Docyard | new advancement in stroke management

Stroke or brain attack is the second largest cause of death amongst people above the age of 60 years. 17 million strokes per year occur across the globe. Out of these, 6.5 million per year will die and another five million will remain permanently disabled. One in six people will suffer from stroke in their lifetime and stroke claims one life every six seconds across the globe.

The incidence of stroke is reducing in the higher income countries due to implementation of  preventive strategies. On the other hand, the incidence of stroke in lower and middle income countries (like India) is increasing because of poor implementation of preventive strategies and hence the global burden of stroke is increasing. To reduce the global burden of Stroke, active work towards prevention and management of Stroke has to be conducted in these lower and middle-income countries including India and China.

Recognise Stroke

Remember the mnemonic  FAST — Face, Arm, Speech Time. If the face appears drooped, the arm drifts on raising it and the speech is slurred. This would indicate a stroke and it is time to act FAST. 60-70 per cent of strokes can be identified by this mnemonic of FAST. Other manifestations of Stroke include:

• Sudden loss of vision in one or both eyes
• Vertigo and imbalance
• Sudden catastrophic headache with vomiting

What to doIJ

1.9 million neurons can die every minute after Stroke starts and hence, urgent treatment is of extreme  importance. Time lost is Brain lost. Two therapies that can be urgently offered in the first few hours called as the “Golden period” and may produce significant benefit are:

• Intravenous thrombolysis (drug given through vein): Can be given up to a window period of 4.5 hours (the earlier the better)
• Mechanical thrombectomy (Stent placed in brain vessel through leg vein and clot pulled out): Can be performed within six hours (the earlier the better).

Advancement in Stroke Management

Major advances and changes in the treatment of Stroke have happened since February 2018.  These two advances are — expansion of patients eligibility for intravenous thrombolysis and expansion of time window for Mechanical thrombectomy up to 24 hours for selected patients. These are major advancements in the field of stroke management and will change the way patients. It includes:

• Indications for Intravenous thrombolysis have been expanded to
• Some patients who have had heart attack in last three months
• Elderly above 80 years and patients with history of diabetes and previous stroke
• Patients on blood thinners and those who develop stroke, post cardiac intervention
• Patients on dialysis, pregnant patients and patients with diabetic, eye changes
• Duration of Mechanical thrombectomy has been extended to 24 hours for selected population

Prevent it

• Stroke occurs more commonly amongst the population with risk factors.
• Regular medication prescribed by doctor to control BP, sugars, cholesterol and blood thinning medication
• Stroke can be prevented by risk factor reduction. Unmodifiable risk factors include advancing age,male sex and family history of Stroke. Modifiable risk factors include:

The Writer is Dr Vinit Suri President, Indian Stroke Association & Senior consultant, neurology Indraprastha Apollo Hospital