Comprehensive Stroke Care Center

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Faculty

• Dr. Sylaja P. N.
  Professor & In-charge
  
• Dr. Sajith S.
  Professor
  
• Dr. Sapna Erat Sreedharan
  Professor
  

Comprehensive Stroke Care at SCTIMST

Burden of stroke - Worldwide Statistics

Stroke is a global health problem and is a leading cause of adult disability. Of 35 million deaths attributable to noncommunicable diseases that occurred worldwide in 2005, stroke was responsible for 5.7 million (16.6%) deaths, and 87% of these deaths occurred in low-income and middle-income counties.

In an important recent study, it was found that in Trivandrum, stroke occurred at rate of 7.1 per 1000 per year in people more than 55 years, and the rate escalated to 13.3 for the more than 75 years age-group.

According to the World Health Organization, approximately 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled.

Facilities

The multidisciplinary treatment approach to every patient with acute stroke starts from decision on thrombolysis to evaluation of aetiology, secondary prevention and management of medical complications. A comprehensive rehabilitation team is involved in patient care which includes physiatrist, physiotherapist, speech therapist, occupational therapist and medical social worker. Continued rehabilitative approaches and optimal medical treatment for secondary stroke prevention are planned for these patients before hospital discharge and is continuously reviewed during subsequent follow up period.

Services

Acute Stroke care services

Facilities include Intravenous thrombolysis (IVT), intra-arterial thrombolysis (IAT), and mechanical thrombectomy.

A stroke helpline is available -0471-2524333 through which the family or treating physician can call and send patients with acute stroke if within 6 hours of onset.

Every case of acute stroke presenting within 4.5 Hrs (window period for IVT) are evaluated on an emergent basis with thorough history to rule out contraindications for Intravenous thrombolysis (IVT), blood investigations and by imaging including CT scan and/or CT Angiogram. MRIperfusion /CT perfusion is considered in situations like wake up strokes where exact time of stroke onset is uncertain and those patients presenting beyond 4.5 hours . This will help in decision of thrombolysis by ascertaining the tissue volume that can be salvaged. All these investigations are carried out in a strictly coordinated and time bound manner so as to avoid any wastage of time before starting thrombolysis. Recombinant Tissue plasminogen activator (rtPA) is used for IVT.

Intra-arterial thrombolysis (IAT) is considered as a rescue in failed intravenous thrombolysis, those with high thrombus load as in major intracranial vessel occlusions and those beyond 4.5 hours with ischemic penumbra. The procedure is done in the Neuro radiology cath lab, by the interventional neuroradiologist, under supervision of the Stroke neurologist. IAT is also considered in posterior circulation strokes up to a window period of 12 hours, after the safety of the procedure is thoroughly ascertained with appropriate imaging modalities. We use mechanical devices like penumbra and solitaire to remove clots.

After the thrombolysis patients are kept under strict monitoring for another 24 hrs at the end of which step down care is considered.

In case of patients with haemorrhagic strokes, control of high blood pressure and medical treatment of brain edema (swelling) are the most important measures to prevent neurological worsening and to ensure a better outcome. Patients are closely monitored and medical interventions are made from time to time.

In those cases with large infarcts who present late for thrombolytic treatment, sometimes decompressive craniectomy will be needed to alleviate pressure effect of infarcted area on the normal areas thus producing further devastating effects or endangering life. This procedure will be undertaken by the Neurosurgeons as and when required.

Once the patient improves, patient will shifted to step down care. Apart from management of medical complications, offering psychosocial support, speech therapy, evaluation and treatment of swallowing function, physiotherapy, occupational therapy etc. will also be initiated during the ICU stay.

Secondary Stroke Prevention

Patients are discharged with an optimal medical treatment plan for secondary stroke prevention, which will also include medication for control of contributory risk factors like hypertension, diabetes mellitus, and high cholesterol. Aspirin or clopidogrel are prescribed as antiplatelet drugs (blood thinners). But in case of cardio embolic stroke anticoagulant medications are prescribed with strict monitoring of the prothrombin time.

After discharge, all stroke patients are carefully followed up and medications/ rehabilitative strategies are reviewed/ optimized periodically.

Interventional approaches for secondary stroke prevention

PFO device closure: Patent Foramen Ovale (PFO) is an embryological communication between right and left atrium of the heart, which can persist into adult life in some people and can rarely be a cause for stroke. In patients with ischemic strokes with no known cause except the presence of a PFO, closure will be considered as a planned procedure by the cardiologist. This decision will be taken after a thorough evaluation to rule out all other causes of stroke and after ascertaining the probable causative role of PFO, by investigations like Transcranial Doppler (TCD) studies and intracranial embolic detection.

Carotid Endarterectomy: In patients with high grade carotid stenosis (blocks) (usually more than 70% stenosis) interventions to remove or correct these lesions have been found to be superior to medical treatment alone in preventing subsequent strokes . Two methods are Carotid Endarterectomy and Carotid and Intracranial angioplasty and stenting. We have facilities and expertise on both procedures. Carotid Endarterectomy is the time tested standard procedure and is done by our vascular surgeon.

Carotid and Intracranial angioplasty and stenting: This is primarily offered to patients who are medically unfit like those having co morbid problems like significant coronary artery disease. The procedure is done through the femoral Artery by the Interventional Neuroradiologist.

Stroke Clinic

The program conducts Stroke clinic on every Fridays from 10.00 AM to 1 PM. After discharge, all stroke patients are carefully followed up and medications/ rehabilitative strategies are reviewed/ optimized periodically.

Emergent TIA evaluation - TIA could be a warning sign of impending major stroke. Proper timely evaluation and initiation of treatment may prevent a catastrophic disabling stroke. Following a TIA, the chances of stroke is 15- 20 % in the next 3 months ,of which 50 % occurs within first 48 hours.We identify high risk TIAs and even admit for rapid evaluation and treatment.

We offer TIA evaluation services on an urgent basis. There are certain situations where there is very high chance of stroke following TIA like high grade carotid stenosis and cardio embolic TIA. These situations warrant urgent evaluation and treatment to bring down the risk of a major stroke.

MCA occlusion

MCA recanalized with TPA

Ongoing research projects

Contact Us

Phone : 0471 - 2524363

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