In 2013, approximately 6.9 million people had an ischemic stroke, and 3.4 million people had a hemorrhagic stroke. In 2015, there were about 42.4 million people who had previously had a stroke and were still alive. Between 1990 and 2010 the number of strokes that occurred each year decreased by approximately 10% in the developed world and increased by 10% in the developing world. In 2015, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.3 million deaths (11% of the total).
In the 1970s, World Health Organization defined stroke as a “neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours”. This definition was supposed to reflect the reversibility of tissue damage and was devised for the purpose, with the time frame of 24 hours being chosen arbitrarily. The 24-hour limit divides stroke from transient ischemic attack, which is a related syndrome of stroke symptoms that resolve completely within 24 hours. With the availability of treatments that can reduce stroke severity when given early, many now prefer alternative terminologies, such as brain attack and acute ischemic cerebrovascular syndrome (modeled after a heart attack and acute coronary syndrome, respectively).
Astroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke, ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Signs and symptoms of a stroke often appear soon after the stroke has occurred and it includes the inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side. If symptoms last less than one or two hours, the stroke is a transient ischemic attack (TIA), also called a mini-stroke. A hemorrhagic stroke may also be associated with a severe headache. The symptoms of a stroke can be permanent.
Long-term complications may include pneumonia and loss of bladder control.
Classification
- Ischemic
In an ischemic stroke, the blood supply to part of the brain is decreased, leading to dysfunction of the brain tissue in that area. There are four reasons why this might happen:
- Thrombosis (obstruction of a blood vessel by a blood clot forming locally)
- Embolism (obstruction due to an embolus from elsewhere in the body),
- Systemic hypoperfusion (general decrease in blood supply, e.g., in shock)
- Cerebral venous sinus thrombosis.
A stroke without an obvious explanation is termed cryptogenic (of unknown origin); this constitutes 30–40% of all ischemic strokes.
The stroke episode is classified as total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) or posterior circulation infarct (POCI).
- Haemorrhagic
There are two main types of hemorrhagic stroke:
- A) Intracerebral hemorrhage, which is basically bleeding within the brain itself (when an artery in the brain bursts, flooding the surrounding tissue with blood).
- B) Subarachnoid hemorrhage, which is basically bleeding that occurs outside of the brain tissue but still within the skull.
There are many types and degrees of paralysis. The condition can be:
- Partial, when you still have some control of your muscles (sometimes called paresis).
- Complete, when you can’t move your muscles at all.
- Permanent, when muscle control never comes back.
- Temporary, when some or all muscle control returns.
- Flaccid, when the muscles get flabby and shrink.
- Spastic, when the muscles are tight and hard and jerk around oddly (spasm).
Paralysis can occur in any part of the body and is either localized when it affects only one part of the body or generalized when it affects a wider area of the body. Localized paralysis often affects areas such as the face, hands, feet, or vocal cords. Generalized paralysis is broken down based on how much of the body is paralyzed:
- Monoplegia affects one limb only, such as one arm or one leg.
- Hemiplegia affects one side of the body, such as the leg and arm of the same side of the body.
- Diplegia affects the same area on both sides of the body, such as both arms and both sides of the face.
- Paraplegia affects both legs and sometimes parts of the trunk.
- Quadriplegia affects both arms and both legs and sometimes the entire area from the neck down. The function of the heart, lungs and other organs might also be affected.
Signs and Symptoms
Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases do not progress further. The symptoms depend on the area of the brain affected. The more extensive the area of the brain affected the more functions that are likely to be lost. Some forms of stroke can cause additional symptoms. For example, in intracranial hemorrhage, the affected area may compress other structures. Most forms of stroke are not associated with a headache, apart from subarachnoid haemorrhage and cerebral venous thrombosis, and occasionally intracerebral hemorrhage.
THE FIRST STEP to Recognize the Signs and Symptoms for Stroke Paralysis and if any of these are seen in the person then immediately shift to the nearest hospital, quick action and perhaps save a life.
- Sudden unresponsiveness or weakness in the face, arm, or leg, especially on one side of the body
- Confusion, trouble speaking, or difficulty understanding speech.
- Trouble seeing in one or both eyes.
- Difficulty in walking, dizziness, loss of balance, or lack of coordination.
- Severe headache with no known cause.
- The good news is that you can stop the brain damage caused by a stroke if you respond quickly to treatment. The cautionary signs of stroke, and to get help right away if you see them.
Acting F.A.S.T. is Key for Stroke
It can help stroke patients get treatments they desperately need. It’s important to act quickly and get medical help as stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms.
Follow simple test:
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person simple phrases to repeat. Is the speech slurred or strange?
T—Time: If you see any of these signs, take him to the nearest hospital
Note the time when any symptoms first appear. This information helps health care providers to determine the best treatment for each person.
Subtypes
If the area of the brain affected includes one of the three prominent central nervous system pathways— the spinothalamic tract, corticospinal tract, and the dorsal column–medial lemniscus pathway, symptoms may include:
- hemiplegia and muscle weakness of the face
- numbness
- reduction in sensory or vibratory sensation
- initial flaccidity (reduced muscle tone), replaced by spasticity (increased muscle tone), excessive reflexes, and obligatory synergies.
In most cases, the symptoms affect only one side of the body (unilateral). Depending on the part of the brain affected, the defect in the brain is usually on the opposite side of the body.
A brainstem stroke affecting the brainstem and brain, therefore, can produce symptoms relating to deficits in these cranial nerves.
