Brain Stroke Treatment in Delhi, India

There are three different types of stroke, including:

1. Ischemic stroke
2. Hemorrhagic stroke
3. Transient Ischemic Attack (TIA)

Ischemic Stroke

This occurs when a blood vessel supplying the brain becomes blocked, often due to a blood clot. The blockage restricts the flow of oxygen and nutrients to the brain, leading to damage or death of brain cells. Ischemic stroke is the most common type, accounting for about 80-85% of all strokes.

Hemorrhagic Stroke

This type of stroke happens when a blood vessel in the brain leaks or ruptures, resulting in bleeding within or around the brain. The bleeding puts pressure on the brain and can cause damage or death of brain cells.

Transient Ischemic Attack (TIA)

Also known as a "mini-stroke," a TIA is a temporary disruption of blood flow to the brain that produces symptoms similar to a stroke. TIAs are caused by a temporary blockage of a blood vessel, but the blockage typically resolves within 24 hours. While TIAs may not cause permanent damage, they are important warning signs and indicate an increased risk of a full-blown stroke in the future.

The acronym FAST can help you identify early stroke symptoms.

• Face – Facial drooping or numbness

• Arm - Weakness in the arms or the inability to lift both arms

• Speech – Slurring of speech

• Time – The time to call for emergency medical assistance is 4.5 hours from the onset 

Brain Stroke symptoms could include one or more of the following –

• Confusion, losing the ability to speak or understand, slurred speech, loss of memory

• Loss of consciousness or dizziness

• Lack of coordination and balance, difficulty in standing or walking

• Paralysis or weakness (particularly on one side of the face or body)

• Sudden onset of headaches, particularly when accompanied by vomiting or altered consciousness

• Blurred vision, double vision, or blind spots (in one or both eyes)

• Sudden behavioural changes like unrequited or raging aggression

• Trouble swallowing

There can be various causes of brain stroke. Common causes of brain stroke are as follows.

• Atherosclerosis: In this condition, a build-up of plaque in the arteries occurs, which can narrow or block blood flow to the brain.

• Hypertension: It can damage blood vessels in the brain, increasing the chances of stroke.

• Cardiac Issues: Conditions such as atrial fibrillation (AFib) or heart disease can increase the chances of stroke by causing blood clots to form in the heart and travel to the brain.

• Diabetes: High blood glucose levels can damage blood vessels in the brain, increasing the risk of stroke.

• Smoking: Smoking can damage blood vessels in the brain, increasing the risk of stroke.

• Alcohol and Drug Abuse: Excessive alcohol and drug consumption can increase the risk of stroke.

• Genetic Factors: Some people may have a genetic predisposition to stroke, putting them at a higher risk.

• High cholesterol, stress, lack of sleep, pollution.

Stroke is diagnosed using the following ways. 

• Physical examination: A doctor will check for signs of a stroke, such as numbness on one side of the body, difficulty speaking or understanding speech and vision problems.

• Neurological examination: A doctor will perform a neurological examination to check for signs of stroke, such as changes in reflexes, muscle strength, and coordination.

• Imaging tests: A doctor may order MRI and CT scans to check for brain bleeding or damage.

• Blood tests: A doctor may order tests to check for clotting disorders, high cholesterol, or other conditions that may increase the chances of stroke.

• Angiography: A doctor may order an angiogram to check for blockages in the blood vessels.

• Carotid ultrasound: A doctor may order a carotid ultrasound to check for blockages in the carotid artery, which supplies blood to the brain.

The following treatment modalities can be used in combination to treat stroke.

• Medications: Thrombolytic drugs, anti-platelet drugs, and anticoagulants are used to dissolve blood clots and prevent further clotting in the brain, depending on the type of stroke.

• Surgery: It may be necessary to remove a clot or repair a damaged blood vessel, known as mechanical thrombectomy.

• Rehabilitation: Physical, occupational, and speech therapy can help individuals recover from the effects of a stroke.

• Lifestyle changes: Changes in diet and exercise and quitting smoking can help reduce the risk of another stroke.

• Support groups: Support groups can provide emotional support and help individuals and their families cope with the effects of a stroke.

• Experimental treatments: Some experimental treatments, such as stem cell therapy, are being tested to see if they can help improve outcomes after a stroke.

• Cognitive therapies can also be used to help individuals improve their cognitive abilities, such as memory, attention, and problem-solving, after a stroke.

Treatment of Ischemic Stroke

At Max Institute of Neurosciences, the primary goal in treating Ischemic stroke is to restore blood flow to the brain. This is done using blood clot-busting drugs known as thrombolytics, such as aspirin, and heparin, that must be administered within 4.5 hours of the onset of stroke. In addition, surgical procedures may be performed that can open up or widen arteries. These include

• Mechanical thrombectomy: It involves the use of specialised devices to physically remove or break up the blood clot, restoring blood flow to the affected area of the brain.

• Carotid Endarterectomy: Removal of plaque and widening of the carotid artery. 

• Angioplasty: A balloon that widens the carotid artery is held open with a metallic mesh tube called a stent.

