Stroke occurs when the blood supply to the brain is interrupted.This deprives the brain of oxygen and nutrients and causes the brain cells to die. It may occur due to blockage of an artery (ischemic stroke) or by the leaking or bursting of a blood vessel (hemorrhagic stroke). Approximately 80 percent of strokes are due to Brain ischemia caused by blockage of arterial blood. About 20 percent of strokes are due to brain hemorrhage when a blood vessel in the brain bursts and the spilled blood damages surrounding brain tissue by compression. Brain cells beyond the leak are deprived of blood and also get damaged.
Following are some other key points that Dr. Ashok Kumar Singh, Senior Consultant Neurologist, Paras HMRI Hospital, Patna shared with us.
Q1. How common is stroke and which age group it can affect?
In India, one stroke occurs every 40 seconds and one stroke death occurs every four minutes ,making it one of the leading causes of death, very similar to deaths due to Heart attacks.
The incidence of stroke increases with increasing age. In fact ,half of all strokes occur in People older than 75 years.But no age is exempt and in our country 10% to 15% of all strokes occur in People younger than 40 years.
Q2. What are the signs and symptoms that are to be kept in mind to detect stroke?
We have to remember the acronym – FAST. Each letter of the FAST stands for Face, Arm, Speech and Time.
- Face : Dropping of the face to one side.
We may ask the person to smile. We need to note if one side of the face droops or if there is any asymmetry in the face.
- Arm: Weakness in the arms.
We may ask the person to raise both arms and note if one arm drifts downward or if the Patient is unable to raise one arm.
- Speech : Slurred and unclear speech
We need to note if the patient is clearly speaking, and if he is able to form sentences.
The phrase “time is brain” emphasizes that Brain tissue is rapidly and permanently lost as stroke progresses. A typical patient loses 1.9 million neurons every minute of an untreated stroke. Stroke is a medical emergency and If we observe any of these signs, we need to urgently take the patient to a hospital where imaging facilities and neurological care are available.
Q3. Does stroke have a golden period?
Time is the most important factor that decides appropriate treatment and good outcome in an acute ischemic stroke patient. For eligible patients in expert centers, intravenous thrombolysis therapy,to bust the clot and remove the blockage of the artery, is available. This treatment can be given only within 4.5 hours of symptom onset.If it can be done within 3 hours of stroke ,it is still better. If within an hour or two, a stroke patient can be brought to an expert neurological centre, he is within the golden period of availing the appropriate treatment for ischemic stroke.
Q4. Why is it important to take patients to specialized neurology care centers in stroke?
It is important to take patients to an expert neurology centre or a tertiary care center because treatment varies with type of stroke and it is crucial to diagnose whether stroke is due to blockage of an artery or due to rupture of an artery.The correct diagnosis ,whether it is an ischemic stroke or a Brain hemorrhage, is possible only where imaging facility such as CT Scan and MRI Scans are available.
It is also imperative to choose the right stroke patient candidates, who can benefit from thrombolytic therapy and for this ,it is vital for the neurological services to be available at the center.