Stroke

Brain Stroke Treatment in Delhi, India

The Brain Stroke Unit at the BLK-Max Super Speciality Hospital is a part of the Centre of Neurosciences and is a specialised unit that provides full prevention, treatment and rehabilitation services, giving hope to stroke patients.

Our unit has a dedicated brain stroke care team which follows a multidisciplinary approach and works closely with other departments at the hospital to provide the best comprehensive care. We make sure that every patient under our care receives a high standard of brain stroke management services while having treatment at our unit.

A stroke occurs when the brain's blood supply is reduced or interrupted due to a blockage or a ruptured artery. This prevents oxygen from reaching the brain tissue. As a result, the brain cells get damaged and begin to die.

Alternate Name of Brain Stroke

Brain attack

Associated Anatomy

Stroke is associated with the brain.

Brain Stroke Causes

The causes depend on the type of stroke. The three types of strokes are as follows:

Ischemic stroke occurs when the arteries that supply blood to the brain get narrow or blocked. The causes are blood clots, narrowed blood vessels due to fatty deposits, reduced blood flow to the brain, and pieces of plaque that block the artery and obstruct the blood flow.
Transient ischemic attack (TIA) is also called the ministroke, as it is temporary and lasts for not more than a few minutes. It occurs when the blood flow to the brain gets interrupted temporarily. The causes are blood clots in the artery and reduced blood flow to the brain due to debris in the artery.
A hemorrhagic stroke happens when an artery in the brain leaks or breaks. Several factors cause a hemorrhagic stroke, such as high blood pressure, protein deposits in the artery, overuse of blood thinners, ischemic stroke, accident and aneurysm, or excessive swelling of the walls of an artery.

Brain Stroke Symptoms

Stroke affects the parts of the body that are controlled by the damaged areas in the brain.

Symptoms of stroke are:

Paralysis
Trouble in speaking, slurred speech
Difficulty in understanding what is being said
Confusion
Lack of reactions
Trouble in walking
Blurred vision or double vision
Inability to see either in one eye or both
Changes in behaviour
Aggressive behaviour
Loss of balance
Dizziness
Unexplained and severe headache
Nausea

Risk Factors of Brain Stroke

Medical factors

Hypertension
Diabetes
High cholesterol
Obstructive sleep apnea
Cardiovascular disease
Family history of stroke and heart attack
COVID-19 infection

Lifestyle factors

Smoking
Alcoholism
Use of illegal drugs
Lack of physical activity
Obesity

Other factors

Age: People in their 50s and up are at a higher risk of stroke.
Gender: Men are at a higher risk of stroke than women.
Hormones: Birth control pills and hormone therapies increase the risk of stroke.

Brain Stroke Diagnosis

Typical test

Doctors advise the following tests to determine if it is a stroke or another health condition.

Blood tests to check for blood sugar levels, platelet count, cholesterol levels, presence of any infection and how fast the blood clots.
MRI to check if brain cells or tissues have been damaged.
CT scan to check for bleeding or damage to the brain or any other brain conditions.
An EKG is advised to record the electrical activity in the heart and check for a heart condition that may have caused the stroke.
A cerebral angiogram helps check the neck and brain arteries for blockages or clots.
A carotid ultrasound is advised to check for any fatty deposits in the carotid artery and if it is narrowed or has blockages.
Echocardiogram checks for clots in the heart that could have travelled to the brain and led to a stroke.

Differential diagnosis

Differential diagnoses of a stroke may include hemorrhagic stroke, neurosyphilis, brain tumour, complex or atypical migraine, meningitis, multiple sclerosis, seizure, hypoglycemia, hypertensive encephalopathy, electrolyte disturbance, or drug toxicity.

Brain Stroke Treatment

Treatment depends on the type of stroke.

Ischemic stroke and TIA:

Emergency IV medication to give drugs that break a clot within a few hours.
Emergency endovascular procedures to deliver the medications directly to the brain.
Using a stent retriever to remove the blood clot from the blocked artery in the brain.
Carotid endarterectomy to remove the plaque that blocks the carotid artery.
Angioplasty and stents to expand the narrowed artery and support it with a stent.

