29 October, 2020
An acute stroke, or brain attack, is caused by the sudden loss of blood flow to the brain (ischemic stroke) or bleeding inside the head (hemorrhagic stroke). As the brain cells starve of the lack of blood and oxygen, they initially stop functioning and later die after a time period called the “window period”. If treated in the “window period,” the neuronal death can be reverted and brought back to normal and prevent disability.
Stroke symptoms appear silently; the brain senses pain but not as painful as that of a heart attack. The results, however, can be just as life-threatening and lead to a lifelong disability worse than death. An acute stroke is an emergency; if treated in the “window period,” it can save lives and prevent disabilities.
How can we recognize a stroke?
Remembering the acronym, ‘BE FAST’, can help.
B – Loss of Balance
E – Loss of Eyesight
F – Face deviation
A – Arms unable to move
S – Speech loss
T – Time to call an ambulance
If you recognize any of these, act fast and call an ambulance. The earlier we treat patients, the better the recovery. Every 2 out of 3 patients that are treated recover if treated on time.
Time is crucial to the brain — the faster we detect and treat patients, the further we can prevent the damage of brain cells. A delay, even by a minute, in the treatment leads to the death of 20 lakh neuron cells. Those affected need to reach a comprehensive stroke hospital as early as possible. The benefits of receiving treatment are even more significant if the treatment is initiated as early as possible, before tissue damage.
SPARSH Group of Hospitals in Bangalore provides 24/7 “Stroke-Ready” ambulances and is the only hospital in Karnataka with an advanced stroke-care ambulance facility that can reach the stroke patient’s doorstep and initiate treatment there. When treatment is started early, the outcomes are better.
Intravenous medicines to dissolve clots can be given in up to 4.5 hours after the stroke and the clot extraction — mechanical thrombectomy — and restoration of flow also can be done in up to 6 hours. For some people, the extended time window can be up to 24 hours. Post-stroke care is done in the neuro ICU, followed by rehabilitation.
Strokes are a leading cause of disability worldwide — 1 in 4 people have a stroke in their lifetime. The burden in India is enormous, as it sees more than 1.5 million stroke cases per year, which is much higher than in the western, industrialized countries. Strokes are the second-most common cause of death in India.
The results of early treatment have proven to be well, scientific and economical, reducing the disability burden to the individuals, families and the nation.
Every minute, three Indians suffer from a brain stroke. The numbers are increasing alarmingly due to changing lifestyles, especially in the young (<49 yrs).
COVID-19 and strokes:
Though a COVID-19 infection itself creates a high risk for stroke, there is a rise in the number of cases due to increased blood clotting efficiency. People reaching the hospital for early treatment of strokes have reduced because of the myths contracting the COVID-19 infection as well.
SPARSH’s comprehensive stroke care is available in 3 centres — SPARSH Super Speciality Hospital, Yeshwanthpur, Infantry Road and Rajarajeshwarinagar — covering almost all of Bangalore city. The centres are equipped well and the stroke-care personnel practise appropriate safety measures to steer clear of COVID-19.
Challenges of stroke treatment in India:
The lack of awareness among the public and physicians is a big challenge. Poor recognition of strokes and low perception of threat, poor availability of transport in rural areas, and busy traffic in urban areas make significant delays in the arrival to comprehensive stroke care centres. 80% of India’s specialist doctors live in urban India. Pre-hospital challenges are mainly ambulances without trained personnel and equipment. In India, there are approximately 35 to 40 stroke centres, most of which are situated in urban private sector hospitals.
Since the burden of untreated strokes is more in rural areas, we need tele-stroke services throughout the country, even as the bigger centres will be required to receive advanced treatment. A mobile stroke unit is a system where an ambulance is equipped with the facility to start the treatment of a stroke in remote places as they move to bigger centres with more facilities for further management.
A combination of tele-stroke services and mobile stroke units is the best choice. SPARSH Group of Hospitals have this combination, which is the first of its kind in Karnataka — a brain stroke-care ambulance. Around one year after its inauguration and service of serving people affected by an acute stroke, it is extremely successful.
This helps in recognizing strokes early. A specialist can examine patients from a distant place through live audiovisual equipment, GPS tracking of the ambulance, basic blood tests, and in suitable patients, the initiation of medical treatment in the ambulance — Transcranial Doppler (TCD) and neck vessels Doppler help in detection of the blockage of larger vessels. Patients under the treatment of the trained stroke ambulance nursing care are shifted for final care with supervised guidance of the specialists in the hospital.
SPARSH Group of Hospitals has a fully functional advanced comprehensive stroke-care unit with experts of treatment of strokes, including emergency department, advanced MRI, CT, Cath Lab and super-specialists of neuroscience, round the clock. We treat stroke patients in one of the best stroke-care hospitals in the city with excellent outcomes.