Stroke: Golden Hour is crucial

Strokes are a life-threatening emergency, and immediate medical attention is critical to prevent permanent damage or death. Some of the causes are mentioned below:

A former Karnataka CM who recovered from a stroke said he had a ‘third birth’ and highlighted the importance of the ‘golden hour.’  He couldn’t be more right. A stroke is your brain’s equivalent of a heart attack. Referred to as brain attack, a stroke is also called a cerebrovascular accident. This can happen when blood vessels are blocked or because of bleeding due to a rupture of a blood vessel in the brain.

Strokes are a life-threatening emergency, and immediate medical attention is critical to prevent permanent damage or death. Some of the causes are:

High blood pressure is the biggest reason that strokes happen. Damaged arteries make it easier for blockages to occur or the vessel to rupture. 

Tobacco: Smoking increases BP and causes the buildup of fat and cholesterol blockages in the arteries. The chances of a stroke increase by 200–400%.

Heart disease and diabetes—defective heart valves, atrial fibrillation, and irregular heartbeats—are the leading causes of strokes in the elderly. Diabetes and high blood pressure often coexist and make the likelihood of stroke even higher.

Lack of exercise and consequent overweight

Blood-thinning medications increase the likelihood of strokes. Hormone therapy and birth control pills also increase the chances.

Age is a factor though anyone from any age group can have a stroke; older people are more likely to experience one. After the age of 55, the likelihood increases and doubles every decade.

High cholesterol—too much saturated and trans fat, that blocks the blood flow in arteries, also cause strokes  

It helps to take note of stroke signs, as in BE FAST:

Balance: Is the person suddenly having trouble with balance or coordination?

Eyes: Is the person experiencing sudden blurred or double vision or a sudden loss of vision in one or both eyes without pain?

Face drooping: Is one side of the face drooping or is it numb? Ask the person to smile. He cannot.

Arm weakness: Ask the person to raise both arms. Does one arm drift downward?

Speech difficulty: Is their speech slurred, are they unable to speak, or are they hard to understand?

It’s Time to rush the patient to the hospital.

The golden hour is a time bracket of 60 minutes or less. It is the door-to-treatment time of acute ischaemic stroke treatment. This crucial hour is paramount for the medical team to establish a focused diagnostic workup that establishes stroke: 10 minutes for the patient to reach and be evaluated by the doctor in the emergency room; 15 to 25 minutes for the CT scan to be performed; and 45 to 60 minutes for the treatment plan to be established and the initiation of the required treatment.

Stroke patients have a high chance of survival and prevention of long-term brain damage if they receive medical treatment and drug therapy within the first 60 minutes of the onset of symptoms. Early identification and management in the golden hour can prevent long-term disability in almost all cases of stroke.

Emergency treatment for stroke depends on whether it is an ischemic stroke or a stroke that involves bleeding into the brain (haemorrhagic).

Ischemic stroke: the sooner these drugs that can break up a clot are given intravenously, the better. Alteplase (Activase) or Tenecteplase (TNKase) is the gold standard treatment for ischemic stroke. This drug restores blood flow by dissolving the blood clot that caused the stroke.

Doctors can treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. These procedures must be performed as soon as possible:

Hemorrhagic stroke: Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in the brain caused by the excess fluid. Surgery may be necessary if the area of bleeding is large to remove the blood and relieve pressure, and to repair blood vessels.

Recovery and rehabilitation: Stroke care focuses on helping you recover as much functions as possible and return to independent living. The
impact of the stroke depends on the area of the brain involved and the amount of tissue damaged.

(The writer is a former
director of the Sri Jayadeva Institute of Cardiology)