Dr NK Venkataramana, Founder Chairman & Director Neurosciences, Brains Hospitals, Bengaluru opines about stroke management techniques and to be extra vigilant with a periodic follow-up to avoid second stroke
The technology adoption in neuroscience is advancing so rapidly, yet it is unable to keep pace with the overall burden and requirement. Starting from paediatric to geriatric age groups, each segment has a predilection to different forms of brain and spine diseases that need to be handled with an effective and customised strategy. The available infrastructure, technological support, skill sets and human resources are nowhere to meet the overall requirements, especially in our country. Bangalore Regenerative Advanced Institute of Neurosciences (BRAINS) Hospitals has been conceptualised to address these gaps systematically,
Cutting-edge stroke care
BRAINS Hospital has initiated a dedicated, comprehensive unit for brain-attack (stroke). At the moment the healthcare burden due to stroke is huge. Every year 2 million people are getting affected. Stroke is the leading cause of disability in the world today. With the increasing life span as well as risk factors like diabetes and hypertension the burden is only increasing further year after year. At the same time, all the advanced research and understanding is not getting translated to the benefit of society. Also, it is to be noted that primarily stroke is preventable. Secondly, the disability following a stroke is again controllable. Thirdly, a stroke isn’t a one-time event in life. It can strike again and again making matters worse. The recovery rate continues to be poor in our country due to a lack of awareness and timely reach for the right treatment. Time is a very crucial factor that determines the outcome, the extent of recovery as well as the disability.
In the light of the above-mentioned problems, BRAINS Hospital has set up a first-of-its-kind programme that provides 360-degree care as a ‘fight against stroke’ for this condition. The dedicated stroke team at BRAINS is committed to fighting this burning problem addressing all relevant factors influencing the management currently. We have established technology, process, protocol, systems, training, call centre, awareness, advocacy, continuity of care in acute, chronic and long-term including rehabilitation, follow up and monitoring. The single most aim is to prevent a stroke in high-risk people, if not, get them back to society as normal as possible.
Recently a 35-year-old lady was brought to BRAINS Hospitals emergency for treatment. She had complained of giddiness and became unconscious. She was put on a ventilator due to insufficient breathing. MRI showed evidence of stroke affecting PONS, an important area of the brain stem. She was supported with medicines after a quick evaluation by neurologists and the critical care team. A brain angiogram showed a huge blood clot in the Basilar artery that supplies the brain stem and small brain (cerebellum). The neuro intervention team immediately passed a special catheter into the blood vessels and removed the blood clot through mechanical thrombectomy. The blood circulation to the brain was re-established instantly. Gradually she became conscious, came out of the ventilator and went home.
Such new advances are still not known to the public and hence many are unable to utilise such services which are locally available.
Time is very crucial after a stroke. Every 10 minutes approximately 20 million brain cells will die in the brain after a stroke. Hence timely treatment can save the brain from permanent damage. The first three hours are the golden hour in case of a stroke for thrombolysis (dissolving of the clot with medicines) and six hours for thrombectomy (mechanical removal of the clot with a special device). Right intervention at the right time will yield wonderful results. Had the clot not been removed at the right time, the lady would have remained in a coma. Infrastructure, technology and teamwork are equally important to enable such high-end stroke treatments. Brains Hospitals has one of the best state-of-the-art centres for stroke that provides the best care and advanced treatments to accomplish rapid recoveries using modern technology.
Advances in stroke diagnosis treatment
The recent advances in neurosciences have brought about a sea change in the way neurosurgery is being conducted. The introductions of minimally invasive and key-hole surgeries have paved the way for better outcomes with minimal tissue injury.
Advances in imaging
Imaging of the blood vessels and the blood flow has made it possible to prevent, diagnose early, treat and also monitor lifelong. They include neurosonology, CT angiography, MR angiography and digital subtraction angiography and transcranial dopplers.
The high-risk people such as people with TIA’s, family history of stroke, history of diabetes, hypertension, obesity and smoking and those after the age of 40 needs periodic screening and preventive medications for the prevention and occurrence of stroke.
Interventional stroke therapy
Cerebral angiography has made it possible not only for accurate diagnosis but also therapeutic interventions to treat instantly as a minimally invasive procedure avoiding major catastrophe and brain damage. These interventions include thrombolysis (dissolving the blood clot) thrombectomy (removal of the clot), clot retrieval, carotid artery stenting, balloon angioplasty and continuous selective intraarterial therapies and treatment for venous thrombosis.
Robotics /Critical care in stroke:
When there is a stroke to the brain the critical care is very essential to provide real-time monitoring and protection of blood flow as well as brain function. Multi-modality monitoring systems are used to continuously monitor the blood supply, blood oxygenation and glucose utilization and neuronal function and intracranial pressure to restore circulation as early as possible to promote brain recovery to prevent further brain damage. In addition, the evaluation will be done to identify all the underlying risk factors that are known generally and also for the individual concerned. All the supportive measures will be instituted to preserve the brain function such as ventilatory support, prevention of convulsions, maintenance of physiological functions, nutritional support, respiratory care and physiotherapy.
Managing long-term effects of stroke & rehabilitation:
Normally unused muscles will disintegrate and the joints will become stiff making the nerve function recovery futile. Therefore, rehabilitation has an important role to play in the overall functional recovery in any long-standing illness of the nervous system, particularly stroke. By this process, all the muscles and joints are kept in the right shape to take on as soon as the brain signals get rewired. In addition, constant physiotherapy also sends signals from the body to the brain encouraging its growth and regeneration.
The rehabilitation process should start as soon as possible and continue till a reasonable level of independence is achieved. This will prevent several other complications like pain, stiffness and eventually contribute to the overall quality of recovery.
Generally, people do physiotherapy for one hour a day and the rest 23 hours remain in idle mode. This will not lead them anywhere unless the actions are repeated as often as possible. Later on, it should be combined and integrated with the day-to-day activities of life. Though the actions look very crude, with perseverance it gets refined quickly. Persistent effort should continue till one achieves perfection in every movement. Then only they can regain their body functions fully with total recovery.
Emotional balance ultimately plays a significant role in the overall recovery and regaining the original abilities. At BRAINS, we have a dedicated unit called ‘Allovedas’ with trained professionals providing a systematic, well-defined and tailor-made approach for each of the stroke patients.
Allovedas caters to acute care within the intensive care, intermediary care for those who cannot be managed at home as well as chronic care. This specialised programme is called ‘Bouncing back’ with a specific goal to make each independent and functional in society. The therapies are multiple, which includes physiotherapy, aqua therapy, speech therapy, dexterity therapy, gait therapy and occupational therapy. These therapies will be tailor-made to suit the requirements of each individual to make them independent.
All stroke patients need strict vigilance and life-long monitoring with a periodic follow-up. The objective is to monitor and control the risk factors, identify, prevent and treat if needed, a second stroke.