Managing a brain stroke

One day while at work, 47-year old, Madhur Pathare noticed that the left side of his face and left arm suddenly felt numb and weak. Next day, the symptoms persisted. “So I consulted a neurologist, who informed me that I had suffered a minor stroke. He told me that it could have progressed into a severe weakness of the left side possibly for the rest of my life. With proper treatment, now I am much better and back at work,” says Pathare.

A stroke is recognised as a leading cause of disability and death across the globe. It occurs when an area of the brain is deprived of its blood supply by a blocked blood vessel or cut due to bleeding in the brain. Soon the neurons of the dependent area of the brain become damaged and start dying unless there is urgent intervention. As a result, the part of the body controlled by the damaged area of the brain loses its function. The faster the treatment begins, the lesser the damage. Prior to the stroke, patients may experience Transient Ischemic Attacks [TIA] i.e. brief periods of neurological symptoms as seen in stroke with spontaneous recovery. Thus, a TIA needs to be treated as an emergency.

Know the types

There are two major types of strokes.

• Ischemic stroke is caused by a blocked or narrowed artery, thereby damaging neurons of the brain.
• Hemorrhagic stroke is caused by sudden bleeding from an artery. Symptoms include sudden onset of numbness or weakness of one side of face, arm or leg. It may also cause difficulty in seeing, thinking or balancing. Severe headache may also follow.

Several known factors increase the risk of stroke. The more risk factors you have, the greater your chances of having a stroke.

Be aware

Non-modifiable risk factors include:

• Age: Older people are more prone.
• Gender: Men are at a higher risk.
• Family history: Your risk is greater if a parent, grandparent, sister or brother has had a stroke.
• Personal health and medical history: History of stroke, heart attack.

Modifiable risk factors include:

• Blood pressure of more than 140/90mm Hg.
• Diabetes mellitus.
• Atherosclerosis of carotid artery.
• Heart diseases like atrial fibrillation.
• Blood clotting disorders.
• High blood cholesterol.
• Smoking.
• Excessive use of birth control pills.

Live healthy

Suggested lifestyle changes to reduce the risk of stroke:

• Maintain proper weight and exercise. Being inactive and obese can increase the risk of stroke.
• Drink in moderation. An average of one alcoholic drink a day for women and two a day for men should not be exceeded, to lower the risk of stroke.
• Stop smoking.
• Limit the use of illegal drug abuse.

Recognise the signs

If you notice these signs, call your local emergency medical services number immediately and get prompt treatment. Every second counts as treatment is more effective when given quickly.

The signs of a stroke are:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble in walking
• Sudden dizziness, loss of balance or co-ordination
• Sudden severe headache with no known cause.

If you experience some of these signs, but they last only a few minutes, you may be having a transient ischemic attack [mini stroke]. You should seek urgent treatment to prevent a severe stroke in the next 48 hours.

In the hospital emergency room, tests will determine if a TIA, stroke or any other medical problem caused your symptoms.

Get it diagnosed

Diagnosis is based on the patient’s medical history and a physical examination. A variety of diagnostic tests are available. If stroke is suspected, the doctor will order an MRI [Magnetic Resonance Imaging] or CT [computed tomography] scan to determine whether the stroke was caused by a clot, or from bleeding inside the brain. Additional tests may be done depending on the scan results.

If disease or narrowing of one of the large arteries in the neck [carotid arteries] is suspected, the following tests may be done.

• Doppler of the carotid artery
• Magnetic Resonance Angiography [MRA] scan to show the flow of blood through the blood vessels
• Digital Carotid Arteriography [DSA] to show specific arteries, to evaluate heart as source of clot [chest X-ray, ECG or EKG, echocardiograph or other heart imaging test].

Laboratory tests to rule out other conditions and check the patient’s blood clotting tendency may also be needed.

Follow the treatment

Treatment is aimed at preventing life-threatening complications that may occur soon after stroke symptoms develop, prevent future strokes and long-term complications and reduce disability. It also helps the patient get back as much normal functioning as possible through rehabilitation.People who have symptoms of a stroke need to seek emergency medical care. Prompt medical attention may prevent life-threatening complications and more widespread brain damage and is critical for the best recovery.

If emergency treatment is sought within the first three hours after symptoms begin, medication may help dissolve the clot increasing the chances of full recovery. Surgery is another option, often determined by type of stroke and seriousness of the symptoms.

Bounce back

Most strokes are minor but some may lead to severe lifelong disability or death. About a quarter of strokes may cause death in the hospital. Younger patients with better general health tend to recover faster and completely. Strokes with loss of consciousness or those with impaired breathing or heart function are particularly serious. About half of the people who have one-sided paralysis and most of those with less severe symptoms recover some function before they leave the hospital. They can eventually take care of their basic needs. The aim should be to limit damage to the brain tissue.

Once a stroke occurs, some brain tissue is dead and its function cannot be restored. However, removing blockages after a small stroke or transient ischemic attack in someone whose carotid artery is more than 70 per cent blocked may reduce the risk of future strokes. While dead brain tissue cannot be restored, intensive rehabilitation can help patients learn to overcome disability by training other parts of the brain to do what the damaged part originally did. Rehabilitation usually begins quickly to keep the patient’s muscles strong, to prevent muscular contractions and pressure sores and to teach the patient to walk and talk again. Rehabilitation may continue after a patient leaves the hospital.

Take proper care

After the phase of acute therapy, the process to maximise the recovery of function should be initiated. This falls in the purview of neuro rehabilitation. It involves the skills of a multi-disciplinary team of professionals—doctors, nurses, physiotherapists, speech and language therapists, dieticians, clinical psychologists, occupational therapists, counsellors, social workers and relatives.

Patients should not despair if their recovery rate is slower than they would have hoped, and if they are unable to regain their previous abilities. Their aim should be to concentrate on what they are able to achieve and to enjoy the best quality of life possible after a stroke.