What is stroke and what causes it?

Stroke is a disease that effects the blood vessels going to the brain Stroke happens when blood vessel going to the brain gets blocked

by a clot or bursts. As a result of it part of brain doesn’t bet oxygen and blood it needs &

dies It is 3rd most common cause of death and disability

HEMORRHAGIC STROKE ISCHAEMIC STROKE

Why is it an emergency?

Most common reason for disability Appx. 1 in 4 people die within 1 year 30%–50% do not regain functional independence Annual incidence rate of stroke in India currently is 145 per 100,000

population 10 - 15% occur in < 40 years WHO estimates suggest that by 2050, 80% stroke cases in the

world would occur in low and middle income countries mainly India and China

Why do we say “time is brain’- Every minute if stroke is untreated, the average patient loses 1.9

million neurons, 13.8 billion synapses, and 12 km (7 miles) of axonal fibers.

Each hour, in which treatment fails to occur, the brain loses as many neuron as it does in almost 3.6 years of normal aging.

Early treatment in first few hours can reverse stroke in many patients

Beyond F.A.S.T. – Other Symptoms You Should Know

Sudden numbness or weakness of the leg Sudden confusion or trouble understanding

  Sudden trouble seeing in one or both eyes  

  Sudden trouble walking, dizziness, loss of balance or

coordination 

Sudden severe headache with no known cause

What should be done if stroke is happening?

Immediately go to a hospital which can do stroke treatment

Do not wait for improvement Do not spend time at local GPDon’t take BP medicine If CT doesn’t show any bleed, Aspirin tablet

Is it possible to reverse stroke?

If the blocked blood vessel can re-opened brain tissue can be saved

If patient comes in first few hours (4.5 hrs), clot busting drug (t-PA) cab ne given

Blood vessel can also be opened by intervention technique Neurointerventionist goes through leg blood vessel and by

special devices can take out the clot to open up the blood vessel

By modern treatment methods may patients recover completely after stroke

Solitaire (ev3)- 2012, Trevo (Stryker), Revive™ SE (Codman), Etc…. etc…..

Stentretrievers - Stent or stent-like system for clot removal

Concept of Penumbra

CBF/MTT CBVMatchedNo penumbra

CBF/MTTCBV

penumbra

CT, CTA (CTP, MR DWI, PWI)

What is mini-stroke and why is it important? “Mini stroke” or Transient ischemic attacks “TIAs” are

temporary blockage of brain blood vessel In these cases stroke symptoms are present for short

period If treatment is no started many patients develop

permanent stroke “Mini-stroke” is an emergency and person should

immediately go to stroke specialist Treatment can prevent permanent stroke from

happening

What are brain aneurysms?

Brain aneurysms are weakness “ballooning” of blood vessel of brain which burst to cause bleeding in brain

The aneurysms have to be repaired urgently to prevent repeat bleeding

Nowadays most cases can be treated by minimally invasive Neurointervention technique which are safer than open surgery

COILING In this procedure metallic rings are placed

in the aneurysm to repair the weak spot. The procedure is known as “coiling”

Is intervention and surgery possible in brain blood vessels the same way as done in heart?

Many patients have cholesterol deposit in blood vessel to brain- this is called “carotid stenosis”. If stenosis is severe, it causes stroke.

It is possible to remove the blockage by stent placement, same way as in heart

This a short procedure which is done with local anesthesia

Surgery can also be done to remove the cholesterol deposit.

CAROTID ARTERY STENOSIS- 20-25% STROKES BY MAJOR VESSEL STENOSIS

Plaque(yellow)

Stent

50 million - About 350 million people worldwide have diabetes, a number likely to more than double in the next 20 years.

1.5 million 2012, diabetes was the direct cause of 1.5 million deaths. More than 80% of diabetes deaths occur in low- and middle-income countries.

90%Type 2 accounts for around 90% of all diabetes worldwide. Reports of type 2 diabetes in children have increased

worldwide.

