Neurology

Knowledge is power. Learn about stroke to fight it now

What is a Stroke?

Stroke is also known as “Brain Attack”. It is similar to a heart attack in nature. It has the potential to affect people of all age groups. The stroke happens when the blood supply directed toward the brain is cut off abruptly. Without blood, the brain cells are deprived of oxygen and other nutrients and hence the brain cell begins to die. The damaged caused by it is relational to the area of the brain it affects. Stroke affects people’s most basic functional aspects such as speech, mobility and their ability to think, feel or respond. Consequences of a stroke on a person depend on where it occurs in the brain and the amount of damage caused by it.

Is a Stroke treatable?

Though Stroke is a complex medical issue, there are effective ways to minimize its effects. Identifying early signs of stroke and seeking emergency medical care in the dedicated “stroke unit” minimizes the effects of it. 
Stroke can be treated effectively if one seeks emergency stroke treatment in the initial 3-4.5 hrs. Also, an early access to the best professional care can significantly improve results.

What are the warning signs of a Stroke?

Symptoms of a stroke are sudden and unexpected. Here are the warning signs of a stroke: 

1. Sudden, severe headache 
2. Sudden trouble seeing in one or both eyes
3. Sudden weakness of the face, arm or leg, particularly on one side of the body
4. Sudden trouble speaking or understanding
5. Sudden trouble in walking, coordination and a significant loss of balance or dizziness

 If you notice one or more of these signs, don’t worry or panic.
Call your emergency medical services and get to a hospital immediately. 

6 Key facts about Stroke Treatment

1.  You can make a positive difference by recognizing the signs of Stroke
Recognizing the signs of Stroke and getting the treatment on time saves lives and accounts for a speedy recovery. 
If you think someone may have had a stroke, check for these signs quickly:
1. Face – Is one side drooping? 
2. Arms – Raise both arms. Is one side weak?
3. Speech – Is the person able to speak? Are words jumbled or slurred?
4. Time – Act quickly. Seek emergency medical attention immediately.

2. When cared for in a specialized stroke unit, around 1 in 10 diagnosed people make fast recovery 
All the patients with stroke (ischaemic or haemorrhagic) should be admitted to a specialized stroke unit, which involves a designated ward with a specialized team. This team includes a Neurologist, Neurosurgeon, Neurointerventionist, Neuroradiologist and a Stroke rehabilitation specialist. 

3. Provide the patient with clot-busting drugs (tPA or thrombolysis) and enhance his or her chances of recovery 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.

4. Provide the patient with clot retrieval treatment and enhance his or her chances of recovery by 50%
Clot retrieval treatment (mechanical thrombectomy) involves removing a blood clot from the large arteries by Neurointerventionists in the cath lab. Clot retrieval can improve survival rates and reduce disability for many people with ischaemic stroke caused by large artery blockage.

5. The most critical step in the treatment process is rehabilitation 
Rehabilitation starts in the hospital by neurosurgeons as soon as possible post a stroke. It can improve the patient’s functionality and assist him or her in regaining maximum independence with time.

6. One in four survivors will have another stroke.
Stroke risk can be reduced by treating risk factors for stroke. Treatments that prevent another stroke include drugs to lower blood pressure and cholesterol, antiplatelet therapies, anticoagulation for atrial fibrillation, surgery or stenting for selected patients with severe carotid artery narrowing.

“Right  Stroke Care Makes a Difference”

Join the fight against stroke.

Stroke affects all of us. So let’s take an action, a drive awareness and push for a better access to stroke treatments.
Learn how to contribute in spreading awareness and access with regard to a stroke. 

Individuals

1. Be aware. Learn the signs of stroke and know to take immediate action.
2. Share this information with family and friends.

Learn How To Prevent A Stroke 

Here are six steps anyone can take to reduce the risk and danger of a stroke:

1. Know your personal risk factors: High blood pressure, diabetes, and high blood cholesterol.
2. Be physically active and exercise regularly.
3. Maintain a healthy diet-  High in fruits and vegetables and low in salt to keep the blood pressure low.
4. Limit alcohol consumption.
5. Avoid cigarette smoke. If you smoke, seek help to stop now.
6. Learn to recognize the warning signs of a stroke.

To know more visit our best neurologists in Bangalore at our hospital

Pituitary Adenoma

A pituitary adenoma is a slow growing and typically benign tumor arising from cells in the pituitary gland. Because they originate from cells in the pituitary gland, they often cause problems related to hormonal dysfunction. A large proportion of these tumors grow to a size where they cause symptoms because they compress surrounding structures. For these reasons, larger pituitary tumors (called macroadenomas) often present with headache, visual loss and pituitary gland dysfunction. Changes in energy level, sexual function and libido, and many other symptoms may be a result of a dysfunctional pituitary gland (called hypopituitarism).

