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The short answer is a Neurologist!

But this is probably a bit of an oversimplification. In fact, your recovery from stroke will involve at least three different types of practitioners, starting with your primary care Doctor. Not only can it take from minutes to hours – stroke patients do not have this kind of time – to get hold of a neurologist, your primary care Doctor is also very well equipped to determine whether or not you are actually suffering a stroke attack. And if they feel that you indeed are suffering from something acute, they can always start the process of evaluating your symptom, and perform all the basic tests before referring you to a specialist, who would need those tests anyway.

Exams and Tests

The first test that your primary care Doctor can perform before he hands over your case to a specialist is the CT scan or an MRI to help confirm the presence of a bleeding in the brain and to determine the exact location thereof. The test will also help establish whether it’s an ischemic stroke or a hemorrhagic stroke. The additional test that your Doctor will typically recommend will include:

  • Electrocardiogram or ECG
  • Blood tests to check Complete blood count (CBC), Blood sugar, Electrolytes, Liver and kidney function, Prothrombin time and INR.

If your Doctor feels that you have a narrowing in the carotid artery, he may order below mentioned additional tests:

  • Carotid ultrasound/Doppler scan
  • Magnetic resonance angiogram (MRA)
  • CT angiogram and Carotid angiogram
  • Echocardiogram, or Holter monitoring, or Telemetry test to rule out heart-related complications

Identifying and Treating Stroke

While a Neurologist is on the way, your primary care Doctor will want to identify the type of stroke, its location, and the extent of damage that has been caused to the brain. He will also want to rule out other conditions and, to that end, he will:

  • Inquire about your symptoms, when they started, and any medical history
  • Check your level of consciousness, ability to move, coordination, and balance
  • Check for numbness or weakness in the body, and vision or speech impairment

Thrombolysis

Once your primary care Doctor has ascertained stroke, and the affected area of the brain, the next course of action will be a Thrombolytic Therapy, which is the procedure to dissolve the clots in blood vessels, thereby improving blood flow, and preventing damage to tissues and organs – in this case, the brain.The procedure might also involve removing the clot, or physically breaking it up. Since this procedure involves using a long catheter to deliver a clot-busting drug directly to the site of the blockage in the brain, your primary care Doctor will defer it to a trained Neurologist.

Your Neurologist will most likely use one of the below-mentioned drugs, also known as Thrombolytic Agents:

  • Eminase (anistreplase)
  • Retavase (reteplase)
  • Streptase (streptokinase, kabikinase)
  • t-PA (class of drugs that includes Activase)
  • TNKase (tenecteplase)
  • Abbokinase, Kinlytic (urokinase)

Stroke Rehabilitation

Once your primary care Doctor and Neurologist have worked together to remove the blood clot or the bleeding from the brain, a therapist will take over to ensure proper post-operative care, including stroke rehabilitation, the goal of which is to help you reacquire the skills that were lost because of the stroke. The actual length of this therapy will vary depending on the severity of the stroke and damage caused, but will typically last from few months to even years after the stroke.

The therapy will primarily focus on two areas:

  • Physical activities – These will include motor-skill exercises to help improve your muscle strength, mobility training to help stabilize and strengthen your body while you relearn to walk, constraint-induced therapy to reduce your dependency on the unaffected limb, and range-of-motion therapy to ease muscle tension and spasticity.
  • Cognitive and emotional activities– These will include therapy for cognitive disorders to help you with lost cognitive abilities such as memory and problem-solving, therapy for communication disorders to help you regain lost abilities in speaking and comprehension, and psychological evaluation to test your emotional adjustment and prescribe counseling or a support group.

So this will be the team of health professionals that will assist you in your journey to recovery from a stroke. However, it will all still depend on whether or not the patient reached a hospital within 3 to 4 hours of suffering the stroke. To that end, the importance of performing the B.E.F.A.S.T. test (Balance loss; Eye-sight impairment; Face drooping; Arm weakness; Speech difficulty; Time to act) on a person who is showing the symptoms of stroke, cannot be emphasized enough. If a loved one has failed the B.E.F.A.S.T. test, contact us at 8008104199 immediately to properly diagnose the issue and evaluate treatment options available to you!

