STROKE (Brain attack, Cerebral haemorrhage, Paralysis, Hemiplegia, Pakshaghat, Lakva, Apoplexy)

STROKE 

(Cerebrovascular accident, Brain attack, Cerebral hemorrhage, Paralysis, Hemiplegia, Pakshavadha, /  Apoplexy/ लकवा /  पक्षाघात)

Surviving a Blood clots / stroke?

Time Is Muscle

Every two second a person suffers stroke and every six seconds a life is lost to stroke somewhere in the world. Also one in six people will get stroke in their life time.

A stroke, also called a brain attack, is a potentially life-threatening event in which a part of brain is deprived of adequate oxygen and energy. A stroke may be ischemic due to the clotting of an artery in the brain resulting in brain damage, or hemorrhagic, due to a tear in the wall of an artery, resulting in bleeding in the brain. Nearly 80% of all strokes are ischemic.

Stroke is the number one cause of disability worldwide. Stroke is one of the most devastating diseases. It is the most distressing experience not only for the patient but also for the family members. The patient is dependent on others, along with the financial burden and mental trauma to the family.

Stroke is the third largest killer after trauma and cancer. Stroke becoming one of the major causes of premature death and disability in the country. Therefore, raising awareness about the symptoms of stroke and a need for a quick hospital admission. In India, it is the second leading cause of death. However, simple measures can prevent about 90% of brain strokes.

As effective management will reduce further health complications. Problem with stroke is lack of awareness among the general population. Most common among them is how to recognize stroke because it is often the delay in recognizing the symptoms which cause further delay in proper treatment. Men are at only slightly greater risk than women

“Rush to nearest Neuro-center,

As early supervision is needed”

Introduction

A brain stroke can happen anytime and at any age. In India, there are around 4,500 incidents of brain strokes every day, which equals to three people per minute.These occurrences are rising due to  changing lifestyle and brain stroke is the leading cause of disability worldwide.

A stroke happens when the blood supply to a part of the  brain is cut off. Without blood the brain cells get damaged.There could be blockage or bleeding that leads to stroke, but normally in 85% of the stroke cases blockage triggers the condition.

The brain is a delicate organ requiring a constant supply of oxygen. A stroke is the sudden death of brain cells in a localized area due to inadequate flow of oxygenated blood. Without access to the blood that supplies oxygen and nutrients and removes waste products, brain cells begin to die quickly. Depending on the region of the brain affected, a stroke may cause loss of consciousness, paralysis, speech impairment, memory loss & reasoning ability, coma, or even death. It is the most common form of brain disease, which can occur at any age, although, the risk increases greatly in the older years of life.

Many strokes occur suddenly and tend to clear after a few hours. In more serious cases, the patient may remain in a deep coma for several days. He may have a fever, rapid pulse and difficulty in breathing.

Most patients recover, if the stroke is due to thrombosis, or if only a small vessel is involved. Many of them may not even lose consciousness, but the weakness and Paralysis may continue for a long time. There may also be permanent disability in spite of the best of care.

With advancement in medical science, we have clot-busting medicine to dissolve the clot to be used within 4.5 hours and newer and latest methods to remove the clot from brain vessels like stent retrievers and thromboaspiration which can be used up to 7 hours although with the added disadvantage of rising cost.

Strokes are of two types:

1 Ischemic stroke: (Caused by blood clots) Ischemic stroke occurs as a result of an obstruction (blood clot) within a blood vessel supplying blood to the brain. It accounts for 87% of all stroke cases. Whilst blood clotting can be beneficial to the body, for instance, to stop bleeding. Blood clots in a stroke cut off the valuable blood flow in arteries. Two types:

a.     Embolic stroke- If a blood clot forms somewhere in the body (usually in the heart) or large arteries of the upper chest and neck, which travel to brain. Once in your brain, the clot travels to a blood vessel that’s too small for it to pass through. It gets stuck there and stops blood from getting through. This kind of strokes is called Embolic strokes. (Cerebral embolism)

b.   Thrombotic strokes- (As the blood flows through the arteries it may leave behind cholesterol-laden ‘plaques’ that sticks to the inner wall of the arteries. Over time this plaque can increase in size and narrow or block the artery and stop blood getting through. In case of stroke, the plaques most often affect the major arteries in the neck taking blood to the brain. These are called thrombotic strokes.(or Cerebral thrombosis)

