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  1. How we treat Brain Attack

Emergency Treatment of Brain attack

Much of the damage caused by a thrombotic or embolic stroke occurs in the first few hours. Drugs that dissolve clots are known as thrombolytic agents. These drugs can dramatically minimize stroke damage.

Thrombolytic Agents: Thrombolytic agents (tissue plasminogen activator or TPA) or clot busting drugs, widely used to dissolve clots that cause heart attacks, are also able to dissolve artery-blocking clots in the brain during the critical early stages of stroke. Early administration of TPA after a brain attack can reduce neurological damage significantly. These medications are most effective when administered within the first three hours of stroke onset. This time window can be extended up to 4.5 hours in a certain group of patients. Intra arterial thrombolysis (injecting clot busting drug directly into the clot itself) has been found to be very effective and is being practiced in all the leading centers of the world that have facilities for the same. The advantage of this technique is that time window is extended and it is effective even in patients who come up to 6 hours. This technique is more effective in patients who have large vessel occlusion. Since Medanta has facilities for MR/CT perfusion (a technique which can identify salvageable tissue) and state of the art endovascular lab, clot can even be removed mechanically with the help of retrieving devices if required.

Medications to prevent Stroke recurrence

There are a number of medications used to help prevent stroke in high-risk patients, particularly those who have had a previous TIA or minor stroke. These drugs fall into two major categories: anticoagulants (such as heparin and warfarin) and antiplatelet agents (such as aspirin, dipyridamole and clopidogrel).

Anticoagulants: These drugs may be given orally, intravenously or subcutaneously. They work by preventing blood clotting. They are also used for deep vein thromboses and pulmonary emboli, and are very effective for preventing stroke in patients with atrial fibrillation (irregularity of heart rhythm), artificial valves or those who are suffering from coagulopathies (factors which increase tendency of the blood to clot). Patients who are on anticoagulants need to monitor their INR (parameter of blood thinning) every 3-4 weeks.

Antiplatelet Agents: Antiplatelet agents work by preventing or reducing the occurrence in the blood stream of a phenomenon known as platelet aggregation. This aggregation can sometimes result in formation of a thrombus (blood clot) that may totally block the artery, break loose or block a smaller artery. By preventing this from occurring, antiplatelet agents can reduce the risk of brain attack in patients who have had TIAs or prior ischemic attacks.

Surgical Techniques

Surgery is an accepted way of preventing stroke for patients with certain conditions. There are a number of conventional surgical techniques that have been in use for some time, including "clipping" aneurysms to prevent further bleeding and removing cerebral vascular malformations. Aneurysms and arteriovenous malformations (bunch of abnormal blood vessels) may also be treated in the endovascular lab where our experts perform the angiography (like coronary angiography for the heart) and block the abnormal vessels using coil/glue/particle. Occasionally in acute situation when brain swelling is increased because of clot or bleed in the brain, patient is taken to the operation theater to do an emergency hemicraniectomy. Hemicraniectomy is a procedure wherein a flap of skull and dura (membranes covering brain) are removed to give brain sufficient space to expand. If this is not done in time, swollen brain can compress the vital centers in the brain and can lead to death.

Carotid Endarterectomy / Carotid stenting

Carotid endarterectomy is a procedure used to remove atherosclerotic plaque from the carotid artery when this vessel is blocked. For certain patients with minor attacks or TIAs, carotid endarterectomy is highly beneficial in preventing future brain attacks. This procedure is also beneficial for some patients with blockage of the carotid arteries who have not had previous symptoms. Carotid stenting is a procedure in which blocked carotid artery is opened like what they do in angioplasty of heart and a stent is placed in the artery to keep it open.

Medanta Rehabilitation program following Brain attack

Because of the tremendous advances in brain attack treatment, along with the ever-increasing sophistication of rehabilitation techniques, the outlook for brain attack patients has never been more hopeful. The ultimate goal of rehabilitation is to return the patient to as independent a lifestyle as possible. Successful brain attack rehabilitation is dependent on many factors, including the severity of brain damage and the cooperation of family and friends. Not surprisingly, the attitude of the patient is a key factor in speed and recovery. A positive outlook and high level of determination may facilitate recovery. Depending on the area of the brain affected by the attack, physical and mental damage may be mild or severe, ranging from dizziness and confusion, to sensory loss, to paralysis and even death. Patients with mild attacks or those who obtained successful medical therapy may need little or no rehabilitation. After a brain attack, other blood vessels may be able to take over for the damaged blood vessel. This allows some cells to recover, although others may still die. If the blood supply is cut off due to a clot, the body works to dissolve the clot. This means that the damaged part of the brain can sometimes improve or return to normal without rehabilitation. Most brain attack patients, however, will benefit from some type of rehabilitation.

Preventive arm of Brain Rescue program

There are many positive steps that you can take now to reduce the risk of brain attack. The most common risk factors for brain attack are listed here. These include some conditions that can be changed by lifestyle modification or medical treatment, and some, such as hereditary factors, that cannot be changed. Most of the controllable risk factors for stroke relate to cardiovascular fitness. Because brain attack is a form of cardiovascular disease, it makes sense that keeping your heart and blood vessels as healthy as possible will reduce your risk.

Risk Factors That Can Be Changed

  • Hypertension (high blood pressure)

  • Smoking

  • Heart disease

  • High-cholesterol level

  • Excess alcohol intake

  • Obesity

  • Sedentary lifestyle

  • Diabetes

  • Elevated hematocrit

  • Use of oral contraceptives (especially

(increase in red blood cells)

for women who smoke)

Risk Factors That Cannot Be Changed

  • Age

  • Race

  • Sex

  • Family or individual history of stroke or TIA

 

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