Ques: stroke can be fatal, don’t ignore it

Ans: In India stroke is amongst the leading causes of preventable death and morbidity as a third of stroke patients will die within a year, and a third are left with significant disability. The cost is considerable, whether measured in financial terms, social care or by the impact on the families and carers.

Ques: Is It A Stroke Or Tia?

Ans: Stroke is a clinical syndrome characterized by rapidly developing clinical symptoms and/or signs of focal, and at times global (applied to patients in deep coma and those with subarachnoid haemorrhage), loss of cerebral function, with symptoms lasting more than 24 hours, or leading to death, with no apparent cause other than that of vascular origin. If the symptoms resolve within 24 hours it is called a Transient Ischaemic Attack (TIA).

Ques: Treatment

Ans: Aspirin: An immediate dose of aspirin for patients with Ischaemic Stroke is definitely effective, but the effect is modest with only one extra independent survivor per 100 patients treated. Still, all acute stroke patients should receive aspirin. Thrombolysis: Recombinant tissue Plasminogen Activator (rt-PA) has a treatment effect of about 10-15 extra independent survivors per 100 patients treated, despite an additional eight patients with symptomatic intracranial haemorrhage. Reducing blood pressure: The effect of lowering blood pressure in the acute phase of stroke is uncertain. Some experts prefer to treat patients with sustained very high blood pressure (greater than 180/120), particularly patients with primary intracerebral haemorrhage, but there is no reliable evidence behind this recommendation.

Ques: Surgical Treatment

Ans: Occasionally, surgery is necessary to relieve acute hydrocephalus caused by a posterior fossa stroke. Hemicraniectomy (removal of a large skull flap) can occasionally save a life by reducing intracranial pressure secondary to massive hemispheric swelling and is now the subject of a randomised controlled trial. The results of a trial of early evacuation of the haematoma for those with primary intracerebral haemorrhage (the STICH trial) did not show any benefit of surgical intervention for all patients, so patients for surgery should be carefully chosen.

Ques: Secondary Prevention

Ans: The best opportunity to commence secondary prevention is in the acute phase. Stopping smoking should halve the future risk of vascular events. Antithrombotic therapy, together with cholesterol and blood pressure lowering are effective for patients with Ischaemic Stroke. Secondary prevention for primary intracerebral haemorrhage depends on effective blood pressure lowering.