Hemorrhagic stroke:

Controlling the bleeding and reducing pressure in the brain.
Emergency measures to counter the effects of blood thinners and reduce pressure in the brain.
Surgery to repair the arteries.
Surgical clipping to prevent the aneurysm from bursting.
Coiling to block the blood flow into the aneurysm.
Stereotactic radiosurgery to repair malformations in the artery.

Brain Stroke Prevention

Primary Prevention

Addressing the following issues to reduce the risk of stroke:

Quitting smoking
Managing diabetes, cholesterol, and hypertension
Including regular physical activity
Addressing weight issues

Secondary Prevention

Reducing blood pressure
Following a low-sodium diet
Quitting alcohol and smoking
Maintaining ideal body weight
Cholesterol management
Anti-platelet therapy
Anticoagulation

Possible Complications of Brain Stroke

Complications of a stroke could be temporary or permanent and minor or major based on the part of the brain that is affected.

Blood clots
Muscle weakness
Mobility issues
Bowel and bladder problems
Urinary tract infections
Risk of pneumonia
Difficulty in swallowing
Vision and hearing issues
Seizure
Swelling in the brain
Memory loss
Depression

Expected Prognosis of Brain Stroke

A stroke can result in paralysis of the limbs, loss of facial muscle movement, loss of speech, and weakness. It can also cause depression, anxiety, and personality changes.

Pathophysiology of Brain Stroke

The pathophysiology of stroke includes loss of energy, acidosis, increased intracellular calcium levels, oedema, the generation of free radicals that damage the membranes, mitochondria, and DNA, and cell death. A stroke also causes excitotoxicity, generation of arachidonic acid products, disruption of the blood-brain barrier, and infiltration of leukocytes.

Natural Progression of Brain Stroke

If left untreated, a stroke can cause more damage to the brain and a loss of brain cells. It increases the risk of paralysis, disability, a change in personality, irritability, confusion, and depression. It can also cause a loss of balance, inability to swallow and talk, memory loss, and fatigue.

What Is A Brain Stroke?

Brain Strokes (also known as a Cerebrovascular condition) are brain attacks that affect the blood vessels of the brain. They occur when the blood supply to the brain becomes blocked. It is rated as the second-highest cause of death and disability(after cancer), in non-communicable diseases.

In fact, the risk for brain stroke is quite high among the Indian population and is as high as 800 per 100,000 people and the actual incidence is increasing considerably. Generally, there are three types of strokes:

Ischemic Stroke: It occurs due to a blood clot that restricts the blood and oxygen from reaching the brain.
Haemorrhagic Stroke: It occurs when the weakened blood vessel ruptures as aneurysms or arteriovenous malformations (AVMs).
Transient Ischemic Attacks (TIAs): Also called mini-stroke occurs when blood fails to flow in a different part of the brain. However, it may reduce after a short amount of time.

What Are Brain Stroke Signs & Symptoms?

The Major Signs And Brain Stroke Symptoms Which Reflect The Probability Of Having A Stroke Involve:

The trouble with speaking and understanding
Paralysis or numbness of the face, arm or leg (often in one side of the body)
The trouble with seeing in one or both eyes (sudden blurriness or blackened vision)
A sudden, severe headache (accompanied by vomiting, dizziness or altered consciousness)
The trouble with walking (experience, loss of balance/coordination or sudden dizziness)

In addition to the persistence of the problems listed above, a patient may also experience:

Depression
Bladder or bowel control problems
Pain in the feet and hands (that gets worse with movement)
Trouble controlling or expressing emotions

What Are The Various Diagnosis of Brain Stroke?

Some of the diagnostic tests that your doctor might as you take in order to evaluate your current medical condition involved:

Blood test

- For bleeding or clotting disorders

- Measure the blood flow

- Measure mental function

MRI
CT scan
Carotid ultrasound
Cerebral angiogram (a procedure done to investigate various abnormalities of the blood vessels in the brain)
Echocardiogram
Positron emission tomography (PET) or PET-CT scan
Electroencephalography (EEG)

What Are The Procedures For The Treatment of Brain Stroke?

