • Numbness on one side of the body
  • Difficulty walking
  • Difficulty & confusion in speaking
  • Loss of balance
  • Difficulty swallowing
  • Clumsiness
  • Difficulty reading & writing
  • Changes in hearing
  • Dizziness & vertigo
  • Loss of coordination
  • Changes in touch and ability to feel different temperatures, pressure or pain.
  • Lack of control over bowels or bladder
  • Mood, personality or emotional changes
  • Changes in taste

Diagnosis of a Stroke

A blood test and physical exam are performed to diagnose stroke. Sometimes imaging is also used. A CT scan or computerized tomography helps in determining whether a person has a stroke and the type of stroke he/she has. Artery structures can be viewed by performing a specialized CT scan where a dye is injected into the vein. In order to view the damaged brain tissue, MRI or magnetic resonance imaging test is performed.

Clotting in the carotid artery (a major artery that travels up the neck into the brain) can be detected by performing a carotid ultrasound. Echocardiography ultrasound is performed to produce images of the heart which help in determining whether the stroke is caused by an embolus.

Treatment of a Stroke

Treatments for both hemorrhagic and ischemic stroke are different.

The purpose of treating ischemic stroke is to restore flow of blood in the brain. Medications are given within the first four and a half hours of the stroke to destroy the clots in blood vessels. An injection of tissue plasminogen (TPA) can also be given to a patient to improve probability of a full recovery.

The main purpose of treating a hemorrhagic stroke is to stop bleeding and decrease pressure on the brain. Clotting drugs can be prescribed instead of blood thinners. After the area has been healed and bleeding is controlled, damaged and leaky blood vessels are repaired.

The first stroke device approved by FDA is the Merci retriever. The aim of this device is to restore flow of the blood in the neurovasculature by removing thrombus in patients suffering from ischemic stroke.

The penumbra system (endovascular thromboaspiration) is the latest FDA approved device that has been primarily developed for removing clots in cases of acute ischemic stroke. In order to eliminate or reduce the clot burden, the system uses dual approaches to clot extraction through debulking and aspiration of the thrombus. Clot retrieval is then performed using a ring like device that captures the thrombus in clasps and places it in a cylinder. The thrombus is then withdrawn when flow stops. This new aspiration device (the penumbra system) has an excellent safety profile and a high rate of ‘target vessel’ recanalization.