A stroke is defined as a condition that occurs when a blood vessel in the brain ruptures and bleeds. It can also happen when there is a blockage in the blood supply to the brain, and the rupture or blockage prevents blood and oxygen from reaching the tissues in the brain. Stroke is one of the leading causes of death and disability in India. The estimated adjusted prevalence of stroke ranges from 84-262/ 100,000 in rural areas, and 334-424/ 100,000 in urban areas. Additionally, in India, stroke rehabilitation is not easily accessible or effective, key reasons being lack of care facilities, especially in rural areas, and medical care which can sometimes become a financial burden for many families.
As the incidence of stroke is rising in India, it is essential to understand and recognize the symptoms because timely diagnosis and treatment is of utmost importance for treatment; in fact, every minute counts. In the first one hour – known as the ‘Golden hour’, if the patient receives necessary treatment, it can reduce the brain damage and even help the patient return to their everyday life with minimal negative repercussions.
Recognizing symptoms of stroke is very important, and some of them include the following:
- Numbness or weakness in the face, arm, or leg, especially on one side of the body that can occur suddenly
- Confusion, trouble speaking, or difficulty understanding speech
- Trouble with eyesight, in one or both eyes
- Difficulty walking, dizziness, loss of balance, or lack of coordination
- Severe headache with no known cause
- Nausea or vomiting
If these symptoms are visible in any person, it is time to head to a doctor immediately, as appropriate treatment at an appropriate time can save lives and help reduce the impact on the quality of ones life. The unfortunate fact is that many patients don’t reach the hospital in time, because of which, immediate medical aid cannot be given to them. Many people come to the hospital only after weeks, when the damage becomes quite irreversible. Recovery and rehabilitation for a patient suffering from a Stroke needs to start as soon as possible. Stroke recovery should begin in the hospital, where a team of experts will help stabilize the patient and assess the impact of the Stroke. The healthcare team is adept at identifying underlying factors and in beginning the therapy process to help the patient regain some of their affected skills.
Stroke treatment in the early phase aims to open up the blocked blood vessels of brain, either using an intravenous medicine or devices for mechanical clot extraction in the cath lab. Other therapies being found useful in promoting Stroke recovery in later stages of Stroke are non-invasive brain stimulation (magnetic or electrical) and Botulinum Toxin (botox) injections to reduce pain and spasticity of the limbs. While acute treatment and Botulinum Toxin injections have been around for many years, the promising technology of non-invasive brain stimulation (TMS-TDCS) is relatively new. These are continuously being evaluated, validated and hold promise for the future in providing effective treatment for Stroke patients. They can result in better outcomes, even if the patients might have missed the ‘Golden Hour’ of acute treatment. As technological advancements and capabilities continue to soar, these treatment options, including electrical brain stimulation and Botox injections can provide patients with a new lease of life, thereby reducing the negative effects that come with delayed treatment. This means that these new technologies are helping harness the brain’s ability to repair itself in ways that haven’t been seen before, making outcomes better for both patients and the healthcare team.
Surgery– Emergency surgery can sometimes be required to remove any blood from the brain & repair any burst blood vessels. Surgeons usually achieve this through a procedure known as a Craniotomy, where a section of the skull is removed so that the source of the bleeding can be accessed. During the operation, the surgeon will repair any damaged blood vessels and, at the same time, ensure there are no blood clots, so that blood (and oxygen) flow is not restricted in the brain.
Non-invasive brain stimulation– Non-invasive brain stimulation is shown to offer a wide range of benefits for neurology patients, especially those affected by stroke. From improving motor skills, cognition and speech to preventing atrophy, brain stimulation can help patients overcome many secondary effects of stroke. This is especially effective in patients who cannot reach the hospital during the Golden Hour after a stroke occurs.
Such is the case of a 28-year-old software engineer who, after suffering a stroke, was unable to receive timely treatment, and brain stimulation with TMS (Transcranial Magnetic Stimulation) and TDCS (Transcranial Direct Current Stimulation) was offered to him as a evolving technique, which improved his condition substantially. Over a course of three years, this treatment helped him improve his communication skills and even retain his job; his life and livelihood would have otherwise been drastically affected due to the Stroke.
Botox– Many studies have shown that repeated Botulinum Toxin intramuscular injections after a stroke may improve muscle tone and reduce pain in the hands & legs of the patients. There was a recent case study of a patient working as a journalist who suffered a stroke two months back. Unfortunately, he was unable to reach the hospital on time, and these Botulinum Toxin injections (which are given in calf muscles) were administered to him to reduce spasticity and jerking of affected limbs. Once injected, its effects generally last about 4-6 months, after which the patients must get another injection, otherwise, spasticity may return. The patient was also offered non invasive brain stimulation to improve his chances of recovery.
In conclusion, while non invasive-brain stimulation and Botulinum Toxin injections are effective treatment options, especially when there is a delay in getting a stroke patient to the hospital, there is no denying the fact that early diagnosis can result in really positive outcomes. That is why awareness about Stroke, identifying its symptoms and reaching the hospital in time for treatment are highly critical for saving a patient from Stroke and its consequences.
Views expressed above are the author’s own.
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