The surgeons at BLK-MAX Centre for neurosciences will treat patients with serious conditions related to Stroke. The treatment might require clot-busting drugs or angioplasty of the brain vessels in a Cath Lab. Other treatments for brain stroke include:

In the case of a haemorrhagic stroke, the treatment will depend upon the cause of the stroke. The major types of stroke causes are:
Aneurysm Treatment Method: In endovascular coiling, a very thin metal wire is inserted inside the brain aneurysm, through a miniature catheter, by a highly experienced neurosurgeon. This microcatheter is navigated through the web of brain arteries under image guidance in a cath lab. Once the catheter reaches the desired location, a series of handmade coils are placed inside the aneurysm and detached from outside the body. These small coils form a coil mass which blocks the blood flow to the aneurysm and subsequently lead to the healing of the artery.
Arteriovenous Malformation (AVM) Treatment Method: An Arteriovenous Malformation (AVM) is an abnormal collection of blood vessels occurring within the brain itself. In an AVM, there is a sort of short circuit which causes the blood to travel rapidly from the arteries directly into the veins. This can lead to a pressure build-up and cause bleeding from the AVM or the veins, which do not have enough support in their walls. Patients can be asymptomatic or may suffer from headaches, seizures, or deterioration of neurologic functions. If haemorrhage occurs, patients may experience severe headaches, stroke-like symptoms, or even loss of consciousness. The treatment of AVMs may include surgical excision, radiation treatment, or embolisation. In most cases, embolisation is used to block the blood supply to the AVMs, making the treatment safe. In 70% of the cases, embolisation may fully treat a lesion. In some cases, patients might have to undergo a surgical resection or radiation therapy to complete the treatment
Carotid Disease (Stenosis) Treatment Method: In recent years, the use of Angioplasty and Stenting for treating cerebrovascular diseases has grown immensely. Patients with more than 70% symptomatic carotid stenosis are the ones who greatly benefit from this intervention procedure. Patients may also have a history of a previous stroke or Transient Ischemic Attacks (TIAs). This procedure is performed under monitored anaesthetic care with the patient sedated or under general anaesthesia, depending on their medical condition, making it a highly personalised treatment.
Tumour Embolization: There are several groups of patients in whom bleeding from a tumour needs to be controlled. This may include pre-operative treatment of the neck masses (paragangliomas and juvenile angiofibromas) or skull base lesions (meningiomas) to decrease the time and risk of surgery. Patients with epistaxis, i.e. persistent severe nose bleeding, may also benefit from tumour embolisation

All the above procedures are called neuro-intervention procedures and are done in a Neurovascular Cath Lab.

In the case of Ischemic Stroke:

Stroke Therapy Treatment Method: The incidences of serious stroke-related, long-term disabilities are rising every year. The current emphasis is on recognizing strokes as early as possible, and all attempts are made to open clogged arteries to prevent the loss of brain neurons. The earlier the endovascular treatment is performed, the better the outcome. This is done by using a clot-removing device, which traps and removes a clot from the artery of the brain in a cath lab. This procedure's functional outcomes are significantly better compared to traditional treatment of brain stroke.

What Are The Precautions One Must Take After The Brain Stroke Treatment?

The Important Precautionary Measures One Must Consider Taking After The Treatment of Brain Stroke:

Take all the medications prescribed by the doctors
Eat a very healthy diet including fresh veggies and fruits
Avoid the use of tobacco and excessive smoking
Heavy consumption of alcohol is prohibited
Visit your doctor for regular check-ups in the outpatient clinics
Keep your blood pressure under control
Manage your diabetes level to normal
Treat obstructive sleep apnoea
Exercise regularly-start with a mild brisk walking and increase it slowly

What Are The Risks Involved in the Treatment Of Brain Stroke?

Some of the Risk Factors Associated with Brain Stroke Treatment include:

Stomach upset
Pain
Nausea
Dizziness
Increase in blood sugar level
Challenge in thinking, remembering, and recognising things

Physical Conditions Post Brain Stroke Treatment Include:

Weakness
Numbness
Stiffness

These risk factors are very mild and usually reversible with adjustments in stimulation or with the help of some medication. However, if the patient experiences these brain stroke symptoms for a longer duration then he must see a doctor immediately.

Are You A Candidate For Brain Stroke Unit?

A doctor will evaluate the patient for the current medical condition with the help of diagnostic tests results and will customise a treatment plan accordingly. However, the chance that a patient will experience stroke increases if a patient is: