Dr. Arun Garg is a renowned neuromuscular surgeon with over 26 years of experience and presently the Director of the Institute of Neurosciences at Medanta, the Medicity. Gurugram. Dr. Arun Garg primarily focuses on stroke and specializes in occupational therapy and neuro-rehabilitation. He is credited with the development of a three-tier system of Stroke Management in North India, where primary and secondary stroke centers are connected, Medanta-The Medicity, Gurgaon via telemedicine and a network of ambulances.
Dr. Arun Garg was the first to emphasize the role of thrombolysis in acute stroke in North India. He is actively developing the “Brain Rescue” program at par with international healthcare standards to manage immediate and long-term patients suffering from a stroke in North India with its hub at Medanta.
Dr. Arun Garg completed his MBBS, MD and DM(Neurology) from Swai Man Singh Medical College, Jaipur. Before Medanta, he worked as a Consultant with Max Superspeciality, Patparganj, New Delhi and at the University of Massachusetts Amherst (UMASS), Massachusetts, the USA where he underwent training in training in stroke prevention, education, treatment, rehabilitation, and the latest research in strokes.
When the brain gets deprived of oxygen and nutrients due to a blockage, stroke occurs. The brain can only survive for a maximum of 5 minutes without oxygen. If the blood supply is not restarted within that window, the brain cells start to die. The faster the oxygen supply is restored, the lesser the brain damage or chances of death.
Strokes are classified into three types
Ischemic stroke: This is the stroke that occurs due to blockage and blood supply not reaching the brain.
Hemorrhagic stroke: This stroke occurs when blood vessels in the brain burst and the blood puts too much pressure on the brain. Those who suffer from conditions like high blood pressure or have an aneurysm are at a risk for hemorrhagic stroke.
Transient ischemic attack: Referred at TIA, this stroke is like a precursor to the Ischemic stroke and can be considered as a mini-stroke or a warning.
Symptoms of Stroke
The symptoms of stroke in both men and women are:
Trouble in maintaining balance or walking
Lack of coordination
Blurred vision or no vision in one or both eyes
Numbness on the face or limbs
The symptoms appear suddenly and it is imperative to call for medical assistance immediately. Fast treatment is key to reduce the brain damage caused by a stroke.
In the case of a TIA, the symptoms go away after a few minutes. However, TIA is serious and medical attention needs to be sought even if the symptoms are gone.
Both men and women can have a stroke although men are at a higher risk. The risk factors for stroke are:
High blood pressure or hypertension
Treatment of strokes differs according to the type of stroke suffered.
For ischemic stroke, treatment targets breaking the clot in the blood vessel that blocks the supply to the brain:
Emergency IV: A combination of drugs is administered intravenously to break the clot. The drugs have to be given within a stipulated window of no more than 4.5 hours.
Emergency endovascular procedure: Ischemic strokes may be treated by:
delivering the medicines via a catheter directly to the location of the stroke in the blood vessel.
Attaching a device (stent retriever) to the catheter to directly remove the blood clot from the artery in the brain. This procedure is used for large clots and in combination with emergency IV.
For TIA, certain diagnostics imaging tests are conducted to determine the cause of the stroke. The treatment for TIA to prevent another stroke is to remove plaque from the affected artery and keep it open. This can be done by:
Carotid endarterectomy: Plague blocking the carotid artery is removed through surgery.
Angioplasty and stent: A catheter with a balloon and/or stent attached to it is inserted through the groin to the carotid artery. The balloon is inflated at the blocked site to reopen the artery and restore blood supply or a stent may be placed to keep the artery open.
For hemorrhagic stroke, the treatments are focused on controlling the bleeding in the brain and reducing the pressure. Treatments are:
Emergency medication to reduce the effects of blood thinners, lower the intracranial pressure, control blood pressure and prevent seizures.
Surgery to remove the bleeding
Surgical clipping of the aneurysm by placing tiny clamps to reduce blood flow into it.
Placing tiny detachable coils through a catheter into the aneurysm to make the blood clot
Stereotactic radiosurgery, a minimally invasive technique that uses high-energy radiation to repair malformations in the blood vessels of the brain.
According to the World Stroke Organization, stroke is an epidemic that affects 1 in 4 adults in the world. Millions of people in the world die or are left debilitated after a stroke. It is crucial to receive treatment as soon as symptoms of a stroke are spotted.