What is stroke? Paralysis? Is it reversible? What is the actual treatment of stroke? Are we doing treatment or secondary prevention? Establishing stroke centers?
ONE IN 6 PEOPLE DEVELOP STROKE IN THEIR LIFE TIME
IF STROKE IS SUSPECTED THE PATIENT SHOULD BE SENT TO THE STANDARD STROKE CENTER WITHIN 4 HOURS OF ONSET OF STROKE.
BRAIN IS TIME. EVERY MINUTE 1.9 MILLION NEURONS WILL DIE.
Stroke is loss of blood supply to some part of brain. Results in death of brain cells exponentially within 6 hours. It is of two types. Ischemic which is around 85%. Hemorrhagic around 15%. Stroke results in facial weakness, deviation of mouth, weakness of upper and lower limbs, speech arrest, vision loss, and many more symptoms according to the part of brain damaged.
Stroke is completely reversible if the patient turns to the stroke centre within 4 hours. Clot bursting drug named r-tPA / Alteplase/ Tenecteplase can be given if the patient come to the hospital within 4 hours. If there is no significant improvement, he has to be subjected to mechanical thrombectomy procedure to remove the clot which is obstructing the flow. Usually thrombolysis with r-tPA can be successful in 10 to 30% cases. Mechanical thrombectomy is successful in 50 to 70% cases.
Stroke center should have Inhouse CT/CT Perfusion/ MRI facility with 24 hr round the clock stroke interventionist, neurologist and neurosurgeon. Not all centers are equipped with CT Perfusion scan which is mandatory for stroke interventions. Many centres don’t have MRI and CT scan facility for emergency situations. Stroke interventionist who has trained in interventional neurology for atleast 2 years and attended atleast 100 stroke cases will have a good knowledge about the management protocols in emergency basis.
Don’t manage with aspirin and heparin if the patient is in the window period.
Establishment of stroke centers with ISA recommendations is required to overcome stroke, the third most common cause of death.