Stroke awareness

3. Brain equals life

4. लकवा
Brain
attack
Stroke

5. India and global burden of Stroke
0.08%
0.33%
0.00%
0.20%
0.40%
Rural India Urban India
ESTIMATED
STROKE…
80%
20%
0%
20%
40%
60%
80%
100%
Stroke
Ischemic Haemorrhagic
1. J Stroke 2015; 17(2): 219.
2. J Stroke 2013; 15(3): 128.
3. New Engl. J Med. 2007; 357(6): 572-9

6. 6
In India

7. Number of stroke cases in India increase dramatically
every year
• Stroke is the 3rd leading cause of death worldwide & 2nd most
common cause of death in India1
• In India stroke-associated mortality is 22 times that of
infectious diseases such as malaria and tuberculosis2
1. http://www.thehealthsite.com/news/number-of-stroke-cases-in-india-increase-by-50-almost-every-year/
last accessed on 6th March 2017.
2. Singla S, Singla R. Stroke in India: Biosocioeconomic determinants. J Soc Health Diabetes 2016;4:71-6.

8. Majority of stroke survivors in India
face persistent disability
13.5 2.9 14.6
43.4
53.6
42
43.1 42.5 42.4
MUMBAI BENGALURU TRIVANDRUM
SEVERITY OF STROKE IN INDIA
Mild
Moderate
Severe
Distribution of post-stroke disability at 28 days from the onset of stroke among stroke survivors
>80% of stroke survivors in India have moderate to severe disability
Pandian et al. J Stroke. 2013 Sep; 15(3): 128–134.

9. What is a Stroke ?
 It is Caused by Disruption in the Flow of Blood to the
part of the brain,Resulting in Hypoxia and Eventually
Necrosis. It May be Due to Occlusion of Blood Vessel
(Ischemic Stroke)or Rupture of the Blood Vessel
(Hemorrhagic Stroke)
Ischemic = Clot
(makes up approximately 85% of all strokes)
Hemorrhagic = Bleed
- Bleeding around brain
- Bleeding into brain
© 2011 National Stroke Association

10. Transient Ischemic Attack (TIA)
 Symptoms of TIAs are the same as stroke
 TIA symptoms can resolve within minutes or hours
 Transient ischemic attack (TIA) is a warning sign of a
future stroke – up to 40 percent of TIA patients will have
a future stroke
 It is important to seek immediate medical attention if
you suspect that you are having or have had a TIA
© 2011 National Stroke Association

11. Perceptions of Stroke
Myth
 Is not preventable
 Cannot be treated
 Only strikes the elderly
 Happens in the heart
Reality
 Up to 80% of strokes are preventable
 Stroke requires emergency treatment
 Anyone can have a stroke
 Stroke is a “Brain Attack”

12. Risk
Factors
Obesity
Family
History
or
Ethnicity
Diabetes
Previous Stroke & TIA Age
Binge
Drinking &
Substance
Misuse
Inactivity
Heart
Disease
Hypertension Hormonal
Contraception
& HRT
Smoking
Risk Factors

13. Stroke Prevention

14. Symptoms of stroke
 B : Loss of Balance
 E : Loss of Vision
 F : Facial Drop
 A : Weakness of Arms
 S : Slurred Speech
 T : Time of onset

15. DIAGNOSIS

16. CT Scan of Acute Ischemic Stroke
 CT commonly used to rule out hemorrhage not to diagnose Stroke
 Initial CT scan may be completely normal with/out minimal changes

17. MRI
MRI scan uses a strong magnetic field and radio waves to
produce a detailed picture of brain tissue.

18. Stroke- an Emergency
BEFAST
Time is Brain......

19. Time is brain
 Every minute if stroke is untreated, the
average patient loses 1.9 million neurons.
Each hour if stroke is untreated, the
brain loses as many neuron as it does in
almost 3.6 years of normal aging.
Stroke ,2006

20. Best Possible Treatment

21. First Generation
• SK: streptokinase
• u-PA: urokinase
• (APSAC: anistreplase)
Second Generation
• rtPA: alteplase
rscu-PA: prourokinase
saruplase
A-74187
Third Generation
• rPA: reteplase
• TNK-tPA: tenecteplase
nPA: lanoteplase
E6010: monteplase
YM866: pamiteplase
DSPAa1: vampire bat tPA
Thrombolytic / Fibrinolytic
Currently 2 thrombolytic agents are approved in India for the
treatment of Acute Ischemic Stroke :
• Alteplase (2nd generation Thrombolytic)
• Tenecteplase ( 3rd generation Thrombolytic)

22. Thrombolytic Guidelines
• As per the guidelines ,thrombolytic therapy is approved within
Window period of 4.5 hours after Stroke Onset.
• Thrombolytic therapy is contraindicated after 4.5 hours of
Stroke Onset.
• Thrombolytic therapy is also contraindicated in Hemorrhagic
Stroke.

23. DTN Time
• When a Stroke patient, reaches to the
Emergency Department of any hospital (door),
within 60 minute patient should get the
Thrombolytic therapy.
• This Golden 60 minutes is called Door to
Needle ( DTN) time.

24. Our Responsibility
 Spot a Stroke Patient through BEFAST Symptoms.
 Record the Stroke Onset time.
 Immediately transfer the patient to CT Scan or MRI (or CT scan
capable hospital).
 Ensure that the patient get early treatment.
 Help every stroke patient to get, A New Life …. free of disability