2. Hemorrhagic strokes (Caused by ruptured blood vessels that cause brain bleeding) Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessel usually cause hemorrhagic stroke: Aneurysms and Arteriovenous malformations (A.V.Ms). But the most common cause of hemorrhagic stroke is Uncontrolled hypertension. Winter is a peak time for the Cardio embolic strokes as a decrease in temperature causes increases in blood pressure.

A brain hemorrhage is bleeding inside the brain and is caused by rupture of blood vessels. It can happen in different anatomical areas and is named accordingly like epidural, subdural, intracerebral, subarchnoid and intravascular. A brain stroke also present as hemorrhage.

Beauty Parlor Stroke Syndrome

How an unassuming hair wash can lead to a neurological nightmare ?

A 50 year old women suffered a beauty parlor stroke after getting a hair wash at a saloon in Hyderabad. A key vessel supplying blood to the brain was pressed when she bent back her neck for wash. The term "beauty parlor stroke syndrome" was coined after it was first reported in 1993 in US. 

"A neurologist says that if he can get to a stroke victim within 3 hours, he can reverse the effect of a stroke totally."

Risk factors:

●    Previous history of stroke

●    Hypertension/Diabetes/Raised cholesterol

●    Obesity/ hereditary/age above 65/ lack of physical activity

●    Smoking and excessive alcohol intake

"About 1 in 10 people make an excellent recovery when cared in a specialized stroke unit."

Cause

●    High Blood Pressure

●    Head Trauma

●    Abnormal blood vessel rupture (Aneurysm)

●    Arterio-venous malformation

●    Drugs like cocaine

●    Drinking alcohol

●    Anticoagulants 

●    Blood thinners

●    Brain tumors causing cells to rupture

●    Low Platelet level

●    Chronic illness like liver disease

●    Poor lifestyle choices

●    High-fat diet

●    Low levels of physical activity

●    Obstruction in the blood supply to the brain.

●    Drug addiction i.e. Morphine/cocaine

●    Six pack abs- Gyms, taking steroids, which increases the risk of clot formation.

●    Contraceptive steroids

●    Air pollution

●    Vitamin. D deficiency

●    Coagulation factors i.e. elevated plasma fibrinogen and factor Vii (clotting factor)

●     Post Corona.

●     Some of the causes of brain strokes may also be associated with iron deficiency anemia.

●    Winter- Atrial fibrillation peaks in winter. Another factor such as seasonal variation in plasma level of fibrinogen, cholesterol, hormones, a vasoactive substance like vasopressin, norepinephrine, epinephrine, angiotensin-ll, aldosterone and catecholamines which tends to rise in winter.

●    According to Ayurveda Pakshaghata (पक्षाघात)  has been used to describe the condition of stroke. Paksha - means one-half of the body. Ghata - means loss of strength, thus Pakshaghata indicates the loss of strength in one-half of the body. The site of pathogens has been described as Dhamani (blood vessel) in Urdhva Deha (in the upper part of the body). It's a degenerative brain disease due to vitiation of vata.

“Symptoms of stroke appears suddenly, without warning”.

Sign & Symptoms

Warning signs:

●    Headache : Sudden severe and persistant headaches 

Weakness : Sudden weakness or numbness of the face, arm or leg on one side of body

●    Trouble speaking : Sudden loss of speech or trouble talking (slurred speech) or understanding.

●    Vision problem : Sudden loss of vision, particularly in one eye 

●    Paralysis

●    Seizures

●    Vomiting

●    Alteration in conciousness, memory loss

●    Difficulty in walking

●   Comatose

●   Elderly with behavioural changes, gait abnormality, urinary incontinance

●    Dizziness : Sudden trouble walking, dizziness, loss of balance or coordination

“Taking the patient immediately to the hospital could avert stroke and linked complications”

Know the symptoms and act fast

FAST:

♣    F for face drooping, Does one side of the face droop? Ask the person to smile.

