7. Number of stroke cases in India increase dramatically
every year
• Stroke is the 3rd leading cause of death worldwide & 2nd most
common cause of death in India1
• In India stroke-associated mortality is 22 times that of
infectious diseases such as malaria and tuberculosis2
1. http://www.thehealthsite.com/news/number-of-stroke-cases-in-india-increase-by-50-almost-every-year/
last accessed on 6th March 2017.
2. Singla S, Singla R. Stroke in India: Biosocioeconomic determinants. J Soc Health Diabetes 2016;4:71-6.
8. Majority of stroke survivors in India
face persistent disability
13.5 2.9 14.6
43.4
53.6
42
43.1 42.5 42.4
MUMBAI BENGALURU TRIVANDRUM
SEVERITY OF STROKE IN INDIA
Mild
Moderate
Severe
Distribution of post-stroke disability at 28 days from the onset of stroke among stroke survivors
>80% of stroke survivors in India have moderate to severe disability
Pandian et al. J Stroke. 2013 Sep; 15(3): 128–134.
11. Perceptions of Stroke
Myth
Is not preventable
Cannot be treated
Only strikes the elderly
Happens in the heart
Reality
Up to 80% of strokes are preventable
Stroke requires emergency treatment
Anyone can have a stroke
Stroke is a “Brain Attack”
16. CT Scan of Acute Ischemic Stroke
CT commonly used to rule out hemorrhage not to diagnose Stroke
Initial CT scan may be completely normal with/out minimal changes
17. MRI
MRI scan uses a strong magnetic field and radio waves to
produce a detailed picture of brain tissue.
19. Time is brain
Every minute if stroke is untreated, the
average patient loses 1.9 million neurons.
Each hour if stroke is untreated, the
brain loses as many neuron as it does in
almost 3.6 years of normal aging.
Stroke ,2006
21. First Generation
• SK: streptokinase
• u-PA: urokinase
• (APSAC: anistreplase)
Second Generation
• rtPA: alteplase
rscu-PA: prourokinase
saruplase
A-74187
Third Generation
• rPA: reteplase
• TNK-tPA: tenecteplase
nPA: lanoteplase
E6010: monteplase
YM866: pamiteplase
DSPAa1: vampire bat tPA
Thrombolytic / Fibrinolytic
Currently 2 thrombolytic agents are approved in India for the
treatment of Acute Ischemic Stroke :
• Alteplase (2nd generation Thrombolytic)
• Tenecteplase ( 3rd generation Thrombolytic)
22. Thrombolytic Guidelines
• As per the guidelines ,thrombolytic therapy is approved within
Window period of 4.5 hours after Stroke Onset.
• Thrombolytic therapy is contraindicated after 4.5 hours of
Stroke Onset.
• Thrombolytic therapy is also contraindicated in Hemorrhagic
Stroke.
23. DTN Time
• When a Stroke patient, reaches to the
Emergency Department of any hospital (door),
within 60 minute patient should get the
Thrombolytic therapy.
• This Golden 60 minutes is called Door to
Needle ( DTN) time.
24. Our Responsibility
Spot a Stroke Patient through BEFAST Symptoms.
Record the Stroke Onset time.
Immediately transfer the patient to CT Scan or MRI (or CT scan
capable hospital).
Ensure that the patient get early treatment.
Help every stroke patient to get, A New Life …. free of disability