- altered smell, taste, hearing, or vision (total or partial)
- drooping of the eyelid (ptosis) and weakness of ocular muscles
- decreased reflexes: gag, swallow, pupil reactivity to light
- decreased sensation and muscle weakness of the face
- balance problems and nystagmus
- altered breathing and heart rate
- weakness in sternocleidomastoid muscle with an inability to turn head to one side
- weakness in the tongue (inability to stick out the tongue or move it from side to side)
If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following symptoms:
- aphasia (difficulty with verbal expression, auditory comprehension, reading, and writing)
- dysarthria (motor speech disorder resulting from neurological injury)
- apraxia (altered voluntary movements)
- visual field defect
- memory deficits (involvement of temporal lobe)
- hemineglect (involvement of parietal lobe)
- disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe)
- lack of insight of his or her, usually stroke-related, disability
If the cerebellum is involved, ataxia might be present, and this includes:
- altered walking gait
- altered movement coordination
- vertigo and or disequilibrium
Associated symptoms
Loss of consciousness, headache, and vomiting usually occur more often in hemorrhagic stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing the brain. If symptoms are maximal at onset, the cause is more likely to be a subarachnoid haemorrhage or an embolic stroke.
Complications
While a few forms of paralysis let the patient continue to lead a normal life, there are a few that can cause severe complications. The dependence on crutches, wheelchairs, full-time nursing, and a lot of other factors can increase significantly. The most common complications are chest pains, high blood pressure, and depression. Sex life and fertility are affected differently in men and women.
Ayurveda Management of Paralysis
The terms Pakshaghata, Paksha Vadha, and Ekanga Vata have been used to describe Paralysis in Ayurveda. Ayurveda has mentioned facial paralysis as a separate disease entity called “Ardita vata”. The treatment guidelines for these conditions have been widely enumerated in the classical texts of Ayurveda.
Various treatment modalities are available in all medical streams. Ayurveda has proved or stands to be one of the most effective treatment methodologies for the best possible recovery in Paralysis or stroke conditions.
So, immediately after getting discharged from an acute medical care center or hospital, it is always highly recommendable to take Ayurveda treatment.
Stroke Management in Ayurveda
Panchakarma (Cleansing therapies) for Paralysis patients include:
- Snehana (Oleation) treatment like massage, Kayaseka, Shirodhara, Shirobasti, Pichu, etc with medicated oils followed by different modalities of Medicated fomentation for 7 – 21 days. Massage with symptom-specific medicated oils followed by medicated fomentation helps to increase circulation also strengthens the muscles and nerves.
- Virechana (Purgation) – To increase the metabolism, relieve constipation, strengthen the gut, also help to improve the functioning of the nerves in the affected area.
- Basti (medicated enema) in the form of Matra Basti, Anuvasana Basti, Nirooha Basti for the period of 8 – 32 days. Medicated enema helps in nourishing, strengthening, and stabilizing the overall body functioning and this treatment takes a major role in healing the stroke patient if they approach within 3 months of the paralytic attack.
- Nasya karma for 7 – 9 days – this therapy helps to strengthen the muscles, nerves, and circulation above the shoulder.
Ayurveda medicine for stroke
All therapeutic measures may be started after crossing the acute phase of attack in the form of herbs like Ashwagandha, Brahmi, Eranda, Rasona, Rasna, etc. Medicines like Mahavatavidwamsana, Balarista, Dashmoola Arista, Sarasawathaarista, Bhihat vata Chintamani, Ekangavira rasa, Sacharadi kasahya, Gandarwahastadi qwatha etc can be used.
Above said various modalities of treatments are common in practice, but the duration of the treatment, dosage, selection of herbs, type of Panchakarma, will be adjusted and planned by the ayurvedic doctors only according to the clinical findings and response to the therapy.
Diet and Lifestyle in stroke paralysis
- Avoid excessive use of spicy, astringent, and/ or salty, oily/ fatty food and incompatible diet, Bengal gram, peas, potato, etc.
- Use black gram, horse gram, onion, garlic, ginger, radish, ash gourd, green gram, etc in regular diet.
- Use fruits like pomegranate, grape, or papaya. Consume low fat and a high fibers diet as advised by the physician.
- Control the treatable risk factors like Diabetes mellitus, hypertension, heart diseases.
- Practice regular exercises or physiotherapy.
- Avoid excessive starvation, excess exercise, suppressing of natural urges.
- Avoid alcohol consumption, smoking.
- Avoid discontinuation of any regular medication without medical advice.
Be active and optimum use of affected part and continue exercises as suggested by the physician. “Punarnava Project” is a unique program conducted and aided by the Govt of Kerala, under the ISM department for Stroke and its rehabilitation from which more than 1000s of patients are benefited so far. It is noticed that some patients are affected with stroke more than once in their lifetime. These measures have helped to arrest the recurrence of stroke in such patients and also to cure allied ailments. Combined therapy with medicines, physiotherapy, and yoga are provided absolutely free of cost, to the patients who are from financially weaker sections of the society. This has proved very helpful for the common working-class people. The stroke patients who suffer from cholesterol, diabetes, hypertension could be treated and help to enjoy a normal life condition because of the treatment through this project. In many patients there BP condition could be attended to a normal level using Ayurveda formulations and even reducing the dosage of medicines is another added benefit of this project.
It is noticed and diagnosed that most stroke patients are addicted to alcohol and smoking habits. By the treatment given to such patients through this project, the addiction to alcohol and use of tobacco could be stopped and to make an awareness in them to stick on to a healthy food habit.
Another major advantage of this project is that the stroke patients who showed symptoms of Parkinson’s disease could be detected at an early stage and proper treatment for the same could be given.
The treatment through this project was helpful to develop and increase the self-confidence of most stroke patients to lead a normal life. With this project, Ayurveda could deliver a cost-effective and fruitful treatment to Pakshaghata / stroke patients.
