 I am Dr. Rohit Pai, Consultant Neurologist, KMC Hospital manual. Today I will be talking to you about Stoke. Stoke is a neurogenic condition caused by empowerment of blood supply to the brain. There are two types of stroke, ischemic stroke and haemorrhagic stroke. Ischemic stroke can be due to ethyl thrombosis or it could be due to cardio embolism. Ethyl thrombosis is due to empowerment of blood supply, due to thickening of the blood vessels which supply the brain. Cardioemolic stroke is due to a clot which forms in the heart, spits through the brain due to various reasons. Most of the strokes are ethyl thrombotic, some strokes are haemorrhagic. Now what are the symptoms of stroke? Stroke manifests by the part of the brain which has been affected. Suppose the left motor area of the brain which serves the function of strength or giving power to the muscles gets affected, you get weakness on the opposite side. If there is an infarct or a stroke in the left occipital area which activates the vision, you will get a visual field effect. If there is a stroke in the sensory area, could be in the thalamus, you will get a sensory symptom on the opposite side. So stroke is manifested by the part which it affects. How do you treat stroke? If the patient comes within the window period of four and a half hours, we can give thrombolysis. Thrombolysis is a simple procedure where an injectable agent is given IV intravenously and it improves the outcome of stroke by at least 30%. If there is a clot in a major blood vessel, we do a procedure called thrombectomy which improves the outcome by at least 50%. What are the risk factors of stroke? The common risk factors of stroke are hypertension, diabetes, smoking, alcohol, obesity, age. How do we prevent stroke? So prevention of stroke will be with healthy lifestyle, adequate exercises for at least half an hour a day, 30 minutes of risk walking, maintaining a good healthy balanced diet which should have less salt, less of oil, less of carbohydrates, high protein diet which this will help in preventing stroke. Avoiding smoking and avoiding alcohol are equally important. The strokes which come in window period can easily be treated with either thrombolysis or thrombolysis. Thrombolysis is given an intravenous agent. Thrombectomy is a mechanical procedure. It is an intervention procedure done by a neuro-radiologist where a catheter is passed through the blood vessel into the vessel which has been affected and the thrombus is extracted by a simple procedure using a catheter. If the patient comes out of window period, suppose the patient has come beyond four and a half to six hours, thrombolysis can be done within four and half hours, thromboectomy can be done within six hours of stroke. If the patient has come beyond this time, we can still treat stroke, but the results are not as good as the patients who have come within window period. How can we treat such patients? These patients will be treated with anti-pay plates as well as anti-coagulation. Now once these initial treatments are given, patient needs to continue anti-platelets or anti-coagulation for life. If the patient is started on anti-platelets, it is usually due to thrombolysis. The patient has to continue the anti-platelets for life. Initially, the patient will be given dual anti-platelets, that is a combination of clopidogrel as well as aspirin, and subsequently, this will be changed to single anti-platelet and this has to be taken along with aterostatic for life. If the patient has a cardio-embolic stroke, this could be because of various reasons. It could be due to a rhythm disorder called as atrial fibrillation. It could be due to any other valolar heart disease. It could be due to a prosthetic heart wall. It could be due to a condition called as patent foramen ovale, where there is a small hole in the septum which separates the atria of the heart. So in these conditions, fibrin-rich clots form in the heart and spread to the brain. We prefer anti-coagulation in such patients. The anti-coagulations of choice are direct acting over anti-coagulation, which are very easy to take, and the patient doesn't need to monitor or do any blood investigation to know the effect of these medicines, unlike the earlier anti-coagulation which was called as vitamin K antagonis. So along with medicines, we also start the patient on rehabilitation measures. The rehabilitation measures include physiotherapy as well as occupational therapy. If the stroke has affected the speech and swallowing of the patient, we will start the patient on speech therapy as well as swallow therapy. Speech therapy consists of various excises which includes excises of the lips, excises of the perioral area. Swallow therapy helps the patient to improve the swallowing process because the swallowing process gets affected in many stroke patients, which leads to aspiration. So good swallow therapy will help the patient prevent aspiration. In the end, I would say if you treat stroke on time, time is brain. So if you treat stroke on time, we can limit the ill effects of stroke. So if the patient comes within four and a half hours, we can treat the patient with thrombolysis or thrombectomy. This will help in preventing morbidity as well as mortality.