Stroke Treatment: Symptoms and Diagnosis

In simple terms, as a heart attack is for the heart, a Stroke is the same for the brain. Brain stroke is also termed a CEREBRO VASCULAR ACCIDENT. It is the damage caused to the brain due to interruption of the blood supply that leads to oxygen starvation and brain damage. The part of the brain affected and the functions it controls get compromised partially or completely. The effect of Stroke can be short-term or long-term, depending on the site of the attack and also how quickly the patient receives acute medical care.

The blood supply can get interrupted due to a block in the form of clot present in one of the arteries of the brain (ischemic stroke). This is the most frequent cause. The most common artery which gets affected due to ischemic stroke is the Middle Cerebral Artery. The less common cause can be leaking of blood into other parts of the brain due to bursting of the artery due to high blood pressure (hemorrhagic stroke). A transient ischemic attack (TIA) is a temporary period of symptoms similar to that of stroke. It lasts only for a few minutes and does not cause permanent damage. It is often termed as MINI-STROKE and should be considered as a warning for a major stroke later.

Stroke has been proven to be one of the primary reasons for death and disability leading to dependency on activities of daily living across the globe. Stroke survivors can experience wide range of disabilities including speech, mobility disorders and even their thinking and cognitive abilities gets affected.

Types of Stroke

1. Ischemic Stroke

This type of stroke occurs when an artery which supplies blood to the brain get clogged or damaged due to the presence of a clot and in turn impairs blood flow to that part of the brain.
This constitutes for almost 87% of the total occurrence of Stroke.

There are two types of Ischemic Stroke

Thrombotic Stroke

Clots that develop inside blood vessels of the brain cause Thrombotic Stroke.
Mainly occurs in older adults who have high cholesterol and/or diabetes.

Embolic Stroke

This type of stroke occurs when a blood clot located elsewhere in the body travels to the brain through the bloodstream. Often occurs in individuals with irregular heart rhythm.

2. Hemorrhagic Stroke

This type of Stroke occurs when a blood vessel that supplies the brain ruptures and bleeds inside the brain. Oxygen and nutrient supply to the brain tissues and cells gets compromised, and internal pressure increases. This, in turn, creates swelling and irritation, which leads to further brain damage.

There are two types of Hemorrhagic Stroke:

Intracerebral Hemorrhage

Usually caused by high blood pressure
Occurs suddenly or rapidly

Subarachnoid Hemorrhage

This type of haemorrhage occurs when bleeding occurs between the brain and the membranes that cover the brain.
It is usually due to Arteriovenous (Arteries and veins) Malformation in the brain. It can also be caused due to Trauma.

Risk Factor of Stroke

High blood pressure
Atrial fibrillation (irregular heart rhythm)
Tobacco use
Physical inactivity
Unhealthy diet
Harmful use of alcohol
High blood lipid levels
Obesity
Genetic disposition
Stress and depression

How to Spot a Stroke

Noticing these FASTER signs can help spot stroke and seek immediate medical care, which prevents major damage and improves outcomes.

F - Face

Drooping or numbness on one side

A - Arms weakness

One arm drifts down when lifting and is numb

S - Stability

Dizziness and difficulty in walking
Loss of coordination

T - Talking

Slurring of words
Sluggish speech

E - Eyes

Double vision
Difficulty in maintaining vision

R - React

Immediately call for emergency medical care

Diagnosis

In emergency medical care, the doctor will perform the following tests to determine the type, size, and intensity of the damage inside the brain.

1. Physical Examination

A complete external examination such as Blood pressure, heartbeat, and other neurological tests to evaluate the sensorimotor system would be conducted and documented.

2. Blood Tests

All major tests pertaining to the vital organs would be conducted to check the vitals.

3. Computerized Tomography Scan (CT Scan)

This scan uses a series of x-rays to reveal a detailed image of the brain. It detects the presence of bleed or clot in the brain.

