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Stroke

  What is it? • Sudden disruption of blood flow in one or more parts of brain causing loss of function of that area.

Causes:

• Bursting of a blood vessel or its blockage due to local or migrating blood clot.

• Unless treated vigorously and immediately, the outcome may be fatal.

Outcome

• The cells in the brain may quickly begin to die. The result can be serious disability or death.

Types

TIA: Transient Ischemic Attack• Temporary loss of function of brain due to sudden blood flow disruption caused by arterial spasm (as due to tobacco use) or minor clot that the body manages to dissolve and wash away.

Stroke: Thrombotic and Embolic/Hemorrhagic types

• Gradually progressive loss of power & sensations in one half of body over a day or two, due to development of Thrombus (clot) over a fatty deposit on the vessel wall.

• Sudden loss of power & sensation due to migrating clot (Embolus) blocking a blood vessel or rupture of an artery at a vulnerable spot (aneurysm / ballooning of an artery)

Features

Loss of power in one or more parts of body on the side opposite to that affected in brain. Muscles may be floppy when the lesion is fresh, but soon spasticity develops in the affected side.

Tickling the sole of the affected foot causes the big toe to go up (Babinski sign).

Sensory and involuntary muscle function loss.

Investigation

Clinical assessments of neurological deficits & dysfunctionsMRI Scan (top) to show anatomical extent of stroke injury

Single Photon Emission CT (SPECT: Bottom image) to show functional status of injured brain

• Blue/black: dead area;

• Green: badly damaged, difficult to revive

• Yellow damaged but revivable;

• Red: normal tissue)

Electro Encephalograph (EEG) if there is epileptic fits.

Immediate Management

Regulate blood pressureDrugs to reduce brain swelling

Drugs to enhance metabolic activity in brain to help it recover faster

Drugs to prevent blood clotting (as that is the commonest cause of stroke)

Strict control of lipids, blood sugar and diet.

Nursing care to prevent bed sore and help in toilet

Physical Therapies to preserve muscle tone, function and power

Specialized Management

Clot busting infusionsBlocking aneurysms

Removal of fatty deposits (plaques) if artery is approachable.

Control of heart rhythm, as abnormal rhythm promotes clot formation.

Blood vessel wall anti-inflammatory agents like Statins

Specialized therapies like rTMS, Pulsed Magnetic Field Therapy, Gyrosonics, etc. may sometimes work

New Experimental Therapy

Hyperbaric Oxygen Therapy, at a pressure and oxygen level to suit the severity and extent of lesion as per SPECT Scan, for 90 minutes per session, for a number of sessions equal or greater than 40, as per clinician’s judgment.• There are a lot of Inclusion and Exclusion Criteria that must be fulfilled before HBOT is attempted, that too, under expert guidance under an expert in this mode of therapy.

Regenerative Medical Therapies are under Experimental Clinical Trial stage.

 

Stroke Treatment

Counseling
Diagnostic and assessment
Physiotherapy
Need based rehabilitation
Pharmacological Intervention
Surgery to remove blood clots
Surgery to repair blood vessels
Surgery to remove plaque from the carotid artery
Carotid angioplasty and stenting
Coiling aneurysms
Hyperbaric Oxygen Therapy
SCT Regenerative Medical Intervention (Experimental) & Clinical case studies