♣    A for arm drooping, Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downwards?

♣    S for speech slurring If unable to speak clearly? Ask a person to repeat a single sentence. Is the sentence repeated correctly? As Tongue is a great indicator of stroke - ask the patient to speak Chicken Soup. Ask the patient to stick out his or her tongue. If the tongue is 'Crooked' or  if it goes to one side or the other that is also an indication of stroke.

♣    T for time to call the ambulance. Time is crucial. Time loss is brain loss.

Complications

●    Pneumonia

●    Depression

●    Contracture

●    Constipation

●    Bed Sores
                                     

Diagnosis

●    Pulse, BP and ECG

●    Blood test for ESR, platelets, F.B.C, clotting factors, blood glucose

●    Kidney and liver functions

●    Spinal Puncture (withdrawal of brain and spinal fluid)

●    MRI scan of brain

●    Brain vessel Angiography (A test to detect  nature of blood vessel in the brain)

●    CT scan of head

●    Syphilis serology

●    Fundoscopy

“Winters may increase the incidence of brain stroke as a decrease in temperature causes increase in blood pressure”

 How should you prepare for a Computerized Tomography (CT) scan ?

Many people feel scared and nervous before a CT scan. Knowing how to prepare for it  can help reduce anxiety  and enhance the likelihood of a  quick and stress free process.

• Don't eat solid foods for four hours before your exam. Fluid such as water, juice black decaffeinated coffee or tea are ok to consume.
• A dye or contrast is used in some CT scans to help your doctor to see your  inside more clearly. If you need contrast material, it will be given to you either orally (oral contrast) or intravenously (IV)
• Any drug you are taking as well as any allergies you have especially to contrast materials should be disclosed to your care giver.
• CT centers provide gowns for the test. Wear loose fittings. Comfortable clothing to your exam so that its easier to change into the gown.
• Metal objects such as jewelry, eye glasses, dentures and hair pins can interfere with CT images. Leave them at home or take them off before your exam.
• Some CT scan will necessitate the removal of hearing aids and removable denture work. Women will be required to remove bras with metal underwire.

Lifestyle

●   Lifestyle changes can reduce the risk of  another stroke changes include eating well
●  Know your personal risk factors: high blood pressure, diabetes and high cholesterol try to minimize it.
●  Being tobacco free
●   Managing stress
●   Be physically active and exercise regularly
●   Avoid obesity by keeping to a healthy diet
●   Limit alcohol consumption
●   Dressing warmly in winter

Yoga

Trikonasana (Triangle pose)

●    Bring your legs apart so your feet are wider than your shoulders

●    Raise both arms out to the side up to shoulder height so that they are parallel to the floor

●    Palms turned down

●    Turn your left foot 90 degrees outwards

●    Keep both hips facing forwards

●    Turn your right foot slightly towards the left foot and keeps the hips forward.

●    Press your hips to the right and place your left hand on your thigh above your knee.

●    Bring your right arm so it is straight with fingertips towards the sky.

Sarvangasana (Shoulder Stand pose)

●    Lie down fixed on your back in the Shavasana – The Corpse Pose

●    Breathe in by your nostrils slowly and put your palms facing in downward direction flat on the floor. Holding the hips fixed on the floor slowly curve your knees and get them upward towards the abdomen through breathing out.

●    Breathe in by the nostrils, pressing your hand in downward direction try to raise your body from the waistline upwardly away from the floor, curving the backbone backwards and unbending the arms, your hips should be on the floor.

●    Breathe in, and then whilst breathing out, raise your legs directly upward perpendicular to the floor. You can support your hips with your hands making sure that your legs should be united, knees straight and toes pointed straight up.

●  Keep your head straight, don’t turn it to any side.

●  The chin should be compressed against the chest.

