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Stroke / Paralysis

Stroke / Paralysis

What is a stroke?

A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues.

What are the types of Stroke?

Ischemic Stroke (80%)
Hemorrhagic Stroke (20%)

What are the risk factors for stroke?

1. Hypertension
2. Cigarette smoking or exposure to second hand smoke
3. High cholesterol
4. Diabetes
5. Obstructive sleep apnea
6. Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm( Atrial Fibrillation) 
7. Personal or family history of stroke, heart attack or transient ischemic attack.
8. Old Age and Male sex
9. Hormones — use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth.

What is BE FAST for stroke symptoms?

The acronym BE FAST is a handy technique to help you quickly recognize common signs of a stroke. This outlines questions to ask about the telltale signs your friend or loved one may be having a stroke, plus action to take:
Balance – Is there a sudden loss of balance or coordination?
Eyes – Is there sudden blurred or double vision or sudden, persistent vision trouble?
Face – Ask the person to smile. Is one or both sides of the face drooping?
Arms – Ask the person to raise both arms. Does one side drift downward? Is there weakness or numbness on one side?
Speech – Does the person have slurred or garbled speech? Can he/she repeat simple phrases?
Time – Call for immediate medical attention if you notice one or more of these signs. Also, take note of when symptoms began.
I can’t overstate the importance of the “T” for time factor. It’s the only part of the acronym that isn’t a symptom, but it’s vital to include – because quick action is key to treatments that can be offered for strokes.

How to diagnose Stroke?

Neuroimaging- CT/MRI brain
Vascular Imaging- CT Angiogram/MR Angiogram/DSA/Carotid-Vertebral Doppler
2DECHO

What are the treatment options available?

Stroke is medical emergency. On knowing the symptoms of stroke, patient should immediately reach to ready to treat stroke hospital. After doing neuroimaging various treatment available.

Emergency treatment of acute ischemic stroke

Intravenous injection of tissue plasminogen activator (tPA-Alteplase) is potent clot-busting drug ideally is given within 4.5 hours. It is the gold standard treatment.

Emergency endovascular procedures - Medications delivered directly to the brain or removing the clot with a stent retriever which can be done upto 24 hours if feasible

Medications- Antiplatelet or anticoagulation given depending on etiology of stroke.

Few patients require surgical intervention e.g. decompressive craniotomy for survival in stroke patients.

Other Procedure- Carotid endarterectomy/Stenting

Emergency treatment of hemorrhagic stroke

Medications- Antiedema measures, BP lowering drugs and other supportive medications

Surgical treatment - Decompressive craniotomy, External ventricular drainage, Clipping or Coiling of Aneurysm, Repair of AVM/DAVF

Neurorehabilitation

After emergency treatment, neurorehabilitation focuses on helping you recover as much function as possible and return to independent living.