Brain Stroke

Overview

A stroke or brain attack is a condition in which the brain cells suddenly die due to a lack of oxygen. It can be caused by an obstruction in the blood flow or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralysed.

Brain stroke is the second most common cause of death and the fourth leading cause of disability worldwide. Approximately 20 million people each year suffer from stroke, 5 million of whom do not survive. In India, it is a leading cause of death and disability in the young population.

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.

Within a few minutes of having a stroke, brain cells begin to die, and symptoms appear. When a person has a stroke, in just one second, approximately 32,000 brain cells die; in the next 59 seconds, an ischemic stroke can kill 1.9 million brain cells. Hence, it becomes very critical to recognize these early symptoms, as prompt treatment is crucial to recovery. Common brain stroke symptoms include:

Sudden or acute onset of dizziness or unconsciousness
Trouble walking, loss of balance, sensation or coordination
Trouble seeing with one or both eyes
Speech problems
Difficulty swallowing
Confusion or loss of memory
Muscle stiffness
Behavioral changes
Numbness, weakness, or paralysis on one side of the body
Blurred, blackened or double vision
Sudden severe headache
Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.

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 treatment options for stroke:

IV Thrombolysis
Mechanical Thrombectomy
Decompressive Craniectomy
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.

At Max Institute of Neurosciences, the primary goal in treating Ischemic Stroke is to restore blood flow to the brain. This is done using blood clot-busting drugs such as aspirin, heparin, or tissue plasminogen activators that must be administered within three hours of the Stroke. In addition, surgical procedures may be performed that can open up or widen arteries. These include:

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.

While Haemorrhagic Stroke is treated differently than Ischemic Stroke. Surgical methods used by our team to treat hemorrhagic stroke include:

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.

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.

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