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A stroke, more appropriately called a brain attack, cuts off blood flow and oxygen to the brain. There are approximately 86,000 million cells (neurons) in the human brain. Every minute in which a stroke due to a blood clot in the brain is left untreated, one loses 1.9 million brain cells and 13.8 billion connections between these cells called synapses.
The acronym Be-Fast (balance, eyes, face, arms, speech, and time) summarises some of the most common symptoms of stroke. If you or any family member has any of the following symptoms, please rush to a nearby hospital, so that treatment for a brain attack can be instituted early to prevent death and life-long disability.
Balance: Sudden dizziness, loss of balance or coordination
Eyes: Sudden trouble seeing out of one or both eyes, double vision
Face: Uneven smile or weakness on one side of the face
Arms: Inability to raise both arms evenly
Speech: Slurred speech or difficulty repeating simple phrases
Time: Time is indeed brain in the context of stroke treatment
Once you call for an ambulance, the whole stroke team is simultaneously alerted and activated. This includes the ER team, neurologist, critical care specialists, interventional neuroradiologist, and neurosurgeon.
When the patient reaches the hospital, a quick evaluation by the stroke team is done in the emergency department. Thereafter, the patient is shifted to the Radiology Department for a CT scan, followed by a stroke protocol MRI.
The only other test which needs to be done before starting treatment is blood glucose. Blood samples may be taken for other tests as well. You need to tell the neurologist if the patient is taking any blood thinning medication or has kidney problems for which they are on dialysis.
The neurologist will then quickly determine if the patient is eligible to receive the clot-busting medication by going through a checklist of all the medical conditions that the patient has at present or has had in the past.
Dissolving the clot-blocking blood vessels in the brain is done with a medication called tPA. The immediate goal of clot-busting therapy is to restore blood flow to the regions of the brain (reperfusion) that are damaged but not yet dead (infarcted). The long-term goal is to reduce disability and death. In a substantial proportion of patients, the occluded blood vessel is completely opened with treatment.
Also, Read: Shhhh! It’s time you know about silent stroke and how to detect it
People who get clot-busting medication for stroke have a better chance of recovering without disability and getting back to the activities they enjoy, as compared to people who do not receive the treatment. There is a small risk of bleeding into the brain with this therapy, but the benefit outweighs the risk. The benefit is similar regardless of the patient’s age or severity of stroke.
Intravenous tPA is the mainstay of treatment and should be given within 4.5 hours of the onset of symptoms. The benefit of treatment decreases continuously over time from symptom onset. So, the earlier the better. A door-to-needle time of ≤60 minutes is the benchmark. In data from over 58,000 patients, it was found that each 15-minute reduction in the time to initiate clot-busting treatment increased the odds of walking independently and decreased the odds of complications and death
Consent must be given quickly, so as not to lose precious time. In some cases, the doctor may even presume consent and administer the medication because of the importance of giving the medication early.
Also Read: A top neurologist reveals 8 health issues that appear harmless but can trigger stroke
All patients treated with intravenous alteplase for acute ischemic stroke should be admitted to an intensive care unit or a dedicated stroke unit for at least 24 hours of close neurologic and cardiac monitoring. Vital signs and neurologic status should be checked every 15 minutes for two hours, then every 30 minutes for six hours, then every 60 minutes until 24 hours from the start of alteplase treatment.
A repeat CT scan is done 24 hours after giving clot-busting medication. Aspirin and such like medication are re-started after ruling out bleeding into the brain
Persons who have blockage of blood vessels in the back of the brain, called posterior circulation stroke, those who are 80 years and older, pregnant women, and children need special consideration before instituting clot-busting therapy.
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Dr (Lt Gen) CS Narayanan is a renowned neurologist from Manipal Hospital. ...Read More
