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Brain Stroke: A Medical Emergency

Dr Rahul Gupta

A Brain Stroke is a disruption of blood flow to a part of the brain, causing it to stop working properly and damaging brain cells. A stroke is a medical emergency that requires immediate treatment. Symptoms usually occur suddenly but will vary depending on the part of the brain that is affected.

Brain Stroke

A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.

Causes of Brain Stroke

A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke).

Some people may experience only a temporary disruption of blood flow to their brain (transient ischemic attack, or TIA).

Types of Brain Strokes

Ischemic stroke: About 85 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia).

Transient ischemic attack (TIA): TIA is also known as a ministroke.  temporary decrease in blood supply to part of your brain causes TIAs, which often last less than five minutes. Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. A TIA doesn’t leave lasting symptoms because the blockage is temporary.

Hemorrhagic stroke: Hemorrhagic stroke or Brain haemorrhage occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension), over-treatment with anticoagulants and weak spots in your blood vessel walls (aneurysms).

Diagnosis of Stroke

An MRI (Magnetic Resonance Imaging) is the gold standard for diagnosing stroke. The MRI can diagnose a stroke as early as 45 minutes from the onset. If the patient cannot be taken for MRI then a good alternative will be CT Scan of the Brain. Most of the cities do have the facility of CT Scan and Neurologists who would be treating the stroke. In metro towns the patient should be rushed immediately to a stroke centre which is equipped with the best MRI machine and backed by a team of neurologists. Time is brain in the case of brain stroke.

Treatment of Brain Stroke

Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions.

If you have a stroke caused by a blood clot inside a vessel, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4 hours of symptom onset. Ideally, it should be given as soon as possible. If a patient comes late or he is not fit for tPA, then Mechanical Thrombectomy is done in a Neuro Cathlab. Mechanical Thrombectomy can be done upto 8 hours of stroke onset and it has very promising results.

Treating a Hemorrhagic Stroke

The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes aren’t treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse.

Surgery also may be needed to treat a hemorrhagic stroke. This requires immediate evacuation of large hematoma. The types of surgery also include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair.

Aneurysm Clipping and Coil Embolization

If an aneurysm (a balloon-like bulge in an artery) is the cause of a haemorrhage, your doctor may recommend aneurysm clipping or coil embolization.

Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again. During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. You’ll be given medicine to make you sleep during the surgery. After the surgery, you’ll need to stay in the hospital’s intensive care unit for a few days.

Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm. Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting again. You’ll be given medicine to make you sleep during the surgery.

Arteriovenous Malformation Repair (AVM)

If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain.

Doctors use several methods to repair AVMs. These methods include:

  • Injecting a substance into the blood vessels of the AVM to block blood flow. (Glue)
  • Surgery to excise the AVM
  • Using radiation to shrink the blood vessels of the AVM

Tips for prevention

Most important is frequent monitoring and control of blood pressure with medication and lifestyle modification. Brain haemorrhages are more frequent in early morning especially in winters. Drinking lot of water and timely consumption of medicines is essential. Minor headaches should not be neglected and a Neurosurgeon/Neurologist should be consulted.

Burden of Brain haemorrhage on the population

Spontaneous brain haemorrhage is very common and almost 50% patients expire before they can be shifted to a tertiary care hospital. Patients who are unconscious before surgical treatment take months to recover. Unfortunately, there are few centres for rehabilitation in India and patient has to be shifted home after definitive treatment. Hence, role of prevention and timely intervention is importantcannot be overemphasised.

The writer is M.B.M.S., MCh (PGIMER, Chandigarh), Additional Director & Senior Brain, Spine and Endovascular Surgeon, Department of Neurosurgery, Fortis hospital, Sec.-62, Noida. His email is rahulguptaneuro@gmail.com

 

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