4. Magnetic Resonance Imaging

A series of powerful radio waves and magnetic fields reveal the extent of tissue damage in the brain.

5. Carotid Ultrasound

In this imaging, sound waves create a detailed imaging of the carotid arteries in the neck and detect the presence of plaques and deposits

6. Echocardiogram

ECG detects the source of clots in the heart that may have travelled from the heart to the brain through the bloodstream and caused a stroke.

Symptoms of Stroke

Immediate medical management post stroke:

For Ischemic Stroke

Emergency IV Injections: Thrombolytic (clot-busting drugs) have to be administered within the first four hours of spotting the symptoms. The timely administration of this drug increases the chances of survival and reduces the intensity of disability.
Emergency endovascular procedures:
In a few cases, Thrombolytic drugs are administered directly into the brain through an artery in the groin, all the way to the brain, with the help of appropriate imaging.
In case of large clots, doctors can use a device attached to a catheter to directly remove the clot from the blocked blood vessel in the brain.

For Hemorrhagic Stroke

Emergency drugs reverse the effect of blood thinners, lower blood pressure, lower intracranial pressure, and relieve spasms in the blood vessels.
Surgery: In case the area of bleed is large, then surgical interventions like Clipping are performed for relieving the pressure on the brain. Surgeries are performed in case of an aneurysm, arteriovenous malformation (AVM), or other types of blood vessel problems.

How to Avoid Stroke

1. Healthy Eating

Limit salt intake
Choose healthy snacking habits
Eat plenty of fruits and vegetables
Avoid high cholesterol diets and include a more fibrous diet

2. Regular Physical Activity

Aerobic and anaerobic exercises should be a part of oneâ€™s daily routine.
It helps to maintain blood pressure, lower cholesterol levels and maintain a healthy weight.
A minimum of three hours of Physical activity per week is the ideal recommendation.

3. Quit Smoking

Nicotine increases the risk of developing a stroke.

4. Limit Alcohol Intake

Too much alcohol can raise the risk of high blood pressure, which in turn increases the risk of Stroke

5. Manage your health conditions such as heart disease, diabetes, high cholesterol, or high blood pressure. Take regular medications and have checkups. Work closely with your doctors on how to manage your health condition.

Complications Involved after Stroke

The most important thing after a stroke is to prevent another stroke. Each type of stroke has its own complications.

1. Complication After Ischemic Stroke.

Blood clots (Deep vein thrombosis or Pulmonary embolism)
Urinary tract infections, or UTI
Bowel and bladder problems
Risk of pneumonia
Muscle weakness
Bed sores
Mobility problems and falls

2. Complications Involved after a Hemorrhagic Stroke.

Blood clots (deep vein thrombosis or pulmonary embolism)
Brain swelling
Seizures
Memory loss
Vision and hearing problems
Muscle weakness
Bed sores
Depression
Risk of pneumonia

3. Complications Involved after Transient Ischemic Attack

Blood clots (deep vein thrombosis or pulmonary embolism)
Difficulty swallowing
Urinary tract infections, or UTI
Bed sores
Mobility problems and falls

4. Complications Involved after Brainstem (Part connecting the Brain with the Spinal cord) Stroke

Difficulty swallowing
Difficulty breathing
Loss of sensation
Vision problems
Motor control problems
Coma
Locked-in syndrome, when the entire body is paralyzed except for the eyes

Recovery after Stroke

1. One to Three Months post stroke

This is the period of spontaneous recovery

The goal of the Stroke rehab program during this period is to attain as much as possible
Physical therapy and speech therapy play the most crucial role during this period.
Positioning and attaining the correct synergy pattern (coordination pattern) between the muscle groups is of utmost importance during this period.
Physical therapy works with the aim of getting sensory-motor coordination back.

2. Post Six Months of Stroke

Neural plasticity is the ability of the damaged brain cells to network with the undamaged cells to create collaterals for relearning skills lost post-stroke.

