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A stroke is a medical emergency wherein the supply of blood to part of the brain is suddenly interrupted. When this happens, brain cells are deprived of oxygen and nutrients, and damage can start within minutes. In a major stroke, nearly two million brain cells can be lost every minute when treatment is delayed. This is why doctors often use the phrase, "time is brain" when talking about stroke treatment.
About 80% of strokes happen because a blood clot blocks an artery supplying blood to the brain. Dr Sunil Furtado, Lead Consultant - Neurosurgery, Manipal Hospital Yelahanka, explains that the lack of blood flow quickly affects brain cells. Recognising the warning signs and getting medical help immediately can make a huge difference in how much brain tissue can be saved and how well a person may recover.
What Happens Inside The Brain During A Stroke?
When a blood clot blocks an artery, the part of the brain supplied by that blood vessel suddenly receives less or no oxygen. Brain cells are extremely sensitive to this shortage. Unlike some other cells in the body, they cannot store enough oxygen and energy to keep functioning for long without a blood supply.
As minutes pass, brain cells begin to lose their ability to function and eventually die. The area directly affected by the blocked artery can suffer permanent damage, while surrounding brain tissue may still be alive but they too are at risk. Rapid treatment aims to restore blood flow before more of this tissue is lost. "About 80% of strokes happen when a clot blocks an artery that supplies blood to the brain," says Dr Furtado.
How To Recognise The Warning Signs
The easiest way to remember the common warning signs of stroke is FAST:
- Face: One side of the face may droop or feel numb.
- Arm: One arm may become weak or numb, making it difficult to raise both arms equally.
- Speech: Speech may become slurred, confused or difficult to understand.
- Time: It is time to call for emergency medical help immediately.
Other warning signs can include sudden loss of vision, severe dizziness, loss of balance or a sudden, very severe headache. These symptoms should not be ignored even if they disappear after a few minutes.
How Doctors Find The Clot
Once a person reaches the hospital, doctors first need to determine what type of stroke has occurred. A CT scan or MRI is usually performed to rule out bleeding in the brain.
If a blocked blood vessel is suspected, additional imaging can show which artery is affected and how much brain tissue may still be saved. This information helps doctors decide whether the patient can benefit from clot-dissolving medicines, a clot-removal procedure, or both.
For eligible patients arriving early, a clot-dissolving medicine may be given through a drip. However, when a large artery is blocked, physically removing the clot may be necessary.
Brain Surgery Without Opening The Skull
The procedure used to physically remove a clot is called mechanical thrombectomy. Despite being an important brain-saving procedure, it does not involve opening the skull.
"A thin tube is inserted through a small cut in the groin or wrist and guided through the blood vessels up to the brain," explains Dr Furtado.
Doctors use digital cath lab images to guide the tube to the blocked artery. A tiny mesh device or suction tool can then capture or remove the clot. Once the blockage is cleared, blood can flow to the affected part of the brain again.
How Long Is The Treatment Window?
For clot-dissolving medicines, the traditional treatment window is about 4.5 hours for eligible patients. Mechanical thrombectomy has a longer window in selected cases.
According to Dr Furtado, guidelines allow thrombectomy up to 24 hours in carefully selected patients with a blocked large vessel, based on advanced brain imaging. However, this does not mean patients should wait. "The sooner the procedure is performed, the better is the outcome and preservation of the patient's functionality," he says.
What Happens After The Clot Is Removed?
Removing the clot is only the beginning of recovery. The patient is generally monitored closely in an intensive care or stroke unit. A repeat scan may be performed to check for bleeding or swelling, while blood pressure is carefully controlled.
Doctors also work to identify and treat the reason behind the stroke. This may include high blood pressure, diabetes, high cholesterol or an irregular heartbeat. Medicines may be prescribed to reduce the risk of another clot. Rehabilitation is also important. Depending on the areas of the brain affected, a person may need physiotherapy, speech therapy or occupational therapy. Starting rehabilitation early can support recovery of movement, speech and everyday functioning.
A stroke can cause permanent brain damage in a very short time. Recognising the signs, recording when they started and getting the person to a hospital quickly can help doctors act before more brain tissue is lost.
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