‘Golden hour’ critical in stroke

A stroke is the brain’s equivalent of a heart attack. A stroke is also called ‘cerebrovascular accident’ and ‘brain attack’. It happens when the blood vessels are blocked or because of bleeding due to a rupture of a blood vessel in the brain.

Causes

A stroke is a life-threatening emergency, and immediate medical attention is critical to prevent permanent damage or death. Here are causes that most people ignore.

High blood pressure: It is the most common reason for a stroke. Damaged arteries make it easier for blockages to occur or a vessel to rupture.

Smoking: This bad habit increases blood pressure and causes build-up of fat and cholesterol blockages in the arteries. The chance of stroke increases by 200-400 per cent.

Heart disease, diabetes: A defective heart valve, atrial fibrillation and irregular heartbeats are the leading causes of strokes among senior citizens. Diabetes and high blood pressure often coexist and make the likelihood of stroke even higher.

Lack of exercise, over-weight: Exercise lowers blood pressure, and improves the health of your arteries. This, in turn, lowers your risk of stroke.

Medication: Blood-thinning medications increase the likelihood of stroke. Hormone therapy and birth control pills also increase the chances.

Age: While anyone in any age group can have a stroke, senior citizens are much more likely to experience one. After the age of 55, the likelihood increases and doubles every decade.

High cholesterol: Consumption of too much of saturated and trans fat leads to high cholesterol plaque build-up in the arteries and blocks the flow of blood, causing a stroke.

Warning signs

An early warning sign can be summarised with ‘BE FAST’.

B – Balance: Is the person suddenly having trouble with balance or coordination?

E – Eyes: Is the person experiencing blurred, double vision or a sudden loss of vision in one or both eyes without pain suddenly?

F - Face drooping: Does one side of the face droop or is it numb? Does the person have difficulty smiling?

A- Arm weakness: Does the person have difficulty raising both arms? Does one arm drift downwards?

S - Speech difficulty: Is speech slurred? Is the person unable to speak or finds it hard to understand?

T - Time to rush to hospital.

Golden hour is critical

The ‘golden hour’ is a time span of 60 minutes or less. It is the door-to-treatment time for acute ischaemic stroke treatment. This crucial hour is paramount for the medical team to establish a focused diagnostic work-up that establishes a stroke.

It takes 10 minutes for a patient to reach the hospital and be evaluated by a doctor in the emergency room. It takes 15 to 25 minutes for a CT scan to be performed, and 45 to 60 minutes for the treatment plan to be established and initiation of required treatment.

Stroke patients have a high chance of survival and prevention of long-term brain damage if they receive medical treatment and drug therapy within the first 60 minutes of the onset of symptoms. The death of brain tissue is irreversible and permanent. Early identification and management within the golden hour can prevent long-term disability in almost all cases of stroke.

Treatment

Emergency treatment for stroke depends on whether the person is having an ischemic stroke or a stroke that involves bleeding in the brain (haemorrhagic).

Ischemic stroke: The sooner the drugs that can break up a clot are given intravenously, the better. They restore blood flow by dissolving the blood clot causing the stroke. Doctors can treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke.

Hemorrhagic stroke: Emergency treatment of haemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain caused by the excess fluid. Drugs to lower the pressure in the brain (intracranial pressure), lower blood pressure, prevent spasms of the blood vessels and prevent seizures are administered.

If the area of bleeding is large, the doctors may perform surgery to remove the blood and relieve pressure on the brain. Surgery may also be used to repair the blood vessel. A surgeon places a tiny clamp at the base of the aneurysm to stop blood flow to it and prevent rupture.

Recovery and rehab

Stroke care focuses on helping the person recover as much function as possible and return to independent living. The impact of the stroke depends on the area of the brain involved and the amount of tissue damaged.

(The author is former director, Sri Jayadeva Institute of Cardiology)