●  Holding the posture for a while breathe softly through the nostrils.

●    Reverse the steps to come back to the Shavasana– The Corpse Pose

Halasan

●    Lie on your back with your arms beside you, palms downwards.

●    As you inhale, use your abdominal muscles to lift your feet off the floor, raising your legs vertically at a 90-degree angle.

●    Continue to breathe normally and supporting your hips and back with your hands, lift them off the ground.

●    Allow your legs to sweep in a 180-degree angle over your head until your toes touch the floor.

●    Your back should be perpendicular to the floor. This may be difficult initially, but make an attempt for a few seconds.

●    Do this slowly and gently. Ensure that you do not strain your neck or push it into the ground.

●    Hold this pose and let your body relax more and more with each steady breath.

Pranayama

Bhastrika (Deep breathing) Inhalation followed by exhalation. Increases oxygen supply to all parts of the body, thus improving blood circulation. It relieves stress.

Anulom Viloma (Alternate nostril breathing) It has a calming effect on nervous system.

Kapal Bhati

●    Sit in any comfortable meditative posture like  Sukhasana, Vajrasana Or Padmasana.

●    Keep your back, head and neck in straight line.

●    Exhaling forcefully followed by a passive inhalation.

●    Let your facial muscle be relaxed while practicing this.

Bhramari Pranayama

●    Sit in any meditative comfortable posture.

●    Inhale through both nostrils.

●    While exhaling produce honey bee sound (humming bee sound) by folding your tongue on your upper palate.

●    Feel the resonance and vibration on your head while practising.

●    Ujjayi Pranayama (Hissing breath)

●    In this pranayama partially close the back of your throat, which covers the windpipe so that as you inhale and exhale through your nose.

●    The air passes through a narrow air passage in your throat, creating the sound made by your breath.

Exercise

●    Exercises can not only prevent strokes to a great extent but could help live a healthier life post-stroke.

●    A daily walk for half an hour

●    Exercise like jogging, cycling, swimming, skipping are good

Meditation

●    Meditation Concentrate on your breath while meditating.

●   Chanting “OM” “Maha mrityunjaya mantra” or “Gayatri mantra” is a powerful way to control your nerves. It can be practised at bedtime or in the morning.

Mudra

Prana Mudra

Formation- The tip of little fingers and ring fingers are joined with the tips of the thumbs. It increases stamina, vitality, strength and immunity.

Vyana Mudra

Formation- The tips of index finger and middle fingers to be joined with the tip of the thumb. It improves the circulation and helps in blood pressure.

Shoonya Vayu Mudra

Formation- The tip of middle finger is to be placed at the base of the thumb and the thumb is to be placed on the back of the middle finger gently. Numbness in the head, body parts, chest, the abdomen can be remedied by this Mudra.

Shankha Mudra

Formation- Place the thumb of the left hand at the base of the right thumb. Fold the fingers of the right hand covering the left thumb. Join the index finger of the left hand with the thumb tip of the right hand. The other three fingers of the left hand are to be placed on the back of the right palm. It helps in weakness and Paralysis of muscles.

Namaste Mudra

Formation- To perform ‘Namaste’ we joined the hands together and place at the heart chakra, close the eyes and bend the head. The electromagnetic power flowing from one hand to another is felt strongly. One feels strong in body and mind.

Many patients do survive a brain hemorrhage, but a sequel can persist, ranging from minimal weakness to significant limitations.

Diet

●    Healthy dietary habits including nutrient-rich in vitamin D and low-fat intake

●    A balanced diet which is high in fiber, fruits, vegetables

●    Diet low in saturated fats

Avoid

●    Sedentary lifestyle

●    Avoid taking steroids in Gym

●    Eat sugar and salt in moderation.

●    Junk food

●    Sugary and refined foods

●    Avoid smoking

●    Excess fat

Herbs and long pepper

●    Gunja taila for the external application helps to improve circulation in the brain and brain function. It is prepared by boiling together, the pulp made of the equal quantity of Gunja seeds in till or mustard oil and buttermilk on slow flame. After evaporation of water content, it is bottled and used as a liniment.

