What is stroke?
Stroke occurs when blood flow to any part of brain ceases, resulting in disruption in supply of oxygen and glucose to the brain, or sometimes when bleeding occurs in the brain. Inspired by heart attack, it is also called “brain attack." This leads to temporary or permanent damage to brain cells.
The permanent damage to the cells may cause irreversible dysfunction in the part of brain controlled by damaged cells; for example; full or partial stroke arising out of the damage to cells in right hemisphere of brain that controls function of movement results in weakness in left arm and leg.
Symptom of Stroke
Weakness in one or both sides of the body: most commonly occurs in arms, legs, hands and face. Usually, both right or left arm and leg are involved.
Sensorial deficit in one or both sides of the body: Some people may experience sensorial deficit in the form of anesthesia, numbing and pins and needles in a part of body. Speech disorder: The stroke patient experiences slurred speech, lisping or sometimes difficulty remembering certain words. Others face difficulty in understanding other people.
Altered mental status: Loss of consciousness, sleepiness, altered place, time and person orientations, inability to comprehend questions and commands.
Visual impairments: Stroke can be manifested by double vision and loss of vision in either right or left field of vision in one eye.
Sudden-onset headache: Headache with unknown cause,
dizziness, nausea, vomiting and postural balance problems may be experienced.
Treatment of Stroke
Place and type of care and treatment are important for stroke patients. The most important recent development is the fact that care and treatment at “Stroke Centers", more commonly called “Stroke Units", which are configured similar to coronary intensive care unit, wherein patients with myocardial infarction is admitted in early stage, significantly help stroke patients.
When stroke patients are admitted to a routine inpatient clinic, even if it is a general neurology inpatient clinic, the risks for mortality and disability will be higher compared to admissions to stroke units. Treatment of stroke is a challenge against time, as is the case with patients with myocardial infarction, and treatment and care by a team of experienced and specialized doctors and nurses in a special unit reserved for treatment of this condition with pre-determined treatment and care protocols forms the basis of modern stroke management.
1. Intravenous thrombolysis
First-line treatment of stroke requires quick restoration of cerebral blood flow that is impaired by clogged vessels, which flow blood to the brain. Even every second since the onset of stroke is very important in the treatment.
Intravenous thrombolytic therapy implies intravenous injection of a drug that breaks down clot not later than 4.5 hours after symptoms of stroke emerge. For this purpose, recombinant or genetically engineered tissue plasminogen activator (rtPA) is used. Optimal approach is to start treatment as soon as possible.
This treatment breaks up the clot and it helps regulate blood flow swiftly and efficiently and accordingly, it helps recovery of the stroke.
If patient's medical condition is unsuitable for this treatment or a long time has elapsed since the onset of stroke, intravenous thrombolytic therapy is not a therapeutic option. Your physician will resort to other medications and methods.
2. Endovascular treatments
If the great arteries that supply blood to the brain is obstructed by clot, intravenous thrombolytic therapy cannot sufficiently break down the blood clot that developed in great arteries. In this case, the principal purpose of treatment is to break down or remove the clot with intraluminal (inside the lumen) approach. This type of treatments is called endovascular or interventional treatments and done through an angiographic procedure.
However, this treatment should be employed within first 8 hours after the onset of stroke.
Intra-arterial Thrombolysis
A thin and flexible catheter inserted into an artery in the groin with angiographic method. It is advanced to vessels that feed the brain and the occluded vessel that causes the stroke and the clot that results in occlusion are accessed. Low-dose thrombolytic agent, rtPA, is directly administered into or close to the clot. Currently, this method is regarded as an adjuvant therapy.
Mechanical Removal of Clot (Thrombectomy)
A thin and flexible catheter inserted into an artery in the groin with angiographic method. It is advanced to vessels that feed the brain and the occluded vessel that causes the stroke and the clot that results in occlusion are accessed. The clot that occludes the vessel is aspirated with a special large-bore catheter or grasped with special retractable stents.
3. How Can I Prevent Stroke?
Following treatments can be administered alone or in combination after patients medical condition and cause of the stroke, if any, are taken into consideration.
Medication therapies
Anti-thrombotic drugs are medications that prevent formation of clot, which may cause stroke, and growth of existing clots. There are two sub-groups in this group of medication;
Anti-platelet drugs
These medications prevent formation of clots by hindering attachment of platelets to plaque formations, which cause stenosis. Aspirin is a drug listed in this group. 2. Anti-coagulant Agents: these medications prevent formation of clot in blood vessels and growth of existing clots.
Surgical Treatments:
Endarterectomy:
Carotid arteries lie at both sides of the neck and supply blood to the brain. The procedure is performed when these vessels are stenotic or occluded. Carotid artery is exposed through a small incision made on front side of the neck and the plaques that cause the stenosis are shaved off the wall.
Interventional Treatments:
Vascular stenosis can be managed with interventional or endovascular treatment methods that are done through angiographic approach instead of endarterectomy, when deemed necessary. This method helps treatment of stenosis not only in blood vessels that can be surgically accessed, such as carotid artery, but also in smaller intracranial vessels, for which surgery cannot be done. For this purpose
Angioplasty
A special catheter is inserted into an artery in the groin and advanced to the blood vessel of the brain that is stenotic secondary to plaque formation. When the stenotic part of the vessel is reached, the balloon located in one end of the catheter is inflated to dilate diameter of the vessel and restore patency of lumen. Thus, the blood flow into the brain is improved.
Stent implantation
A special catheter is inserted into an artery in the groin and advanced to the stenotic segment of the vessel in the brain secondary to plaque formation. The balloon in one end of the catheter is inflated, if required, to dilate the stenotic segment. Then, a stent is placed at the stenotic part of the vessel and thus, the stenotic segment is dilated. So, blood flow to the brain is restored.
