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Ischemic Stroke Patient Saved By Combination Of Three Complicated Medical Procedures

In a recent event, Apollo Hospitals Chennai hospitals have performed three multi-disciplinary complicated procedures on a 35-year-old patient, who had an Ischemic stroke. The patient was reported to have developed a sudden inability to use his left arm and leg and with symptoms of facial paralysis.

The patient was brought into the hospital in a drowsy condition and was only able to respond to the doctor's queries feebly. He had a vision loss in his left eye and his eye was deviated to the right side.

What Is Ischemic Stroke?

Ischemic stroke is the most common type of stroke. It occurs when the arteries supplying blood to the brain is interrupted or blocked, due to the build of plaque or blood clots in the arteries. According to the Centers for Disease Control and Prevention (CDC), 87 per cent of strokes are an ischemic stroke.

Ischemic stroke is also referred to as brain ischemia and cerebral ischemia and approximately 87 per cent of all strokes are ischemic strokes [1]. Symptoms of an ischemic stroke depend on what region of the brain is affected and the common symptoms of ischemic stroke are vision problems, weakness or paralysis in your limbs, dizziness and vertigo, confusion, loss of coordination and drooping of the face on one side [2][3].

The main treatment for ischemic stroke is intravenous tissue plasminogen activator (tPA), which help break up the clot. If this does not work, clots can be removed through surgery [4]. And the long-term treatments include aspirin or an anticoagulant to prevent further clots.

In the case of ischemic stroke caused by conditions such as high blood pressure or atherosclerosis, you will need to receive treatment for those conditions [5].

Why Was There A Need For Combining Three Medical Procedures?

The patient showed every possible symptom for stroke and was diagnosed the with stroke (with NIHSS) scale of 18. An urgent MRI (DWI) screening revealed a large infarct in the right middle cerebral artery territory. The blood supply to the large part of the right-side brain had reduced due to a clot in the major blood vessel supplying blood to that part of the brain. MR ASPECT score was exceptionally low (2), indicating poor outcome. After informed consent, thrombolysis planned immediately.

What is thrombolysis: Also known as thrombolytic therapy, it is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs [6].

The doctors decided on bridging procedure, that is, thrombolysis followed by mechanical thrombectomy.

What is mechanical thrombectomy: It is a type of minimally invasive procedure in which an interventional radiologist uses specialised equipment to remove a clot from the patient's artery [7].

The patient underwent the same and the clot was removed, and the blood vessel was revascularised. He was shifted back to ICU and was connected to ventilator support. On repeating the CT scan there was a swelling in the right-side brain which was about to compress and damage the left side brain.

The swelling was treated initially with medications, but since the pressure was rising, it was decided to proceed with emergency decompressive craniectomy, which is removing one part of the skull to release the pressure that built up inside the cranium.

Post-procedure he was shifted back to ICU and mechanical ventilation was continued. The patient gradually started to improve and has been discharged. The patient is now undergoing Neuro Rehabilitation and is communicating well and can walk with minimal support. Neurological rehabilitation is a doctor-supervised program designed for people with diseases, injury, or disorders of the nervous system [8].

How Does Post Stroke Rehabilitation Help Stroke Patients?

Post-stroke rehabilitation is an especially important phase for a patient's complete recovery. The long-term goal of rehabilitation is to help improve the stroke survivor's physical and cognitive functions, to relearn the skills they have lost, and to ultimately improve their overall quality of life so that they can become as independent as possible.

Stroke support groups are one way for stroke survivors and caregivers to receive beneficial psychological and social support after a stroke and are unique because the shared experiences enable peers to understand others and allow them to provide and receive relevant emotional, affirmational, and informational support [9].

Also, for stroke survivors, providing support for peers has been shown to be beneficial because those providing support enjoy it, feel a sense of personal growth from providing it, and feel they are making a difference in someone else's life [10].

On A Final Note...

Newer advancements including thrombolysis, thrombectomy, timely decompressive craniectomy and improving awareness about stroke leading to faster "onset to needle time" - mean people are surviving strokes that would have killed them in the past. There is no doubt that more people are surviving stroke than did in the past.

Unfortunately, many of those who survive a stroke experience chronic deficit that affect their quality of life, mobility, and independence, the doctors added.

Story first published: Thursday, December 3, 2020, 19:02 [IST]