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Stroke is a silent, deadly and all-too-common killer. But with immediate treatment, patients have a high chance of recovery.

When 19 million brain cells die each minute Why surviving a stroke is all about time
Wednesday, August 21, 2019 - 08:16


Arun (name changed), a 40-year-old business professional in Chennai, woke up one morning feeling dizzy. Blaming it on the heat, Arun went about his day. When his dizziness didn’t subside even hours later, he went to a local nursing home, received basic treatment and returned home. It wasn’t until two days later that he was finally brought in to Apollo Hospital. But by then, too much damage had already been done.

Arun’s dizziness was, in fact, balance problems brought on by a stroke. And by the time he arrived to get treated for it, he had suffered significant brain damage. It took weeks in the ICU for doctors to simply pull him away from death’s door. And despite all their efforts, Arun still lives with a significant speech disability.

Dr U Meenakshisundaram, the Senior Neurologist who treated Arun at Apollo Hospital, says that he sees several cases like Arun’s each year, where insufficient awareness and costly time delays lead to patients’ deaths or leave them significantly disabled for years. “We say time is brain. Every minute after a stroke, 1.9 million brain cells die.”

Strokes are a silent, deadly, and all-too-common killer. Studies have reported that India suffers from a significantly higher stroke burden, with nearly 1.8 million people suffering a stroke each year, one-third of whom may die as a result.

Time is of the essence

The most troubling part of such statistics, says Dr Meenakshisundaram, is that a significant number of such patients suffer death or disability simply because they do not seek medical help early enough. “There is a simple acronym to remember for symptoms of stroke, BE FAST. B is for balance problems, E is for eye and vision problems, F is for facial deviation, A is for arm drift, and S is for speech slurring. If you see someone suddenly having any or all of these symptoms, time is of the essence. That’s why the last letter of the acronym is T for time.”

Dr. U Meenakshisundaram, Senior Neurologist, Apollo Hospitals.

Unfortunately, adds the doctor, “We have found that patients tend to ignore symptoms when they are milder.” Comparing strokes to heart attacks, he explains, one of the major problems is that strokes are not accompanied by severe pain and discomfort, which may make patients ignore the milder systems. “People have so much pain when they have a heart attack, that they rush to the hospital. It makes them very uncomfortable. It's not the same here. It's just that one hand becomes a little weak, they slur a little,” he explains.

What is a stroke?

Strokes are classified into two types, based on what is affecting the brain cells. In an ischemic stroke, a clot blocks off a major or minor artery, thus cutting blood flow to parts of the brain. In a haemorrhagic stroke, a burst aneurysm or a weakened blood vessel leak results in blood accumulating around the brain. The resulting swelling and pressure cause tissue damage. The extent of damage a patient suffers as a result depends on the severity of the stroke and the area of the brain affected. Most importantly, if fewer brain cells are killed as a result, the patient suffers less damage and disability and hence has a better chance of recovery.

The importance of well-equipped hospitals

When talking of the importance of receiving immediate medical care, Dr Meenakshisundaram adds that well-equipped hospitals are a key factor in the success of treatments for stroke. As soon as the patient arrives, the first step for the doctors is to determine the nature of the block or bleed causing the stroke. At the minimum this requires a CT scan, though CT angiography (where the blood vessels are mapped using a special dye) is also recommended.

At this point, the role of a stroke specialist is crucial, as he or she takes a call on whether a patient requires a thrombolysis (injecting an intravenous drug to break up clots) or a thrombectomy, where the clot is dissolved or removed surgically. In the case of a hemorrhagic stroke, similarly, surgical intervention may be needed to repair the damage. While thrombolysis can be successful in the case of minor blocks, the treatment window can be as narrow as 3-4.5 hours from the onset of symptoms. A thrombectomy is necessary for major clots, and can be performed up to 16-24 hours from the onset of symptoms. “But even in that time, damage to the brain would have happened, and we can’t be sure how much recovery is possible.”

All of this means, says Dr Meenakshisundaram, that every minute of the first 24 hours are crucial, if patients are to have a chance at recovering fully from a stroke. “If a patient comes in late, receives treatment late, the damage is done, and we would only be dealing with further complications. So, it is very important that patients recognise their symptoms quickly and come in on time.”

This article has been produced by TNM Brand Studio in association with Apollo Hospitals and not by TNM Editorial.