A stroke may be called a brain attack. It may happen to any person at any time. A stroke occurs when there is a vascular event in the brain causing a blockage of blood vessels or a rupture of vessels causing hemorrhage. The brain cells are starved of food and oxygen or are assaulted by a barrage of harmful agents released as a result of hemorrhage, suffering reversible or irreversible damage. Dead or disabled brain cells result in brain dysfunction due to which patients may lose control over parts of the body or lose the capacity to speak, think or remember.
Strokes can be mild to severe and require immediate medical attention. Stroke requires advanced care and a stroke patient is ideally treated by a multidisciplinary team of experts. At various stages of treatment, the attention of doctors specializing in Neurology, Neurosurgery, Critical Care, Medicine, Radiology and Physical Medicine may be required. Besides, good nursing care and physiotherapy are essential for better recovery from stroke.
Types of Stroke-
- Ischemic Stroke: This kind of stroke occurs when there is a blockage in a blood vessel, which supplies blood to the brain. The commonly seen underlying causes are atherosclerosis (which is a condition where fatty deposits occur in the walls of the blood vessels) or embolism (blood clot formed elsewhere reaches the brain circulation and blocks a smaller blood vessel). Other rarer causes of ischemic stroke are trauma, hypotension, vasospasm, etc..
- Hemorrhagic Stroke: This type of stroke occurs when a blood vessel ruptures into the brain. This can be caused by high blood pressure, weakened vessel wall due to atherosclerosis, or vascular malformations like aneurysms, AVM, or cavernomas.
- Transient Ischemic Attack: This type of stroke is also known as a mini-stroke. The blockage caused is temporary or transient in nature, and may happen repeatedly.
Treatment of Stroke:
A. General Treatment: Most cases require supportive management to prevent the secondary complications of stroke, so that the patient gets adequate time for the brain tissue to recover functions. Medicines are administered to control brain pressure, prevent convulsions and aid brain tissue recovery. Paralysis of muscles, difficulty in eating, drinking, breathing, controlling urine etc. make the patient highly dependent. Physiotherapy is essential for good recovery of impaired functions. It is essential for family and friends to encourage the patient and involve themselves in supportive care to prevent depression from setting in and for robust rehabilitation.
B. Specific Treatment of Ischemic Stroke
- Tissue Plasminogen Activator: This is one of the best ways to treat ischemic strokes presenting early. This medicine is given to the patient intravenously. It dissolves the blood clot and improves blood flow to the area of the brain which is affected. The medicine should be given within three to four hours after stroke symptoms appear.
- Endovascular procedure: This is again useful only if the patient reaches early. This is a process by which the blood clot is removed using a catheter, which gets inserted into the area of the blocked blood vessel. It helps in restoring blood flow to that area.
- Decompressive craniectomy: Large ischemic strokes cause a rise of brain pressure which may cause death. To reduce brain pressure, decompressive craniectomy surgery may be required if medicines alone are not effective.
In this, a large part of the skull on one side or in the front may be removed to allow space for a swelling brain and relieve intracranial pressure.
C. Specific Treatment of Hemorrhagic stroke
- Surgical treatment: Different modes of neurosurgery may be undertaken to remove blood clots, repair vascular malformations and for relieving pressure within the skull. The need for surgery depends on the cause, location and volume of hemorrhage besides other factors. It is an important decision, and the family needs to consult with the neurosurgeon and understand the implications thoroughly before agreeing or disagreeing for treatment.
- Endovascular coiling or embolisation: Act as standalone treatment or as an additional aid to surgery especially in vascular malformations like aneurysms or AVMs.