Consultancy Corner: Increase in number of cases of youth getting strokes

Stroke otherwise called as “brain attack” is one among the leading causes of serious long term disability. Approximately two million brain cells die every minute after the onset of stroke. Intravenous thrombolysis with tissue plaminogen activator is the only approved treatment worldwide within first four and half hours of stroke onset.  Hence early admission to nearby stroke care centre helps in reversing and reducing the stroke symptoms and disability in majority of cases.  Such a stroke centre should encompass in-house 24 X 7 CT Brain facility, Stroke Neurologist, IV thrombolytic therapy, angiogram and Endovascular Mechanical Thrombectomy facility, stroke rehabilitation, all executed by a dedicated multidisciplinary stroke team. 

An advanced comprehensive stroke centre in your neighbourhood hospital reduces the Door to Needle Time (DNT) by 30 minutes less. While a majority of patients suffering from stroke reach the stroke centre late, leaving a little opportunity for treatment outside the window period. Time lost is brain lost. Time is brain. Approximately around 2000 to 3000 persons suffer from stroke every month in Chennai, among them less than 10 percent of stroke patients only reach within window period. After every stroke untreated it leads to accelerated aging of 36 years because every minute after stroke two million brain cells keep dying. Every six seconds someone somewhere dies of stroke.

Many patients go to nearby hospitals without CT scan facilities and Stroke Neurologist thereby leaving behind the chance of window of treatment opportunity in first 8 hours. Among the strokes 12% of them are young strokes less than 40 years. Many stroke survivors may not be able to walk, speak or understand thereby causing a huge socio-economic burden to the family and the society. In India stroke is one of the second leading cause of death. Females are affected more when compared to males. Stroke in young are more on the increasing trend like heart attacks now. There should be awareness among public less than 40 years of age to screen for modifiable risk factors like high blood pressure, diabetes, smoking, high cholesterol, alcoholism, irregular heart rate/atrial fibrillation, heart valve abnormalities, asymptomatic blocks in carotid blood vessels, obesity, sedentary life style, lack of sleep, migraine headaches, use of oral contraceptives in females and family members affected of stroke or heart attack. 

Unlike heart attack which presents with chest pain, stroke or brain attack can be missed in early few hours and hence there is need for awareness of stroke symptoms. FAST is a mnemonic which means F: Facial drooping or asymmetry, A: Arm or Leg weakness or numbness, S: Speech disturbances or loss of speech and T: Time, which means early admission to nearby Comprehensive Stroke Centre is of utmost importance. Newer advancements in Brain Imaging and Endovascular (Mechanical Thrombectomy) treatment, breakthrough in  technologies, help us to navigate small catheters, wires and stent retrievers and aspirate/ retrieve these clots in the blocked brain arteries, through  minimally invasive pinhole puncture from the arteries of the leg/ hand under fluoroscopic X ray guidance, which can reverse / reduce the stroke disability up to the window period of lesser than 24 hours in selected group of patients according to the American Heart Association Stroke 2018 guidelines.  Stroke is treatable within golden hours in a comprehensive stroke centre. Remember fast Mnemonic for stroke recognition and act fast.