Diabetes

We Indians…• At the same BMI, Asians had more than double the risk of

developing type 2 diabetes than whites• Increases in weight over time were more harmful in Asians

than in the other ethnic groups: For every 11 pounds Asians gained during adulthood, they had an 84 percent increase in their risk of type 2 diabetes

• At the same BMI, Asians have higher risks of hypertension and cardiovascular disease than their white European counterparts, and a higher risk of dying early from cardiovascular disease or any cause

Type 1 diabetes Type 1 diabetes (sometimes called insulin-dependent,

juvenile or childhood-onset diabetes) occurs when the pancreas does not produce enough insulin, a hormone that regulates blood sugar.

Many countries are documenting higher numbers of newly diagnosed cases of type 1 diabetes, particularly in younger children.

Type 2 diabetes Type 2 diabetes (sometimes called non-insulin-dependent

or adult-onset diabetes) happens when the body cannot effectively use the insulin it produces.

Often preventable, it can result from excess body weight and physical inactivity, and sometimes, a genetic predisposition.

Recently, type 2 diabetes has increasingly been reported in children and adolescents

FOOD…

Mental

• Work satisfaction • Relationship• Social circle• Fitness • Keep growing

Relationship….

Spirituality – mental skills

Being aware of oneself Channelizing energy of our positive

emotionsHandling the negative ones Finding full expression of ourselves –

professional and personal lives Balance in life – “Living a balanced life is a piece of art”

Six key facts about stroke treatment

Early recognition makes a big difference.

Knowing the signs of stroke and gettingtreatment quickly saves lives and improves recovery. If you think someone may have had a stroke, do this

FAST check:

Face: Is one side drooping?

Arms: Raise both arms. Is one side weak?

Speech: Is the person able to speak? Are wordsjumbled or slurred?

Time: Act quickly and call emergency services.

2. Specialized stroke unit care increases the chance of a good outcome by 14%

All patients with stroke (ischaemic or haemorrhagic) should be admitted to a specialized stroke unit, which involves a designated ward with a specialized team.

3. Clot-busting drugs (tPA or thrombolysis) increase the chance of a good outcome by 30%

Clot-busting drugs break up blood clots. This treatment can be administered up to 4.5 hours of symptom onset in many patients with ischaemic stroke. The earlier it is given, the greater the effect.

4. Clot retrieval treatment increases the chance of a good outcome by more than 50%.

Clot retrieval treatment (mechanical thrombectomy) involves removing ablood clot and can improve survival rates and reduce disability for manyPeople with ischaemic stroke caused by large artery blockage.

5. Rehabilitation is a critical step in the treatment process.

Rehabilitation starts in the hospital as soon as possible following a stroke.

It can improve function and help the survivor regain as much independence

as possible over time

6. One in four survivors will have another stroke.

Treatments that help prevent another stroke include drugs to lower Blood pressure and cholesterol, antiplatelet therapies, anticoagulation for atrieal fibrillation, surgery or stenting for selected patients with severe carotid artery narrowing. Lifestyle changes cans also greatly reduce the risk of another stroke. Changes include eating well, being physically active, being tobacco-free, managing stress, and limiting alcohol consumption.

Action

Join the fight against stroke. Stroke affects us all. Let’s take action, drive awareness, and push for better access to stroke treatments.

Individuals

• Act FAST. Learn the signs of stroke and know to take immediate action.

• Share this information with family and friends.

Health care professionals• Even with limited resources, you can do something.

• Follow best practices and provide evidence-based treatments.

– Download the World Stroke Organization Global Stroke Service Guidelines and The Roadmap to Delivering Quality Stroke Care.

• Strive for continuous improvement.– Do a simple audit of your regional/local services to monitor and improve your care delivery.

Governments and health care system decision makers

• Take a leadership role in stroke care by increasing access to evidence-based stroke treatment.

• Support the development of coordinated systems of care including

specialized stroke units and stroke care teams.

• Fund stroke awareness campaigns.

• Support excellence in stroke research.

Everyone must advocate together in one world voice for stroke

• Download the Advocacy Toolkit from the World Stroke organization to get your campaign started.

For more information on:STROKE & NEUROVASCULAR INTERVENTIONS:

URL:www.sanif.co.in

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Dr Vipul Gupta