Most Advanced Stroke Recovery Treatment in India

What is Stroke?

Stroke refers to a brain disease caused by either blockage of blood supply or rupture of a blood vessel to a particular part of the brain. This results in reduction of blood and oxygen supply to the affected part of brain resulting in loss of function

A Stroke can be categorized into two types:

• Hemorrhagic Strokes: This type of stroke occurs when a blood vessel bleeds and burst within the brain. This accumulated blood compresses the nearby tissues of the brain. This could be due to:
  • A blood vessel on the brain surface starts bleeding in between the area of the skull and the brain.
  • A blood vessel bleeding or bursting inside the brain
  • Hemorrhagic strokes has two main types:
    • Subarachnoid hemorrhage: In this, there is bleeding in between the area of the brain and the thin tissues covering the brain.
    • Intracerebral hemorrhage: This is considered as the most common type of hemorrhagic strokes. This occurs when an artery bursts inside the brain and resulting in the flooding of the nearby blood tissues.
• Ischemic Stroke: This occurs when something is causing blockage in an artery which is carrying blood to the brain. The potential causes are:
  • When there is a blockage in the small blood vessels within the brain
  • When a blood clot develops in the main artery to the brain
  • When an air bubble, a blood clot or fat globule develops in a blood vessel which is carried to the brain.
  • There are two common types of Ischemic stroke:
    • Embolic Stroke: This stroke occurs when other debris or a blood clot develops away from the brain. This mostly happens in the heart and is swept from the bloodstream into the narrow brain arteries. This kind of blood clot is known as an embolus.
    • Thrombotic Stroke: This occurs when thrombus (a blood clot) develops in one of the arteries which supply blood to the brain. This clot may be due to the accumulation of plague (fatty deposits) in the arteries that causes decreased blood flow.

When there is temporary blockage in the blood supply to the brain and there is a feeling of stroke for a little time. This entire process is termed as mini stroke or a transient ischaemic attack (TIA). A mini stroke is an indication that a part of the brain is not getting sufficient blood and this can result into a severe stroke in the future.

Causes

Some of the causes that can lead to a stroke are as follows:

• Ageing
• High blood pressure
• Diabetes
• Cardiovascular diseases
• High cholesterol
• Obesity
• Vitamin B12 deficiency
• Excessive alcohol and drug abuse

Symptoms

Symptoms of a stroke occur suddenly. Symptoms vary depending on the location of the stroke. Each area of the brain is supplied by specific arteries. If an artery supplying the area of the brain that controls the left arm movements is blocked, that arm becomes weak or paralyzed.

The five most common signs and symptoms of stroke are:

• Sudden numbness or weakness of the face, arm, or leg - like weakness of half of the body called as hemiplegia.
• Sudden confusion or trouble speaking or understanding others called aphasia in medical terms.
• Sudden trouble seeing in one or both eyes called as mono or binocular vision disturbance. This could be due a stroke anywhere in the visual pathway.
• Sudden dizziness, trouble walking, or loss of balance or coordination, this is commonly due to posterior circulation strokes.
• Sudden severe headache with no known cause is due to hemorrhage or sometimes infarction.

Diagnosis

The diagnosis is based on the symptoms and a good history given by the patient or an observer. Usually any neurologic symptom occurring suddenly in a neurovascular territory is attributed to a stroke. CT scan done immediately after a stroke is almost always normal in ischemic strokes. MRI with diffusion images is sensitive to diagnose acute infarction.

Treatment of a Stroke

The treatment for both hemorrhagic and ischemic stroke is different.

The purpose of treating ischemic stroke is to restore the flow of the blood in the brain. Medications are given in the first four and a half hours of the stroke for destroying the clots in the blood vessels. An injection of tissue plasminogen (TPA) can also be given to a patient for improving the probability of a full recovery.

The main purpose of treating a hemorrhagic stroke is to stop bleeding and decrease the pressure on the brain. Instead of blood thinners, clotting drugs can be given. After the area has been healed and the bleeding is controlled, the damaged and leaky blood vessels are then repaired.

The first stroke device approved by FDA is Merci retriever. The aim of this device is to restore the flow of the blood in the neurovasculature by removing thrombus in those patients who have ischemic stroke.

The penumbra system (endovascular thromboaspiration) is the last FDA approved device that has been primarily developed for removing a clot in the case of acute ischemic stroke. In order to eliminate or reduce the clot burden, this system uses dual approaches to clot extraction by using debulking and aspiration of the thrombus. Clot retrieval is then used where a ring device holds the thrombus by capturing it in clasps with a cylinder. This is then withdrawn at the time of flow arrest. This new aspiration device (the penumbra system) has an excellent safety profile and a high rate of ‘target vessel’ recanalization. 

 

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