Dr. Sreenivas U.M., Consultant Neurologist, Arunai Neuro Centre and Research Foundation
Recognising a stroke is the first step in management of a stroke. Early recognition is extremely important, since the treatment options are time dependent. Stroke can present in multiple ways, but the most common ways are a loss of balance, blurring of vision, drooping of one side of the face, slurring of speech and weakness of arm or leg. Beyond this, patients can also present with headache, confused speech, fogging of thought, dizziness, double vision, difficulty swallowing, numbness of hand, leg or face, and sometimes loss of consciousness. It is imperative to be suspicious of a stroke whenever there is a sudden change in a normal functioning individual.
There are two different types of stroke- ischemic or hemorrhagic. Ischemic stroke refers to a clot in the blood flow to the brain, while hemorrhagic refers to bleeding inside the brain. Both types of strokes have the same effect of causing dysfunction of certain parts of the brain, leadings to symptoms and disability.
An ischemic stroke presenting to a hospital within 4.5 hours has the option of being provided clot-busting medication. This is called thrombolysis. This has better chance of success when administered earlier, since there are 2 million neurons dying every minute after a stroke. There is a small risk of worsening with this drug, which can occur in 10 out of every 100 patients. Beyond 4.5 hours, there is the option for removing the clot by an interventional procedure called thrombectomy, which can be done upto 24 hours. However this is possible only for certain types of strokes and not all. This carries the same risk of worsening as well.
In hemorrhagic strokes, the major issue is the increased pressure within the brain. We will need to arrest the bleeding and reduce the risk of recurrence of the bleed immediately. Patients might require surgical intervention to remove the bleed from the brain in severe conditions.
All strokes will require urgent admission to the hospital and proper management by a neurologist, with support from neurosurgeons, Intensivists and Neuro-interventionists as needed.