Treatment of Haemorrhagic Stroke

While Haemorrhagic Stroke is treated differently than Ischemic Stroke, surgical methods used by our team to treat hemorrhagic stroke include:

• Aneurysm Clipping - It consists of a small clamp placed at the base of the aneurysm that isolates it from the circulation of its attached artery and keeps the aneurysm from bursting or re-bleeding.

• Aneurysm Embolisation (coiling) - This involves using a catheter inserted into the aneurysm to deposit a tiny coil that fills the aneurysm, causing clotting and sealing off the aneurysm from arteries.

• Arteriovenous Malformation (AVM) Removal - A surgical procedure to remove usually smaller AVMs or AMVs that are in a more accessible portion of the brain in order to eliminate the risk of rupture.

There are four stages of stroke which are as follows.

• Acute phase: This is the initial stage of stroke recovery, typically lasting up to three months. During this time, the focus is on stabilising the patient's condition, controlling symptoms, and preventing complications.

• Subacute phase: This stage typically lasts three to six months and focuses on rehabilitation and therapy to improve physical and cognitive function.

• Chronic phase: This stage can last for several months or even years. During this time, the patient continues to work on improving function and independence, with a focus on community reintegration and long-term care.

• Maintenance phase: This is the final stage of stroke recovery, where the patient has reached their maximum level of recovery and is working to maintain their current level of function. This can include ongoing therapy and support to help the patient adapt to any permanent changes in their abilities.

If the stroke is not managed efficiently well in time, it can lead to complications.

• Weakness on one side of the body or paralysis: A stroke can affect the nerve cells that control muscle movement, leading to weakness or paralysis on one side of the body.

• Difficulty speaking or understanding speech: A stroke can damage the areas of the brain that control language and communication, making it difficult for the person to speak or understand speech.

• Vision problems: A stroke can cause vision problems, such as double vision or blindness in one eye.

• Difficulty swallowing: A stroke can affect the muscles used for swallowing, making it difficult for the person to eat or drink.

• Cognitive impairment: A stroke can cause cognitive impairment, such as difficulty with memory, attention, or problem-solving.

• Depression: Stroke survivors may experience depression, which can be a result of physical and emotional changes.

• Headaches: A stroke can cause headaches, which can be severe and persistent.

• Blood clots: A stroke can lead to the formation of blood clots in the brain, which can be life-threatening if not treated promptly.

• Seizures: A stroke can cause seizures, which can be dangerous and unpredictable.

• Infections: A stroke can make the person more susceptible to infections, such as pneumonia, urinary tract infections, or sepsis.

Stroke can be prevented by following a healthy lifestyle. Take the following measures to lead a healthy life.

• Maintain a healthy diet:

• Exercise regularly

• Quit smoking

• Control your blood pressure

• Manage diabetes

• Limit alcohol consumption

• Get enough sleep

The only approach for stroke treatment is to act FAST. Ischemic stroke is best treated when treated within 6 hours from onset of cerebral attack, as the clot can be dissolved more effectively by giving Inj r-tPA within 4.5 hours and the outcome will be far better. Mechanical thrombectomy can be offered upto 6 hours and in selected few patients upto 24 hours.

Max Institute of Neurosciences is equipped with modern diagnostic & imaging equipment and the latest therapeutic options, to help all types of stroke pateints; adding to this, we also have the faculty, infrastructure, and experience to be one of the top centres of its kind in the country. The institute has a 24*7 Stroke Helpline (9910204043), a dedicated number which can help the patient get an immediate assessment.

We offer super speciality tertiary care for all kinds of neurological diseases, conditions and disorders. We have a team of highly skilled neurosurgeons, neurologists, intervention neurologists, neuro anaesthetists, experts in critical care and specialised nurses who work together to deliver world-class healthcare services. They are supported by state-of-the-art facilities such as dedicated high-end Neuro ICU and HDU beds with 24*7 neurosurgery and neuro anaesthetist backup, advanced medical technology, high-end operation theatres and more.

The team brings together expertise from years of experience and skills, all directed towards providing the highest standards of patient care. This team is guided by internationally accepted protocols and integrated care pathways. A robust audit system is planned to ensure continual improvement. Equipped with Bi-plane cath labs, which produce high-resolution 3D images of the highly complex blood vessels; high-quality images help in providing safer and better treatment to the patients.

Biplane labs also provide decreased radiation in comparison to single-plane labs and so helpful in limiting radiation to the paediatric population. CT scan can be obtained in a minute during the procedure without shifting the patient to the neuroradiology department thus saving a significant time which is very crucial in neuro-intervention. 

1. Can stroke be cured?

Stroke is not typically considered curable, but recovery and rehabilitation can improve symptoms and functional abilities. Treatment for stroke may include medications, therapy, and lifestyle changes.

2. Can stress cause a stroke?

Stress can contribute to the risk of stroke by increasing blood pressure and heart rate, which can damage blood vessels and lead to clots. However, it is important to note that stress alone is not a direct cause of stroke, and other factors such as genetics and medical conditions also play a role in the development of stroke.

3. What is the prognosis of a stroke?

The prognosis of a stroke can vary greatly depending on the severity of the stroke, the location of the affected area in the brain, and the individual's overall health and medical history.

Reviewed by Dr. Sahil Kohli, Senior Consultant, Neurology, Neurosciences on 15-Jun-2023.

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