Brain Stroke

A stroke happens when the blood supply to a part of the brain suddenly stops. Most strokes are caused by a blocked blood vessel (ischaemic stroke), while some are caused by a burst blood vessel that bleeds into the brain (haemorrhagic stroke). Brain cells begin to die within minutes, so a stroke is always an emergency.

Symptoms

Remember BE FAST to recognise a stroke:

• Balance: sudden loss of balance or dizziness
• Eyes: sudden blurred vision or loss of vision in one or both eyes
• Face: drooping of one side of the face
• Arms: sudden weakness or numbness of an arm or leg, usually on one side
• Speech: slurred speech or difficulty in understanding
• Time: note the time symptoms started and reach hospital at once

Causes

• High blood pressure
• Diabetes
• Smoking and tobacco use
• High cholesterol
• Heart problems, including an irregular heartbeat
• Narrowing of the blood vessels in the neck
• Obesity, lack of exercise and heavy alcohol use
• Older age, family history or a previous stroke or mini-stroke

Diagnosis

An urgent CT scan of the brain shows whether the stroke is due to a blockage or bleeding, which decides the treatment. CT angiography or MRI may be done to look at the blood vessels and the affected brain area. ECG, heart scan (echo), Doppler of the neck vessels and blood tests help find the cause.

Treatment

Most strokes are treated without surgery, by a team that includes neurologists and critical care doctors. For a blocked vessel, a clot-dissolving medicine may be given in suitable patients if they reach hospital within a few hours of the stroke starting. In some patients with a large blocked vessel, the clot can be removed through a thin tube passed from the leg (thrombectomy) at a hospital with this facility. Blood-thinning medicines, control of blood pressure, sugar and cholesterol, and early physiotherapy help recovery and prevent another stroke.

Neurosurgery is needed in a smaller number of patients. If a large bleed is pressing on the brain, it may be removed by surgery, sometimes through a small opening using endoscopic or minimally invasive techniques. If a large stroke causes severe brain swelling, a part of the skull may be removed for some time to give the brain room (decompressive craniectomy), which can be life-saving in selected patients. Surgery may also be needed for a stroke or bleed in the back part of the brain (cerebellum) that presses on the brainstem, for blocked brain fluid (hydrocephalus) that needs a drain, for a burst aneurysm or abnormal blood vessels, or to open a tight narrowing of a neck artery to prevent future strokes.

The decision for surgery depends on the examination, scans and the patient's overall condition.

When to Seek Urgent Care

• Any BE FAST sign, even if it goes away within minutes
• Sudden severe headache unlike any before
• Sudden confusion, drowsiness or unconsciousness
• Fits (seizures)
• Difficulty in swallowing or breathing

Go to the nearest emergency immediately. Do not wait for symptoms to settle, and do not give food or water by mouth.

If you or a family member has had a stroke and has been advised to see a neurosurgeon, you can consult Dr. Prashant Sharma at Keshav Super Speciality Hospital, Meerut, for an evaluation of the scans and treatment options.

Related Conditions

• Epilepsy (Fits / Seizures)
• Brain Tumour
• Brain Infections: Meningitis and Brain TB
• Headache
• All Neurological Treatment ›