A quick guide on Stroke

Any sudden neurological dysfunction is termed a stroke.

Stroke occurs from either an interruption in blood flow to a part of the brain or bleeding into a part of the brain.

Ischemic Strokes occur due to blood clot or plaque causing an interruption of blood flow to a part of the brain resulting in a death of the brain cells being supplied by that specific blood vessel. 

Hemorrhagic Strokes occur when a blood vessel breaks and bleeds into the brain. 

Both types are an emergency !

In Clinical parlance, when some one refers to a Stroke, it usually means an Ischemic stroke.

Hemorrhagic strokes are usually referred to as Brain Bleeds.

 “BE FAST” 

B - Balance problem

E - Eye/Vision problem

F - Face droop on one side

A - Arm weakness on one side

S - Speech problem

T - This is a reminder to get help fast!

When you spot a stroke, call the emergency services immediately to get to the nearest hospital‘s emergency room. 

Do not neglect or waste time as there is a short time window for treatment. 

Stroke leads to disability and death.

Stroke is the fifth leading cause of death and a leading cause of adult disability in the world.

The spectrum of disability can range from mild residual symptoms such as mild weakness in an arm, leg, or face to being bed ridden.

A CT scan is done immediately after arrival.

The CT scan determines if the stroke is an Ischemic Stroke or a Hemorrhagic stroke.

An MRI can be done although it takes longer than a CT scan. Since time is of the essence, CT is preferred over MRI to make timely decisions.

In addition to a CT scan, CT angiography and/or CT perfusion are also done.

The CT Angiography is basically a imaging study of the vessels that supply the brain. It determines if there is a vessel occlusion in any of the vessels supplying the brain.

A Perfusion imaging gives an idea of how much of the brain is at risk and how much of the “at risk“ brain has “completed” the stroke and is not salvageable via interventions.

The treatments for a stroke are IV tPA/clot busting medication and/or Mechanical thrombectomy.

The treatment for a stroke starts with determining if the patient is a candidate for “clot busting medication”.

The “clot busting medication” is a blood thinning agent designed to dissolve the clot and reestablish blood flow to the brain thus halting the stroke from completion. 

Recombinant tissue plasminogen activator or IV tPA can be administered if the patients are within a window from 4.5 hours of their last known normal time. Using special perfusion scans this time window can be extended sometimes.

Since, IV tPA is a blood thinner, patients who recently had surgery or recent head trauma or other bleeding problems are not candidates for this treatment. There are other exclusions for this medication.

This is the standard of care treatment for a stroke that is being caused by a clot in the blood vessels supplying the brain.

Mechanical thrombectomy means retrieving a clot from the blood vessels in the brain and reestablishing blood flow to the brain at risk for stroke.

Major randomized controlled trials showed a number needed to treat of around 2. This makes it one of the most effective treatments among all of Medicine.

The Number needed to treat is the average number of patients who need to be treated to prevent one additional bad outcome . The best intervention has a low number needed to treat.

 
Once the clinician determines the safety, risks and benefits of IV tPA and/or Mechanical thrombectomy they are performed.