What is Brain attack?

The brain is an important organ in the body, it controls hand and leg movement including walking, it ‘feels’ sensations (like touch, vision, hearing, smell), it controls emotions (happiness, sadness), it memorises (names, places, persons), etc. A brain attack, commonly known as Stroke, is the loss of brain function, many times permanently, which is due abnormalities brain blood circulation. As brain controls bodily functions like hand and leg movement, speech, vision, balancing etc., any sudden loss of brain function results in brain attack. A major brain attack is a life threatening condition similar to heart attack.

How common is Brain Attack?

A brain attack is the leading cause of acquired disability, third leading cause of death in India. 1 in 6 people worldwide have a stroke in their lifetime. 1 in 5 women are at risk of stroke worldwide. Stroke is a more common cause of death than breast cancer among women, yet the awareness is less. One person will develop stroke every 45 seconds. 20 lakh people are affected every year in India. What is more concerning in India is, 20-30% stroke patients are less than 45 yrs age!

What are the types of brain attack?

Brain attack can be either due to blockage of an artery supplying blood to the brain or due to rupture of brain blood vessel. The blood from ruptured brain vessel can be either within brain tissue (the medical term is Intracerebral Hemorrhage, ICH) or on the surface of the brain (the medical term is Subarachnoid Hemorrhage, SAH).

How is brain attack identified?

A brain attack is identified by one of the following symptoms:

• . Sudden arm or leg weakness
• . Sudden loss of sensations (numb) on one of body
• . Sudden seeing problem in one or both eyes (vision)
• . Sudden loss of balancing/walking difficulty
• . Sudden understanding and speaking difficulty
• . Sudden dizziness
• . Sudden worst ever headache of life

Timely treatment can reverse many/all these symptoms.

What is ‘FAST’ acronym?

FAST is a mnemonic which stands for F –Face droop, A - Arm weakness, S - Speech slurring and T – Time is brain. This easily memorable acronym helps any common person to identify stroke within seconds. The bystanders have to look for symptoms of stroke:

• . By asking patient to lift both arms in air, if one arm drops or could not lift
• . By asking patient so smile – if face becomes asymmetric
• . By asking patient to talk – if he can’t understand or speak or speaks with slurring of speech.
• . Time is brain; each second 33,000-brain nerve cells start dying. Call immediately ‘stroke ready hospital’ or start shifting to such hospitals for scanning and treatment. It is sad to know that every 30 minutes; one stroke patient could have saved by treatment on time.

What to do when a stroke is identified?

A brain attack is a medical emergency. Every second delay in treatment can lead to loss of 33,000 brain nerve cells. There is a treatment if the patient is shifted to ‘stroke ready hospital within 6 hours from onset. Without any delay, the stroke patient should be shifted to a hospital, which has CT scan facility, availability of 24 x 7 stroke specialist and advanced stroke treatment facilities.

What does the brain scan tell?

All patients with suspected stroke will have to undergo brain scanning – either CT scan or MRI. The scanning will give the status of the brain like – whether the stroke is due to a clot in a blood vessel or due to a brain bleed. In addition, the amount of brain saved by early treatment can be determined. Any type of treatment that could be offered depends on brain scan results.

What treatment options are available for brain attack?

The treatment options depend on the type of brain attack. If a brain blood vessel is blocked by a clot, dissolving the clot by giving clot-bursting drugs intravenously or/and removing the clot directly using special devices and cath lab. The latter is proved to be more effective for large artery blocks. If a ballooning of brain artery is found, it needs to coil through a keyhole surgery or sometimes need opening skull & clipping.

What is the role of surgery in stroke patients?

Sometimes, if acute treatment fails, a large part of damaged brain may swell up causing compression of the adjacent normal brain. In such conditions, removing a part of skull bone (called craniotomy) may save the life of the patient. The removed skull bone flap kept under the abdominal skin for few months. Once danger period passes out, the bone flap can be taken out of the abdominal wall and deposited into skull vault.

In some patients, fat deposits in brain blood vessel (the medical term is carotid atherosclerosis) may be causing partial blockage of the artery. In such conditions, urgent surgical removal of such fat deposits (the medical term is endarterectomy) will prevent future strokes.

Can we prevent first ever stroke happening?

Yes, 90% of strokes can be prevented by treating stroke risk factors – which is called ‘primary prevention’. The modifiable risk factors are high blood pressure, high cholesterol, high blood sugar, obesity, sedentary lifestyle, healthy dietary practices, daily moderate exercises.

Can we prevent stroke recurrence in a patient with stroke?

To an extent YES, it is termed ‘secondary prevention’. Blood thinners (either anti-platelets or anticoagulants) lifelong can significantly reduce recurrent strokes. Apart from risk factor control mentioned above, certain heart conditions like atrial fibrillation/Flutter, valvular diseases can be identified by investigations & treated. Identifying fat deposits (called plaques) in brain blood vessels and addressing it also reduced stroke risk. Certain rare diseases also cause stroke, which if identified, can be either controlled or treated.

What can family physicians do in a brain attack?

The role of family physicians is important at all levels of stroke care. Many times, they may be the first to encounter an acute stroke patient, in which case, timely identification of acute stroke, debriefing condition to bystanders and referring to appropriate ‘stroke ready’ hospital can save a life.

The burden of identifying and treating risk factors for primary prevention of stroke also lies on family physicians in small cities, towns, and villages. Also, post stroke long-term care, drug compliance, blood thinner dosage monitoring etc., can be carried out by a family physician staying near to patient’s house.

Stroke Clinic launched at Brains Super Speciality Hospital

At the moment the health care burden due to stroke is huge. Every year 2 million people are getting affected. Stroke is the leading cause of disability in the world as on today. With the increasing life span as well as risk factors like Diabetes and Hypertension the burden is only increasing further year after year. At the same time all the advanced research and understanding is not getting translated to the benefit of society. Also it is to be noted that primarily stroke is preventable. Secondly, the disability following a stroke is again controllable. Thirdly, stroke isn’t a onetime event in life. It can strike again and again making the matters worse. The recovery rate continues to be poor in our country due to lack of awareness and timely action. Time is very crucial factor that determines the ultimate outcome, extent of recovery as well as time taken to it.

In the light of above mentioned problems & to mark the World Stroke Day (29 th October) Brains Super Speciality Hospital is launching a first of its kind Stroke Clinic that provides 360 degree care for this condition. The dedicated Stroke team at BRAINS is committed to fight this burning problem addressing all relevant factors influencing the management currently. We have established technology, process, protocol, systems, training, call centre, awareness, advocacy, continuity of care in acute, chronic and long term including rehabilitation, follow up and monitoring.

The single most aim is to prevent a stroke in high risk people, if not get them back to the society as normal as possible.