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Brain stroke

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Emergency care can help thwart the disabling, long-term effects of a brain attack.

Warning signs: Mini attacks often precede a major brain attack.
Warning signs: Mini attacks often precede a major brain attack.

Hema Vijay

Shekar was in a meeting at his office in Mumbai, when he developed a splitting headache. Soon he was dizzy and couldn’t stand or sit. He wanted to speak but couldn’t move his throat muscles. Soon after, his arms and legs went numb. He was immediately rushed to a hospital, where a brain stroke was diagnosed. Luckily, the hospital had facilities to treat brain attacks. Today, Shekar survives to tell the tale. But most people are not so fortunate.

Brain attack or stroke is the third largest cause of death after heart attacks and cancer. Experts estimate that in India, 1-2 person(s) in every 1,000 people are struck by brain attack. Worse still, doctors estimate that six out of 10 brain attack victims die or remain severely or moderately disabled or paralysed following an attack due to lack of awareness and access to critical care facilities.

How it happens

A brain attack occurs when blood supply to the brain cells is disrupted. Blood provides oxygen and nutrients to the brain cells. Once dead, these cells cannot be revived. Consequently, the function controlled by that part of the brain is lost.

This could happen if a blood clot blocks a blood vessel in the brain (also known as ischemic stroke) or when a blood vessel in the brain ruptures, causing bleeding inside the brain (also known as hemorrhagic stroke). In the latter, the blood vessel normally bulges out at a weak spot before bursting and this bulge is called aneurysm. This type of brain attack is more sudden and often fatal.

“The longer the blood flow is cut off and the longer the treatment delayed, the greater and more permanent will be the damage to the brain and loss of brain function,” says Dr Santhosh Joseph, Interventional Neuro Radiologist, Sri Ramachandra Medical College, Chennai. Brain attack is often preceded by one or many mini-attacks (also known as TIA or Transient Ischemic Attacks). They have symptoms very similar to brain attack, but for very brief periods of time, sometimes for as little as a second. “The victim may recover immediately, but don’t take it lightly. These mini-attacks are a warning and they lead to a brain attack in near future, if not treated immediately,” Dr Joseph says.

Persons with high blood pressure, high cholesterol, heart disease, those who have had a TIA, smokers, those who consume alcohol in excess, those with a family history of brain attack, those with diabetes, sickle cell anaemia and hyper-homocysteinemia, and the elderly run a higher risk of getting a brain attack. About 20 per cent of heart patients are susceptible to this ailment.

Treating brain strokes

Administering critical care immediately is crucial for a brain stroke patient. “If a brain attack victim is given emergency care within three to six hours of the first symptom, the disabling, long-term effects of stroke can be thwarted or at least greatly reduced,” says Dr Joseph. Doctors call this the crucial ‘window period’. “The symptoms may seem arbitrary, but lives can be saved if action is taken immediately,” says Dr Mathew Cherian, Interventional Radiologist, Kovai Medical Centre.

“When the patient with brain attack reaches a hospital, a series of diagnostic tests are quickly performed to assess the damage and the damage area. The subsequent medical therapy could be either to dissolve the blood clot before it kills the brain cells, or open the narrowed blood vessel or block the aneurysm that has ruptured,” explains Dr Cherian. “If the diagnostic tests show bleeding in the brain, the patient must be given immediate medical intervention to stop the bleeding and save the brain cells from dying.”

In brain attacks caused by bursting of the aneurysm, the treatment aims to block the spot where the blood vessel has burst. Earlier, this was done by performing a brain surgery, where the aneurysm is “clipped” with the help of metal clips. “Burst” aneurysms are now treated with a procedure called “coiling”.

These procedures are far more effective and safer. After the coiling procedure, the patient can get back home in 2-3 days’ time, against the 8-10 days of hospitalisation required after a brain surgery.

Brain stroke symptoms

■ A sudden numbness or weakness in the face, arm and/or leg, especially on one side of the body. Ask the suspected victim to smile and raise his/her hands, and walk a few paces.

■ A sudden inability or trouble in walking, dizziness, loss of balance or coordination.

■ A sudden severe headache with no known cause (victim often describes it as the worst headache of their life).

■ Sudden nausea, vomiting, brief loss of consciousness, fainting, and convulsions.

■ A combination of these factors.

(This article was published in the Business Line print edition dated June 22, 2007)
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