Acute Stroke (Brain Attack) Is Alarming But Treatable Now: Facts

Brain attack (stroke) is globally the second leading cause of death and is recognised as the leading aetiology of long-term physical and cognitive disability in adults. 

In Delhi and the NCR region, approximately 75,000 patients suffer from brain attacks (strokes) each year. 3 Indians suffer from brain attacks (strokes) every 2 minutes, and one dies due to a brain attack every 3 minutes. It has been observed that of the 4,000 who are afflicted with acute ischaemic stroke in India every day, around 300 or 7-8%, reach on time (within 60 minutes—the golden hour period) and that too in metro cities. In smaller cities, it is hardly < 2 %. 

Traditionally seen as a disease of older age, the increasing burden of stroke as a public health issue among younger individuals is alarming and increasing gradually, with stroke in young individuals <50 years of age accounting for ~15–20% of all strokes.

How to Recognise Brain Attack (Stroke)?

Recognise the brain attack with the following symptoms and take the patient to the nearest brain attack-equipped hospital at the earliest. 

BE FAST: Reminder of Stroke Signs


  • B: Balance

Is the individual experiencing sudden difficulties with balance or coordination?

  • E: Eyes

Is the person experiencing a sudden onset of blurred or double vision or rapid vision loss in one or both eyes without any associated pain?

  • F: Face Drooping

Is there noticeable drooping or numbness on one side of the face? Ask the individual to smile.

  • A: Arm Weakness

Is there weakness or numbness in one arm? Ask the individual to raise both arms. Does one arm tend to drift downward?

  • S: Speech Difficulty

Is the individual's speech slurred, are they unable to say words, or is their speech difficult to understand? Ask the individual to repeat a simple phrase such as, “The sky is blue.” Is the phrase repeated correctly?

  • T: Time to call the Nearest Hospital

If the person shows any of these symptoms, even if the symptoms go away, call and get them to the nearest stroke-ready hospital immediately.

Risk Factors of Brain Attack (Stroke)

The risk factors for a brain attack include hypertension, hypercholesterolaemia, diabetes mellitus, smoking, obesity, chronic alcoholism, heart diseases, sleep apnea syndrome and migraine.

 

However, there are additional factors that are unique to the young population and further potentiate stroke risk, including increased homocysteine and low vitamin B12 levels in the blood, migraine headaches, oral contraceptive use, pregnancy and postpartum state, patent foramen ovale (hole in the septum of the heart), recreational drug abuse (cocaine, amphetamine, marijuana) and genetic factors. 

Treatment

The golden period of treatment

Earlier golden hours of treatment (window period) for brain attack were 4.5 hrs for clot-bursting injection and 6 hrs for mechanical thrombectomy (clot is extracted through a catheter), which has been extended to 24 hrs in a selected group of patients nowadays. Newer stroke guidelines have recommended giving clot-bursting injections to patients who have wake-up strokes now.   

We have successfully treated more than 1800 acute stroke patients with clot-busting injections or mechanical thrombectomy in Max Hospital Saket, New Delhi, to date. Around 80% of patients are independent now after treatment. Few cases that deteriorate even after clot-bursting injection require brain surgery (decompressive hemicraniectomy), which is life-saving and helps in further improvement. 

Some cases of acute stroke have bleeding in the brain (brain haemorrhage or subarachnoid haemorrhage) due to high blood pressure or rupture of the weak vessel (aneurysm) and require urgent admission to a nearby stroke-ready hospital for medical treatment, surgery, as well as the endovascular procedure to stop further bleeding.

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