Other types of tumors and cysts are also often seen in the pituitary area, and some require surgical management. These include craniopharyngiomas, Rathke’s cleft cysts, meningiomas, and other less common neoplasms and inflammatory processes.

Causes of pituitary adenomas
The specific cause of pituitary adenoma development is unknown, although they are likely to be caused in part by random mutations in cells of the pituitary gland. Congenital syndromes known to be associated with some pituitary adenomas make up only a minority of patients with these tumors.

Treatment for pituitary tumors involves various options, including removing the tumor, controlling its growth and managing your hormone levels with medications.

Signs and symptoms of pressure from a pituitary tumor may include:

• Headache
• Vision loss, particularly loss of peripheral vision
• Nausea and vomiting
• Symptoms of pituitary hormone deficiency
• Weakness
• Less frequent or no menstrual periods
• Body hair loss
• Sexual dysfunction
• Increased frequency and amount of urination
• Unintended weight loss or gain

Risk factors:

Although pituitary tumors can occur at any age, they're most likely to occur in older adults. People with a family history of certain hereditary conditions, such as multiple endocrine neoplasia, type I (MEN I), have an increased risk of pituitary tumors. In MEN I, multiple tumors occur in various glands of the endocrine system. Genetic testing is available for this disorder.

COMPLICATIONS

Vision loss, permanent hormone deficiency and diabetes insipidus.

A rare but potentially serious complication of a pituitary tumor is pituitary apoplexy, when sudden bleeding into the tumor occurs. Pituitary apoplexy requires emergency treatment, usually with corticosteroids and possibly surgery.

Tests and diagnosis: Blood and urine tests to determine whether there is any over production or deficiency of hormones.

Brain imaging: CT and MRI to judge the location and size of pituitary tumor.

• Vision testing. Such tests can determine if growth of a pituitary tumor has impaired your sight or peripheral vision.

Treatment involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a nervous system specialist (neurologist). Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels.

Surgery includes: Endoscopic transnasaltranssphenoidal and Transcranial approach (craniotomy).

Radiation therapy includes: External beam radiation and Gamma Knife stereotactic radiosurgery.

Craniosynostosis

Craniosynostosis is derived from the terms cranio, syn and ostosis that relates to the bone. It is a birth defect in which one or more of the joints between the bones on an infant's skull close prematurely, before the infant's brain is fully formed. Craniosynostosis transpire in one in 2000 births. An infant’s skull has seven bones. In general, these bones don’t fuse until the age of 2, giving enough time for the infant’s brain to develop. These bones are held together with a joint called cranial sutures, made of strong fibrous tissue.

Symptoms of Craniosynostosis

• Increase of pressure inside the skull such as intracranial pressure
• A distorted skull having the shape that depend upon which of the cranial sutures are affected
• Development of a hard or raised ridge near the affected sutures
• No or slow growth of the head as the baby grows
• Abnormal disappearing or feeling of a soft spot on the skull of the baby

Craniosynostosis can be categorized into many types. Some of the most commonly found types are:

Sagittal synostosis (scaphocephaly)
Premature fusion of the sew up at the top of the head forces the head to grow long and thin, rather than wide. Scaphocephaly is the most common type of craniosynostosis.

Coronal synostosis (anterior plagiocephaly)
The premature fusion of a coronal suture may force the infant’s forehead to flatten on the affected side. It can as well cause a deviated nose and slanted skull.

Bicoronal synostosis (brachycephaly)
In this stage, the baby may have a flat, elevated forehead and brow. This happens when both of the coronal sutures fuse prematurely.

Treatment of Craniosynostosis
The overall health and medical history of the child has to be taken into priority. The only treatment for craniosynostosis is an intervention of surgery. An open surgery is performed for reshaping the skull of the child. This is made at the top of the head by an incision. Followed by the affected suture is removed by a neurosurgeon, giving a more normal shape to the skull bones by a craniofacial plastic surgeon. Screws and plates are used for holding the new shape till the time bone heals. The screws and plates are made up of special material that absolutely dissolves in 1-2 years. Only one surgery is required if a baby has single suture craniosynostosis. More than one surgery is required if a child has craniosynostosis caused by craniofacial syndromes.

Blog by

Dr. Derick A. Mendonca
Consultant - Plastic Surgery
Plastic and Reconstructive Surgery
Sakra World Hospital