Creating Stroke Awareness

2. What is stroke and what causes it?
 Stroke is a disease that effects the blood vessels going to the brain
 Stroke happens when blood vessel going to the brain gets blocked by
a clot or bursts.
 As a result of it part of brain doesn’t bet oxygen and blood it needs &
dies
 It is 3rd most common cause of death and disability
HEMORRHAGIC STROKE
ISCHAEMIC STROKE

3. Why is it an emergency?
 Most common reason for disability
 Appx. 1 in 4 people die within 1 year
 30%–50% do not regain functional independence
 Annual incidence rate of stroke in India currently is 145 per 100,000
population
 10 - 15% occur in < 40 years
 WHO estimates suggest that by 2050, 80% stroke cases in the
world would occur in low and middle income countries mainly
India and China

5. Why do we say “time is brain’-
 Every minute if stroke is untreated, the average patient loses 1.9
million neurons, 13.8 billion synapses, and 12 km (7 miles) of axonal
fibers.
 Each hour, in which treatment fails to occur, the brain loses as many
neuron as it does in almost 3.6 years of normal aging.
 Early treatment in first few hours can reverse stroke in many patients

7. Beyond F.A.S.T. – Other Symptoms You Should Know
 Sudden numbness or weakness of the leg
 Sudden confusion or trouble understanding
 Sudden trouble seeing in one or both eyes
 Sudden trouble walking, dizziness, loss of balance or
coordination
 Sudden severe headache with no known cause

8. What should be done if stroke is happening?
Immediately go to a hospital which can do stroke
treatment
Do not wait for improvement
Do not spend time at local GP
Don’t take BP medicine
If CT doesn’t show any bleed, Aspirin tablet

9. Is it possible to reverse stroke?
 If the blocked blood vessel can re-opened brain tissue can be
saved
 If patient comes in first few hours (4.5 hrs), clot busting drug (t-
PA) cab ne given
 Blood vessel can also be opened by intervention technique
 Neurointerventionist goes through leg blood vessel and by
special devices can take out the clot to open up the blood
vessel
 By modern treatment methods may patients recover
completely after stroke

11. Solitaire (ev3)- 2012, Trevo (Stryker), Revive™ SE
(Codman), Etc…. etc…..
Stentretrievers - Stent or stent-like system
for clot removal

12. Concept of Penumbra
CBF/MTT CBV
Matched
No penumbra
CBF/MTT
CBV
penumbra
CT, CTA (CTP, MR DWI, PWI)

13. What is mini-stroke and why is it important?
 “Mini stroke” or Transient ischemic attacks “TIAs” are
temporary blockage of brain blood vessel
 In these cases stroke symptoms are present for short
period
 If treatment is no started many patients develop
permanent stroke
 “Mini-stroke” is an emergency and person should
immediately go to stroke specialist
 Treatment can prevent permanent stroke from
happening

14. What are brain aneurysms?
 Brain aneurysms are weakness
“ballooning” of blood vessel of brain
which burst to cause bleeding in brain
 The aneurysms have to be repaired
urgently to prevent repeat bleeding
 Nowadays most cases can be treated
by minimally invasive Neurointervention
technique which are safer than open
surgery
 COILING
 In this procedure metallic rings are
placed in the aneurysm to repair the
weak spot. The procedure is known as
“coiling”

15. Is intervention and surgery possible in
brain blood vessels the same way as
done in heart?
 Many patients have cholesterol deposit in blood
vessel to brain- this is called “carotid stenosis”. If
stenosis is severe, it causes stroke.
 It is possible to remove the blockage by stent
placement, same way as in heart
 This a short procedure which is done with local
anesthesia
 Surgery can also be done to remove the
cholesterol deposit.

16. CAROTID ARTERY STENOSIS-
20-25% STROKES BY MAJOR VESSEL
STENOSIS

17. Plaqu
e
(yello
w)
St
en
t

19.  50 million - About 350 million people worldwide have
diabetes, a number likely to more than double in the next 20
years.
 1.5 million 2012, diabetes was the direct cause of 1.5 million
deaths. More than 80% of diabetes deaths occur in low- and
middle-income countries.
 90%Type 2 accounts for around 90% of all diabetes worldwide.
 Reports of type 2 diabetes in children have increased
worldwide.
Diabetes

