Medgate Today


- Authored by Dr. Pawan Ojha, Senior Consultant-neurology, Fortis Hiranandan­i Hospital, Vashi

AStroke 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 Stroke 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

• Seizures

• 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. 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 noninvasiv­e 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 (TMSTDCS) 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 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 from 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.


– Many studies have shown that repeated Botulinum Toxin intramuscu­lar injections after a Stroke may improve muscle tone and reduce pain in the hands & legs for 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.

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