Though the brain is in a heightened state of Plasticity immediately post-stroke, recent research has proven that neural plasticity can be activated even after 6 months to even years after stroke.
Recovery may be slower than the immediate month post stroke, but the brain's capacity to re-learn and adapt to newer ways of functioning can be initiated even after six months.

At Medigence, we have treated patients after three years of attack post Stroke. With customized rehabilitation protocols we have successfully activated the muscles which had gone into non-use post Stroke and helped them achieve a completely independent life. This has proven that recovery is possible even after six months post-stroke and that 6-month deadline is a myth.

Rehabilitation Post Stroke

After acute care management at the hospital, Rehabilitation plays a significant role in improving and developing the skills left post-stroke to the maximum possible functional capacity. The amount of damage is determined by the type, site and the side of the brain involved. When the right side of the brain is affected, the physical impairments are seen on the left side and vise a versa. In the case of hemorrhagic stroke, the damage depends upon the extent of the spread of bleeding in the brain. Rehabilitation protocols majorly depend upon the above factors and are set according to the individual stroke survival.

Stroke Rehabilitation Service by MediGence

What is Stroke Rehabilitation:

Stroke rehabilitation is a combination of different therapies designed to relearn and regain the skills lost after a stroke. Depending on the type of stroke and the site of the attack in the brain, rehabilitation can help you with movement, speech, strength, and daily living skills.

What do we deliver in our Stroke Rehabilitation Services:

Our programs include:

Physical therapy: For restoring strength, functions mobility balance, and coordination
Speech therapy: For speech and swallowing difficulties
Cognitive and Behavioral Therapy: For better acceptance and a positive mindset
Occupational therapy: For adaptability and modifications according to the present condition for moving back to work.
Prosthetics and Orthotics consultation and delivery: For assistive devices for functional recovery.
Nutrition and diet management
Counseling sessions to the primary caregivers in the family.

Expected Outcome

We realize how important it is to get back to a quality independent life after a debilitating attack of Stroke.

We not only aim to deliver comprehensive customized rehab protocols but also ensure that the patient re-habituates toward community living in the best possible manner.

Physical and functional independency
Improvement in speech and audio
Improvement in swallowing functions in the early stages through De-glutology therapy
Improvement in cognitive health through Psychotherapy programs
Community living and adaptation

Three Phases of Delivery of Our Care Delivery

1. Acute injury phase: the immediate phase after the attack

Sensory integration
Cognitive restoration
Synergy balancing
Correct positioning
Establishing coordination between sensory and motor systems
De-glutology , speech and voice therapy
Counseling for mental well being

2. Repair Phase: 3-6 Months Post-Attack

Progressive coordination between sensory-motor systems
Correction of deformities caused due to non-use
Progressive strengthening exercises
Balance and coordination protocols
Assistive gait training
Speech and voice therapy
Counseling for mental well-being

3. Remodelling Phase: Post Six Months

Progression towards independence as much as possible
Occupational therapy
Community adaptability programs

Living after Stroke

Stroke strikes. Suddenly out of the blue. Simple activities like getting out of bed, brushing, toileting, dressing up, etc., all become complex sets of tasks. Dependency increases.

But is all this permanent? The answer is NO.

Rehabilitation aims to train the leftover skills after completing your evaluation post-discharge from acute care. The training and re-training help the brain to re-learn the skills through the process of neural plasticity. Neural plasticity is the process of re-wiring of the nervous system by modifying its function and structure, to compensate for the loss that occurred due to the injury.

Our brain has cells beyond the size of a galaxy, and the unmatched capacity of this networking helps us to recover from the catastrophic effects of stroke.

Be it any kind of stroke, RECOVERY IS POSSIBLE, to the maximum possible functional capacity left after the attack.

Along with the best rehabilitation, the most important thing required after a stroke is the WILL POWER to get better.

Always remember, Neuro Rehabilitation is a progressive journey, not a destination.

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