Brain Stroke

There are two main types of stroke, they depend on the causes of brain stroke behind them.

Ischemic Stroke - Nearly 80% of all brain strokes are ischemic strokes. These can be thrombotic strokes or embolic strokes: both are caused by the narrowing of arteries due to fatty deposits or plaques. This narrowing is referred to as atherosclerosis. Narrowing of the arteries of the brain can also be caused because of aging, which consequently puts the elderly at higher risk of suffering ischemic strokes.

• Thrombotic strokes occur when a blood clot forms in one of the arteries that carry blood to the brain.
• Embolic strokes occur when the thrombus or clot is formed elsewhere but travels to the brain through the bloodstream. It then gets lodged in the narrow blood arteries of the brain and restricts blood flow.

Hemorrhagic strokes are caused by hemorrhaging or bleeding due to a ruptured blood vessel in the brain.

• Intracerebral haemorrhage occurs when the arteries of the brain get ruptured due to conditions like uncontrolled hypertension. In such cases, bleeding occurs in between the brain tissue.
• Subarachnoid haemorrhage may be caused by an arteriovenous malformation (AVM) or a cerebral aneurysm (weakening or thinning of the arteries in the brain). In these cases, the bleeding usually occurs between the brain and the skull.

Some patients experience a transient ischemic attack or a TIA. These are also referred to as mini-strokes and are caused by a temporary blockage of blood flow to the brain, usually due to clots that resolve on their own within a few minutes. A TIA, however, is a serious matter, and treatment must be started at once. Nearly a third of the people who experience these mini-strokes also have a major brain stroke subsequently.

Ischemic Stroke

It accounts for about three-quarters (or 80%) of all strokes and occurs when a blood clot (or thrombus) forms and blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause an Ischemic Stroke.

Haemorrhagic Stroke

It occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid haemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral haemorrhage). 20% of stroke cases are haemorrhagic.

Many stroke patients are left with weakness on one or both sides of the body, experience difficulty speaking, incontinence, loss of speech or thinking, inability to walk or are rendered bedridden. Early action can minimize brain damage and potential complications.

During a stroke, or a cerebral vascular accident (CVA), blood supply to the brain is impaired, which causes the death of brain cells. A stroke is also called a “brain attack” and can lead to disability, paralysis, coma, or even death. Identifying the brain stroke symptoms early on is really crucial, for people can get immediate medical attention if they realize they are suffering a stroke.

The acronym FAST can help you identify early brain stroke symptoms.

• Face – Facial drooping or numbness
• Arm - Weakness in the arms or the inability to lift both arms
• Speech – Slurring of speech
• Time – Time to call for emergency medical assistance

Brain stroke symptoms could include one or more of the following –

• Confusion, losing the ability to speak or understand, slurred speech, loss of memory
• Loss of consciousness or dizziness
• Lack of coordination and balance, difficulty in standing or walking
• Paralysis or weakness (particularly on one side of the face or body)
• Sudden onset of headaches, particularly when accompanied by vomiting or altered consciousness
• Blurred vision, double vision, or blind spots (in one or both eyes)
• Sudden behavioral changes like unrequited or raging aggression
• Trouble swallowing

If someone around you is experiencing one or more of these brain stroke symptoms, it is imperative you call for emergency medical assistance and seek treatment immediately.

Max Institute of Neurosciences is equipped with modern diagnostic & imaging equipment and latest therapeutic options, to help all types of stroke pateints; adding to this, we also have  the faculty, infrastructure, and experience to be one of the top centres of its kind in the country. The institute has a 24*7 Stroke Helpline (9910204043), a dedicated number which can help the patient get immediate assessment.

We offer super specialty tertiary care for all kinds of neurological diseases, conditions and disorders. We have a team of highly skilled neurosurgeons, neurologists, intervention neurologists, neuro anaesthetists, experts in critical care and specialised nurses who work together to deliver world-class healthcare services. They are supported by state-of-the-art facilities such as dedicated high-end Neuro ICU and HDU beds with 24*7 neurosurgery and neuro anaesthetist back up, advanced medical technology, high-end operation theatres and more.

The team brings together expertise from years of experience and skills, all directed towards providing the highest standards of patient care. This team is guided by internationally accepted protocols and integrated care pathways. A robust audit system is planned to ensure continual improvement. Equipped with Bi-plane cath labs, which produces high-resolution 3D images of the highly complex blood vessels; high-quality images help in providing safer and better treatment to the patients. 

Biplane labs also provide decreased radiation in comparison to single plane labs and so helpful in limiting radiation to the paediatric population. CT scan can be obtained in a minute during the procedure without shifting the patient to the neuroradiology department thus saving a significant time which is very crucial in neuro- intervention. 

The only approach for stroke treatment is to act FAST. Ischemic stroke is best treated when treated within 6 hours from onset of cerebral attack, as the clot can be dissolved more effectively by giving Inj r-tPA within 4.5 hours and the outcome will be far better. Mechanical thrombectomy can be offered upto 6 hours and in selected few patients upto 24 hours.

At Max Institute of Neurosciences, we offer the following stroke treatment options:

1. IV Thrombolysis
2. Mechanical Thrombectomy
3. Decompressive Craniectomy
4. Stroke Rehabilitation

Rehabilitation is a critical aspect of Stroke care. Most stroke victims will require rehabilitation after the event. A person's condition is generally dependent on the area of the brain and the amount of tissue that was damaged. It is common for the rehabilitation process to include a wide range of therapies along with family education.

Accordingly, our rehabilitation programme includes physiotherapy, occupational therapy, dysphagia therapy, speech therapy, cognitive therapy, continent advisor, recreational therapy, advice on orthotics and vocational counselling. We also have Advanced Stroke Rehabilitation modalities like Functional Electrical stimulation, Biofeedback and VitalStim therapy for Dysphagia. Our physiotherapy and rehabilitation doctors and staff specialize in helping stroke patients regain their independence.

Max Institute of Neuroscience (MINS) is equipped with a wide range of advanced technologies, including the following:

• Biplane Cath Lab
• Intraoperative CT
• Neuro Navigation System
• Intraoperative Neuro Monitoring system
• Stereotaxy
• EEG – Video, Ambulatory & Sphenoidal
• Microscopic Surgery
• High-intensity Microscope & Endoscope
• ENMG (including single fibre EMG) & Intraoperative Evoked Potentials
• Sleep Labs

The stroke treatment depends on which kind of stroke the patient had.

• Carotid Endarterectomy: Removal of plaque and widening of the carotid artery. 
  
• Angioplasty: A balloon that widens the carotid artery and is held open with a metallic mesh tube called a stent.

• Aneurysm Clipping - It consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of its attached artery and keeps the aneurysm from bursting or re-bleeding.
  
• Aneurysm Embolisation (coiling) - This involves using a catheter inserted into the aneurysm to deposit a tiny coil that fills the aneurysm, causing clotting and sealing off the aneurysm from arteries.
  
• Arteriovenous Malformation (AVM) Removal - A surgical procedure to remove usually smaller AVMs or AMVs that are in a more accessible portion of the brain in order to eliminate the risk of rupture.

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• Brain Stroke Symptoms & Emergency