Every minute counts in a stroke: a neurologist on which treatment works when

Timely, correct treatment can save a stroke patient's life and reduce the risk of lasting disability, yet many families wait for symptoms to pass or try first aid at home. Writing in Ajker Patrika, Dr Somen Chowdhury, consultant and coordinator in the neurology department of Evercare Hospital Chattogram, warns that every moment of delay can kill more brain cells.

There are two main kinds of stroke. In an ischaemic stroke a blood vessel in the brain is blocked by a clot or another cause; in a haemorrhagic stroke a vessel bursts and bleeds. Either way, brain cells deprived of oxygen and nutrients are quickly damaged.

Dissolving the clot with drugs through a vein is called intravenous thrombolysis. Under the 2026 guideline of the American Heart Association and American Stroke Association, Dr Chowdhury writes, suitable adult patients with an ischaemic stroke can be given alteplase or tenecteplase within four and a half hours of symptoms starting. If advanced imaging shows brain tissue that can still be saved, thrombolysis may be considered between four and a half and nine hours, including for some people who wake up with stroke symptoms.

When a large brain artery is blocked, selected patients can have the clot removed with a device, a procedure called mechanical thrombectomy. It is usually done within six hours, but for patients who meet specific clinical and imaging criteria it can be done between 6 and 24 hours. So even a late arrival at hospital should be assessed for treatment. A bleeding stroke may need blood pressure control, reversal of drugs that worsen bleeding and sometimes surgery.

To reduce risk he advises controlling blood pressure, diabetes and cholesterol, giving up smoking, regular physical activity, less salt, a balanced diet with vegetables and fruit, a healthy weight, and taking medicines as a doctor prescribes.

Many people are left with weak limbs or trouble speaking or walking after a stroke. Medicine alone is not enough, Dr Chowdhury writes: rehabilitation, including physiotherapy, speech practice, treatment for swallowing problems and training for daily tasks, should begin on a doctor's advice once the patient is stable.

Source: Ajker Patrika