Recent Advances in Stroke Management.

So, this is what a stroke feels like…

In 2016, 66-year-old Doug Taking was dining out at a bustling steakhouse in California with their wife and friends, when he got a muscle cramp in his left arm. He had had these cramps earlier that day. So, like other times, Doug dismissed the pain and kept talking about their upcoming vacation. Soon, his friend John noticed something was off. ‘Doug, you’re mumbling. Why are you suddenly mumbling?’ John asked. All were confused when the left side of Doug’s face started drooping at once. Sudden severe pain shot through his body, and his left limbs went completely numb. With sweat rolling down his forehead, Doug felt dizzy and gravely ill. Through a pounding headache, he could not see/think straight, when John shouted in panic, ‘Are you having a stroke?’ The paramedics arrived and rushed Doug to the nearest hospital, where doctors diagnosed ischemic stroke and immediately initiated the treatment. 

What is a Stroke? 

Stroke was first documented by Hippocrates, the father of medicine, in the 5th century BC. He named it ‘apoplexy’, meaning ‘struck down by violence’ in Greek. In 1658, a Switzerland-based pathologist and pharmacologist Dr Johann Jacob Wepfer performed post-mortem examinations on people who died from apoplexy. He discovered that apoplexy or a stroke occurs when blood flow to a portion of the brain is 2 impaired due to a blood clot or ruptured blood vessel. Similar to a heart attack, the lack of oxygen-rich blood leads to tissue death. There are two main types of strokes: 1) ischemic—a blood clot causing a sudden cessation of blood supply to a part of the brain and 2) hemorrhagic—caused by rupture of blood vessels 3 in/around the brain.

Stroke and Statistics:

Stroke is a major cause of death and disability worldwide, causing ~56 million deaths/per year. The incidence of stroke is likely to increase, considering increased life expectancy and the fact that the > 65-year-old global population continues to increase by ~9 4 million/year. Mortality from stroke is rising in 3 developing countries, particularly among young adults. The incidence of stroke increased by >100% in low- and middle-income countries from 1970-79 to 2000-08. In India, stroke is the fourth and fifth leading cause of mortality and disability, respectively. Although a disease 3,4 of aging, stroke can occur at any age.

Diagnosis of Stroke 

X-rays discovered by Wilhelm Conrad Röntgen in 1895 soon became a revolutionary diagnostic tool. However, until the 1920s, X-rays could only help visualize calcified tumors or foreign metallic objects in the brain. The skull and cerebrospinal fluid hindered the generation of good-quality diagnostic images. In 1927, Portuguese neurologist António Egas Moniz and his colleagues reported the first clear image of the carotid artery and intracerebral branches after injecting intravenously 25% sodium iodide (contrast agent) into a patient’s internal carotid artery and temporarily 2 occluding it with a ligature. X-rays discovered by Wilhelm Conrad Röntgen in 1895 soon became a revolutionary diagnostic tool. However, until the 1920s, X-rays could only help visualize calcified tumors or foreign metallic objects in the brain. The skull and cerebrospinal fluid hindered the generation of good-quality diagnostic images. In 1927, Portuguese neurologist António Egas Moniz and his colleagues reported the first clear image of the carotid artery and intracerebral branches after injecting intravenously 25% sodium iodide (contrast agent) into a patient’s internal carotid artery and temporarily 2 occluding it with a ligature. 

Previously, stroke was diagnosed using electro encephalography, thermography and radioisotope techniques. Nevertheless, in the 1970s, the development of CT and MRI led to a breakthrough in medical diagnostics and clinical medicine. Physicians could now produce good quality images of the blood vessels and tissues and identify if a patient had a 2 ischemic stroke or cerebral hemorrhage.

Magnetic Resonance Imaging 

MRI is a multimodal imaging technology (2) used Figure to study anatomy and bodily functions by producing high-resolution images of soft tissues, including the brain. It provides better contrast between different tissues than CT. MRI uses the magnetic properties of hydrogen nuclei to the internal structures of visualize anatomical regions. These nuclei are obtained from water molecules present in tissues. Different MRI sequences are used to regions of the brain.

T1- and T2-weighted image sequences form a part of all MRI protocols and enable tissue visualization with tremendous detail. In T1-weighted images, fluid considers lifestyle patterns and risk factors that predispose to cerebrovascular risk, e.g., diabetes and 4 hypertension.

Testing at Thyrocare 

The most substantial improvement in stroke management so far is the awareness of the need to manage stroke patients in dedicated stroke units, followed by the development of novel diagnostic tools, 4 reperfusion therapies, and prognostic measures. Thyrocare has recently launched a Cardio map Profile that provides information about your genetic risk to develop cardiovascular diseases, including stroke, AF, coronary heart disease and heart attack as well as associated factors like hypertension and obesity. The profile also predicts one’s response to different medications and useful lifestyle information like a response to exercise. Free genetic counseling is also provided.