‘A dedicated stroke unit in every hospital should be the goal to provide best care’

What is a brain stroke and what are its causes?

Dr P P Ashok

The blood vessels in the heart get blocked to produce a heart attack, a similar problem occurs in the brain to produce a brain stroke. Unlike the heart, where only the blood vessels can get blocked, causing low blood flow, the blood vessel in the brain can not only get blocked but can also rupture, producing bleeding into the brain. Such rupture does not happen in the heart.

Occlusion of a blood vessel in the brain produces ischemic infarct in the brain tissue, whereas rupture produces brain haemorrhage. In both situations, the site of the brain, where this happens, decides which part of the body can get paralysed. Such paralysis can involve one arm or one arm and leg on the same side, a speech defect or a visual loss.

One suspects an individual to have suffered an acute stroke by the sudden appearance of weakness in a part of the body. Stroke is caused by various conditions which are similar to those that cause a heart attack like high blood pressure, diabetes, smoking, heart disease, high lipids, obesity, sedentary habits etc.

Explain the rising burden of brain stroke in India?

India is a developing country with a high incidence of diabetes. In fact, India has already become the diabetic capital of the world. Metabolic syndrome is highly prevalent in Indian subjects. In a recent study conducted at Hinduja Hospital, it was found that there is a high prevalence of small blood vessel blockage in the brain among Indian patients. This is in sharp contrast to large blood vessel blockages in the Western countries. We believe high blood pressure and diabetes amongst Indian subjects cause small vessel disease, peculiar to Indian and some of the Asian countries. Some of these patients may not suffer from acute stroke, but years of small vessel occlusion can cause cognitive decline and dementia.

Unless we educate our Indian public about the need to control body weight, regular exercise etc. to prevent diabetes, we will end up with more patients suffering from this malady.

What is the role of a stroke management team within the hospital?

Stroke has to be prevented through lifestyle management, prompt treatment of diabetes, blood pressure etc. Also, patients with acute stroke should be treated immediately by thrombolytic therapy, for which patients need to be administered the ‘tPA drug’ within 3 to 4 ½ hours.

To achieve this, one has to quickly transfer the patient to the hospital, where a quick assessment, urgent imaging and interpretation is done, so that the window period of 4 ½ hours is achieved. For this we need a dedicated stroke unit or at least a team which recognises the importance of speed. ‘Time is brain’. The earlier we treat them, less the chances of residual handicap!!!

What were the traditional ways of managing stroke within hospitals?

Prior to the advent of thrombolytic therapy or in those patients who come to the hospital after the window period, there is precious little that we can achieve in the form of treatment. In such patients, after the imaging is over, we can only put them on anti-platelets and statins to try and control all risk factors.

Is stroke still treated by general practitioners within hospitals or by specialists. Do you think that hospitals need to have a separate stroke centre within hospitals? If yes, how will it help in providing better treatment?

Stroke should be treated by a neurologist; certainly the neurologist can take help of a general physician/cardiologist for supportive treatment. However, a dedicated stroke unit in every hospital should be the goal to provide the best care in the management of acute stroke.

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