●    Abrus precatorius Rati + long pepper in sesame (till) oil or mustard oil.

●    Garlic- It decreases the risk of blood clots, hence used in heart attack and strokes.

●    A decoction of the bark of the root of the drumstick with fried asafoetida and rock salt.

●    Dashamoola rishta is very effective for toning up the nervous system. 4 tsb with water twice a day.

“An early admission within 4 hours is very important for effective stroke treatment”.

Rehabilitation

●    Rehabilitation starts with communication:  what has to be communicated is the “will to recover”.

●    Start with passive movement of the limbs to prevent the worst effects of spasticity (contractures)

●    Next, try to get the patient standing

●    Arrange exercises to strengthen the limbs

●    Once walking is progressing, plan a home visit with the occupational therapist.

●    Physiotherapy plus speech therapy helps to rehabilitate the patients of stroke to get back to normalcy.

●    Acupuncture therapy helps in stimulating various meridians and thereby aid recovery. It helps to relieve pain and get the blood flowing more and balance the energy. Good for Paralysis.

●     Aromatherapy Lavender, Peppermint or rosemary.

●    Yoga

"Early recognition makes a big difference. Knowing the signs of a stroke and getting treated quickly saves lives and improves recovery."

Formula of 80

B.P Diastolic Less than 80

Heart Rate less than 80

L.D.H (Bad Cholesterol) Less than 80

Fasting Sugar less than 80

Abdominal Circumference  Less than 80

Sit in a sun for 80 Days in a year

Give daily 80  minutes to your self daily.

Clap 80 times to avoid Heart Attack, Diabetes & Stroke.

For Heart 80 mg Statin, and 80 mg Aspirin to avoid thrombus formation.

If Heart Block less than 80 % Medical Treatment

If Heart Block more than 80 % Surgical intervention. (Angiography / By-Pass)

Cardiac Bypass Rs 80,000

Do 80 cycles of Deep Breathing (Pranayama) daily. (Parasympathetic activity)

Lungs and Kidney functions should be more than 80 %

Walk 80 Minutes

Brisk Walking 80 Steps

Without cereals 80 day / Year (Fasting in both Navratra good practice)

Air & Noise Pollution less than 80

Food less than 80 calories at a time

Liquor less then 80 ml

In  a year 80 days no cereals wheat ( anaj ) or refined carbohydrates.

No Smoking, otherwise Rs 80,000 expenditure

F.V.R Less than .8 (Fore Arm Vascular Resistance)

Cardio Respiratory Resuscitation 

Treatment

Medicines to stabilize blood pressure

Revers the effect of blood thinners

Carry out Platelet transfusion

Administer drug to prevent and abort seizures if any.

Medicine to decrease brain swelling

Undertake other supportive care.

Patient may need to admit in I .C. U with ventilatory support as patient have altered breathing pattern

Clot busting treatment
In first four and a half hours in eligible patients

Manage risk factors

●    Controlling the risk factors like smoking, obesity, hypertension, physical inactivity, stress etc.

●    In case of any warning signs are observed, the patient must be rushed to hospital within 4 hours.

The cause of bleeding helps in deciding the necessary treatment whether:

●    In the acute stage treatment, which is an emergency, extreme skill and precision are required to treat the patient within a small frame of time.

●    Has to be differentiated whether ischemic or hemorrhagic stroke.

●    Drug of choice- Plasminogen activator, time within 4 hours. TPA therapy. Use of Thrombolytic therapy is the method adopted in Allopathy specifically in ischemic strokes.

●    Consider anticoagulants and antiplatelet drugs

●    Surgery in hemorrhagic strokes.

●    Thrombolytic therapy is used to quickly dissolve the block and allow the blood flow. These are mainly used for ischemic strokes. Recombinant tissue plasminogen activator (rtPA) for which the time window is 3- 4.5 hours.

●    Surgery Treatment : In case of internal bleeding. It is done in 48 to 72 hours after hemorrhage depending upon the condition of the patient.