20. We Indians…
• At the same BMI, Asians had more than double the risk of
developing type 2 diabetes than whites
• Increases in weight over time were more harmful in Asians
than in the other ethnic groups: For every 11 pounds Asians
gained during adulthood, they had an 84 percent increase in
their risk of type 2 diabetes
• At the same BMI, Asians have higher risks of hypertension
and cardiovascular disease than their white European
counterparts, and a higher risk of dying early from
cardiovascular disease or any cause

24. Type 1 diabetes
 Type 1 diabetes (sometimes called insulin-dependent,
juvenile or childhood-onset diabetes) occurs when the
pancreas does not produce enough insulin, a hormone
that regulates blood sugar.
 Many countries are documenting higher numbers of
newly diagnosed cases of type 1 diabetes, particularly in
younger children.
Type 2 diabetes
 Type 2 diabetes (sometimes called non-insulin-
dependent or adult-onset diabetes) happens when the
body cannot effectively use the insulin it produces.
 Often preventable, it can result from excess body weight
and physical inactivity, and sometimes, a genetic
predisposition.
 Recently, type 2 diabetes has increasingly been reported
in children and adolescents

35. FOOD…

46. Mental

47. • Work satisfaction
• Relationship
• Social circle
• Fitness
• Keep growing

49. Relationship….

50. Spirituality – mental skills
Being aware of oneself
Channelizing energy of our positive
emotions
Handling the negative ones
Finding full expression of ourselves –
professional and personal lives
Balance in life –
“Living a balanced life is a piece of art”

53. Six key facts about stroke treatment
Early recognition makes a big difference.
Knowing the signs of stroke and getting
treatment quickly saves lives and improves
recovery. If you think someone may have had a
stroke, do this
FAST check:
Face: Is one side drooping?
Arms: Raise both arms. Is one side weak?
Speech: Is the person able to speak? Are words
jumbled or slurred?
Time: Act quickly and call emergency services.

54. 2. Specialized stroke unit care increases the chance of a good
outcome by 14%
All patients with stroke (ischaemic or haemorrhagic) should be
admitted to a specialized stroke unit, which involves a designated
ward with a specialized team.
3. Clot-busting drugs (tPA or thrombolysis) increase the
chance of a good outcome by 30%
Clot-busting drugs break up blood clots. This treatment can be
administered up to 4.5 hours of symptom onset in many patients
with ischaemic stroke. The earlier it is given, the greater the
effect.

55. 4. Clot retrieval treatment increases the chance of a good
outcome by more than 50%.
Clot retrieval treatment (mechanical thrombectomy) involves
removing a
blood clot and can improve survival rates and reduce disability
for many
People with ischaemic stroke caused by large artery blockage.
5. Rehabilitation is a critical step in the treatment process.
Rehabilitation starts in the hospital as soon as possible following
a stroke.
It can improve function and help the survivor regain as much
independence
as possible over time

56. 6. One in four survivors will have another
stroke.
Treatments that help prevent another stroke include drugs
to lower Blood pressure and cholesterol, antiplatelet
therapies, anticoagulation for atrieal fibrillation, surgery or
stenting for selected patients with severe carotid artery
narrowing. Lifestyle changes cans also greatly reduce the
risk of another stroke. Changes include eating well, being
physically active, being tobacco-free, managing stress,
and limiting alcohol consumption.

57. Action
Join the fight against stroke. Stroke affects us all.
Let’s take action, drive awareness, and push for
better access to stroke treatments.

58. Individuals
• Act FAST. Learn the signs of stroke and know to take immediate action.
• Share this information with family and friends.
Health care professionals
• Even with limited resources, you can do something.
• Follow best practices and provide evidence-based treatments.
– Download the World Stroke Organization Global Stroke Service
Guidelines and The Roadmap to Delivering Quality Stroke Care.
• Strive for continuous improvement.
– Do a simple audit of your regional/local services to monitor
and improve your care delivery.

59. Governments and health care system decision makers
• Take a leadership role in stroke care by increasing access to
evidence-based stroke treatment.
• Support the development of coordinated systems of care
including
specialized stroke units and stroke care teams.
• Fund stroke awareness campaigns.
• Support excellence in stroke research.
Everyone must advocate together in one world voice for stroke
• Download the Advocacy Toolkit from the World Stroke organization to get your
campaign started.

60. For more information on:
STROKE & NEUROVASCULAR INTERVENTIONS:
URL:
www.sanif.co.in
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https://www.facebook.com/strokeawarenessindia
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LinkedIN
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Dr Vipul Gupta