Dr Prabhudev
Former director of Sri Jay Deva Institute of cardiology
Stroke — BE FAST- Golden hour!
Former Karnataka CM who recovered from a stroke says he got a ‘third birth’. He also highlighted the importance of the ‘golden hour’ and said a person suffering from a stroke must reach the hospital at the earliest!
A stroke is your brain’s equivalent of a heart attack. A stroke — also called a cerebrovascular accident! It is also referred to as a Brain attack! This can happen when blood vessels are blocked or because of bleeding due to Rupture of blood a vessel in the brain.
Reasons A Stroke Happens -That Most People Ignore!
Strokes are a life-threatening emergency, and immediate medical attention is critical to prevent permanent damage or death.
· High blood pressure — is the biggest reason that strokes happen. Damaged arteries make it easier for blockages to occur or the vessel to rupture
· Tobacco — Smoking increases BP and causes build-up of fat and cholesterol blockages in the arteries. The chances of stroke increases by 200–400%.
· Heart disease and diabetes — defective heart valves, atrial fibrillation, and irregular heartbeats — are the leading causes of strokes in the elderly. Diabetes and high BP often coexist and make the likelihood of stroke even higher.
· Lack of exercise and consequent overweight. Exercise lowers blood pressure, and improves the health of your arteries which lowers your risk of strokes.
· Medication — Blood-thinning medications, increase the likelihood of strokes. Hormone therapy and birth control pills also increase the chances.
· Age — While anyone from any age group can have strokes, older people are much more likely to experience one. After the age of 55, the likelihood increases and doubles every decade.
· High cholesterol — too much saturated and Trans fat. With high cholesterol plaque builds up in the arteries and blocks the blood flow, causing strokes
Stroke Signs
BE FAST-
B — Balance — Is the person suddenly having trouble with balance or coordination?
E — Eyes — Is the person experiencing sudden blurred or double vision or a sudden loss of vision in one or both eyes without pain?
F — Face Drooping — Does one side of the face droop or is it numb? Ask the person to smile. He cannot!
A-Arm Weakness — Ask the person to raise both arms. Does one arm drift downward?
S — Speech Difficulty — Is speech slurred, are they unable to speak, or are they hard to understand?
T — Time to rush to the hospital
What is golden hour?
“Golden hour” is a time bracket of 60 minutes or less. It is the door-to-treatment time of acute ischaemic stroke treatment. This crucial hour is paramount for the medical team to establish a focused diagnostic workup that establishes stroke.
10 minutes for the patient to reach and be evaluated by the doctor in the Emergency Room
15 to 25 minutes for the CT scan to be performed
45 to 60 minutes for the treatment plan to be established and initiation of required treatment.
Stroke patients have a high chance of survival and prevention of long-term brain damage if they receive medical treatment and drug therapy within the first 60 minutes of the onset of symptoms. The death of brain tissue is irreversible and permanent. Early identification and management within the golden hour can prevent long-term disability in almost all cases of stroke.
Treatment
Emergency treatment for stroke depends on whether you’re having an ischemic stroke or a stroke that involves bleeding into the brain (haemorrhagic).
Ischemic stroke -the sooner these drugs that can break up a clot are given intravenously, the better. Alteplase — Activase or Tenecteplase -TNKase — is the gold standard treatment for ischemic stroke. This drug restores blood flow by dissolving the blood clot causing the stroke.
Doctors can treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. These procedures must be performed as soon as possible:
Hemorrhagic stroke
Emergency treatment of haemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain caused by the excess fluid. Drugs to lower the pressure in the brain (intracranial pressure), lower blood pressure, prevent spasms of the blood vessels and prevent seizures.
If the area of bleeding is large, may perform surgery to remove the blood and relieve pressure on the brain. Surgery may also be used to repair blood vessel. A surgeon places a tiny clamp at the base of the aneurysm to stop blood flow to it and prevent rupture.
Stroke recovery and rehabilitation- stroke care focuses on helping you recover as much function as possible and return to independent living. The impact of the stroke depends on the area of the brain involved and the amount of tissue damaged.