Understanding stroke- The New Indian Express


Express News Service

CHENNAI: Silent and stealthy, strokes impact millions of lives in India, and ranks among the top five causes of death. The ischemic type, occurring when blood vessels supplying to the brain become blocked, accounts for approximately 80% of all strokes. Prompt attention to this type can lead to near-complete recovery, preventing potential bedridden outcomes. October 29 is observed as World Stroke Day to raise awareness about stroke signs and the vital importance of timely access to emergency medical care. Here’s everything about this silent killer. 

The ‘not so long ago’ past
In the not-so-distant past, the diagnosis of stroke in a casualty was far from urgent. A basic CT scan was conducted, albeit in its own time, primarily to differentiate between ischemic and hemorrhagic strokes. Ischemic strokes in such cases were often conservatively managed with a few tablets aimed at preventing further incidents. Patients with large vessel occlusions (LVO) frequently experienced dense weakness, significantly compromising their quality of life.

Mechanical thrombectomy 
A ground-breaking development in acute stroke management has been the mechanical thrombectomy performed by Interventional Radiology (IR) doctors. Through a minuscule opening in an artery (typically in the leg), IRs navigate small tubes and wires through blood vessels to reach the brain. For patients with large vessel occlusions, mechanical removal of clots has shown significant benefits.

However, this requires swift action, with patients reaching a stroke-ready hospital in the shortest time possible. After a rapid assessment with a CT scan, the patient is taken to the angio suite, where mechanical thrombectomy is performed as an emergency. Often, remarkable improvements are observed, with patients regaining movement in affected limbs even on the operating table.

The introduction of thrombolytic medication, particularly Tissue Plasminogen Activator (TPA), has been revolutionary. Multiple studies have demonstrated the effectiveness of TPA in many cases of acute stroke, provided it is administered within 4.5 hours of onset. This underscores the critical importance of rapid hospitalisation for preliminary evaluation and CT scans, making the patient eligible for potentially life-saving TPA. When administered within this critical window, TPA enhances the chances of recovery.

As emphasised, time is of the essence. The brain, comprising approximately 130 billion neurons, suffers significant loss when a large vessel ischemic stroke goes untreated. Each passing minute leads to a loss of approximately 1.9 million neurons, 13.8 billion synapses, and 12 kilometres (7 miles) of axonal fibres. For every hour of delay, the brain undergoes neuronal losses equivalent to nearly 3.6 years of the normal ageing process, an irreversible loss.

The acronym F.A.S.T.E.R represents the critical symptoms of a stroke: Face drooping (uneven smile), Arm weakness (drifting or numbness), Stability loss (acute dizziness, loss of balance), Talking (slurring), and Eyes (vision loss in one or both eyes). Recognising these signs is paramount, as timely action can make the difference between an active life and one confined to a bed.

A ‘stroke-ready’ hospital offers a ray of hope. Such a hospital has a designated ‘stroke pathway’ in place, equipped with all necessary infrastructure to manage any type of stroke intervention at any time of day. Unfortunately, these hospitals are few and far between, and India requires many more to cater to its vast population.

The writer is a consultant vascular interventional radiologist at Medical Trust Hospital, Kochi

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