Stroke is an exception, rush to hospital

Published - April 20, 2020 11:43 pm IST

The COVID-19 pandemic has changed patient care protocols at hospitals all over the world. However, it is important that, in these difficult times, we do not forget the basics of staying healthy and safe.

Stroke or brain attack still remains one of the main causes of death and disability, even during the pandemic. One should not forget the basic concept – time is brain or golden hour – emphasising that time is crucial in any brain emergency. The reason for this emphasis on time is because the brain is extremely dependant on a constant supply of oxygen and nutrition, as it does not have any storage capacity. Its requirements are also very high – almost 20% of the blood that is pumped from the heart goes to the brain. A stroke may occur because adequate amount of blood does not reach the brain, or because there is bleeding in the brain.

Stroke recognition

Remember the mnemonic B (Balance), E (Eyesight), F (Face), A (Arms and legs), S(Speech) T (Time to go immediately to the hospital) – this will help in the early recognition of a stroke. Add to this severe headache and loss of consciousness or fits.

The question asked is – should we go to hospital even when there are only mild symptoms? The answer is that one has to go to the appropriate hospital even when there is a doubt of symptoms. These should be taken as a warning and treatment started immediately.

While going to the hospital for minor ailments has been discouraged currently, please remember that a stroke is an exception. It is an emergency and therefore, even when in doubt, one has to rush to hospital.

What happens when a patient reaches hospital?

A CT scan is done to see if there is bleeding, and depending on the clinical status of the patient and the time from onset of symptoms, a clot dissolving medicine can be given intravenously. A CT angiogram is also done which will show if there is any involvement of a large vessel. If yes, then the patient will be immediately shifted to the cath lab for a procedure called Mechanical Thrombectomy, where through a small catheter placed into the artery in the groin, the clot is removed. Remember, for this to happen the patient must reach the hospital at least within 4 hours from the onset of symptoms.

Occasionally, surgery may be indicated as a life saving procedure, to remove a large blood clot or to prevent bleeding from happening again. Decisions and actions are taken in a very short period of time. For this to be effective it is necessary for the concerned hospital to have not only the equipment and infrastructure but also a comprehensive stroke team including specialised doctors in Neurology, Neuro Critical Care, Neuro Radiology, Neuro Intervention and Neurosurgery, other than specialised nursing and technicians.

Currently many stroke teams are working on the concept of tele-stroke, where the stroke team leader at the hospital can remotely direct the general practitioner or family physician on starting the treatment even before the patient reaches the designated hospital. Education of, and good communication between the different health care professionals is key to the success of this initiative that promises to reduce the time taken to initiate treatment of a stroke.

Safety in hospital

All hospitals are taking precautions to keep patients and healthcare workers safe. Limitations on visitors, rational use of PPEs and screening with segregation ensure that the stroke patient is not exposed to a potential COVID-19 positive patient. Sometimes patients may hesitate to go to the hospital for fear of getting infected with corona virus, or that doctors would be too busy treating COVID-19 patients. Both assumptions are untrue.

People in an extremely vulnerable group need to follow the specific advice about their health condition. A healthy diet, regular physical activity (at home) and reduction of anxiety and stress will help maintain your brain health. Smoking and alcohol are to be avoided at all costs.

While the anxiety of contracting the virus is understandable, emergencies like a brain attack or stroke cannot wait – prompt attention at the earliest is the only way to achieve the best outcomes.

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