Evacuation of clot

Securing the ruptured blood vessel by coiling or cliping it

Draining the blood and brain fluid

Sometimes the skull bone is removed to relieve brain swelling

●    Nasya Nasal administration of therapy through medicated oils. Nasya is the fastest route of drug delivery to increase the circulation of blood to the brain, thereby initiating collateral vessels to provide sufficient blood/oxygen/ nutrients to the brain trying to overcome the insufficiency caused by the stroke. This procedure is practiced in ischemic stroke.

Chronic stage treatment

Rehabilitation as well as Physiotherapy to gain strength and recover body functions.

●    Massage In chronic stage. Mahanarayana oil for external massage.

●    Ayurvedic treatment Snehana (Oleation therapy), followed by Swedana (Sudation therapy) that is sweating. And finally Virechana (Purgation).

●    Enema or basti

●    Gandush Regular Holding of mouth with sesame oil helps in Facial Palsy.

More alternative stroke treatment

●    Massage Regular massage lowered blood pressure and heart rate in stroke patients and also eased anxiety. It also helps in stress reduction and combat feeling of depression

●     Allopathic:
●    Clot busting drug : (TPA for Thrombolysis) increase the  chance of a good outcome by 30%. This treatment can be administered for 4-5 hours of the symptoms manifesting. The easier  it is given, the better is the effect.
●  Clot retrieval treatment increases tne chances of a good outcome by 50%. This involves removing a blood clot and can improve survival rates and reduce disability in ischemic strokes caused by artery blockage.
●  Rehabilitation is a critical step in the treatment process.
●  One in four survivors may suffer from another stroke. Treatment that prevents another stroke include drug to lower blood pressure and cholesterol., antiplatlet therapies,anticoagulation for atrial fibrillation surgery or stenting for patients with severe carotid artery narrowing. 
●   Tab Aspirin 150 mg BD

●    If not controlled Heparin and warfarin (antiplatelet agents)

●    Cerebral hemorrhage Control cerebral edema

●    Control hypertension ~ medication

●    Care of comatose patient ~ ICU

●    Care of respiration ~ remove dentures

●    Oxygen plus ventilation ~ if hypoxia cyanosis

●    Retention of urine ~ catheterize

●    Constipation ~ enema

●    Care of skin ~ frequent turning

●    Fever ~ Antibiotics
What should be done
     Get to the hospital immediately. The window of opportunity for salvaging dying brain tissue is the first four and a hail hours since the onset of a stroke.

Neurologist

• P.P. Ashok Head of Neurology, PD Hinduja Hospital
• Dr Neha Kapoor Senior consultant and head neurology, Asian Hospital.
• Dr Sumit Goyal, Head Neuro-intervention and senior consultant, neuro surgery PSRI Hospital.
• Dr Rohit Gupta Chairman Neurosciences, Accord Super Specialty Hospital. 
• Dr Vikas Gupta Director Neuro Surgery, Kailash Deepak Hospital.

Neurology Hospitals in Delhi

●    Indraprastha Apollo Hospital

●    Max Super Specialty Hospital Saket

●    BLK Super-specialty Pusa Road New Delhi

●    Fortis Memorial Research Institute, Gurgaon

●    Moolchand Med city

●    Columbia Asia Hospital, Ghaziabad

●    Artemis Hospital, Gurgaon

●    Fortis Flt. Lt. Rajan Dhall Hospital Vasant Kunj

●    Columbia Asia Hospital, Palam Vihara

●    Max Super Specialty, Vaishali

●    Fortis Hospital, Noida

●    Manas Neurological Centre C R Park Delhi
●   Jaypee hospital sec 128, Noida Dr K M Hassan 0120-4122222

Watch out for signs of stroke, and lead a healthy life!

                   Fight stroke, a  brain attack by acting fast

“So leading a healthy life is necessary, so stay fit” 

Link: https://madhuchhandacdmo.blogspot.com/2017/10/stroke-brain-attack-cerebral.html

* Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.