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A very complex and highly specialized interconnection of the human body’s internal circuitry, the nervous system is like the body’s multimeter to the outside world, in the sense that it controls:

  • The body’s sense of sight, hearing, taste, smell, and sensations
  • The body’s ability to perform movement, balance, and coordination
  • The mind’s ability to think, reason, be conscious, and have thoughts, memories, and language

Divided into three parts – viz the brain, the spinal cord, and the nerve cells – the nervous system also regulates a whole range of voluntary and involuntary vital actions, such as blood flow and blood pressure. Given their enormity, they are prone to a host of problems, the symptoms of which might manifest all of sudden, posing a life-threatening situation or they might develop over a long period, all the while causing slow deterioration in one or a group of certain brain functions. Also, the symptoms can be mild or severe, transient or permanent, physiological or psychological, but never nonexistent, and when they do manifest, they will be in one of the following forms:

  • Numbness, tingling, weakness, or loss of mobility in certain body parts
  • Lack of focus, reduced light sensitivity, double vision, tunnel vision, or loss of vision
  • Incoherentor illegible speech, confusion, and change in level of consciousness
  • Sudden onset of a severe headache, nausea, and vomiting
  • Dizziness, unsteadiness, or loss of balance and equilibrium
  • Seizures and abnormal body movements, such as twitching

In addition to these, there might also be certain behavioral changes that might not seem like an indicator of anything serious, but might actually be due to an underlying cause. These can include:

  • You find it difficult or impossible to move certain parts of your body
  • You can’t put weight on one leg as you have pain running down that leg
  • You find it hard to coordinate your movements, making you clumsier than before
  • You seem to be having to run to the bathroom too frequently and for no apparent reason
  • You get intense headaches that come and go frequently, but without any pattern

These symptoms will depend on the specific area of the nervous system that has been impacted and the underlying cause and the nature of these symptoms can provide clues as to the site of the issue. These sites can be divided into categories – Lower Level Sites, which include muscle, motor-end plates, peripheral nerves, spinal nerve roots, etc; and Higher level Sites, which include brainstem, cerebellum, thalamus etc. Below are the typical symptoms of issues in these specific areas:

  • Lower-level sites
    • Weakness in a specific set of muscles: Depending on the set of muscles impacted, the symptoms will be noticed when climbing stairs, getting up from a chair, lifting something, or even chewing the food.
    • Fatigue and weakness in motor end plate: This happens when the motor nerve impulses are unable to properly connect with the muscle end plate at the neuromuscular junction.
    • Weakness and muscle atrophy: This happens when there is sensory nerve damage, and might cause numbness, tingling, shooting or burning pains, hyperesthesia, and an absence of reflex activity.
    • Abnormal posture, abnormal deep and plantar reflexes: Caused by damage to the spinal cord, and often results in pain, temperature, and loss of scratch sensations.
  • Higher-level sites
    • Loss or reduced activity of cranial nerve functions: Caused by damage to the brainstem, this can also be life threatening, since many critical functions, such as consciousness, respiration, and blood pressure, are controlled from there
    • Difficulty in maintaining an upright posture: Caused by damage to the cerebellum, this can also be accompanied by other symptoms such as jerky movements of the eyes at rest, ataxia of the limbs, and even a severe tremor
    • Loss of sensation on the opposite sides of the body: This is typically caused by a lesion in the thalamus, and might be accompanied by extreme pain. Other related symptoms can include disorders of eye movement and speech impairment.
    • Loss of ability to perform purposeful actions: Damage to the various parts of the cerebral hemisphere can result in a loss of different day-to-day abilities, including something as complex as foresight, planning, and comprehension; or something as simple as the ability to put on clothes.

Unfortunately, the symptoms of a nervous system disorder might resemble the symptoms of other medical conditions or problems, making it difficult for family members to realize the gravity of the affliction. If you or a loved one has these symptoms, call us at 8008104199 immediately to properly diagnose the issue and evaluate treatment options available to you!

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Back when I was in college, I could never start studying at odd timings such as 9:27 am, or 11:05 am – it always had to be the beginning of an hour, or half an hour later, else it just didn’t feel right, and before I would know, the day was gone with nothing to show for it. Classic procrastinator, I know!

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It’s called Silent Killer for a reason. High Blood Pressure or Hypertension, a disease of the cardiovascular system that is characterized by a blood pressure of 140/90 or above, does not have many symptoms – some may experience occasional headaches, nosebleeds or shortness of breath, but for the most part, the body endures the disorder without any signs.

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My grandfather used to tell me stories about how he, his five siblings, and their 11 cousins used to spend their childhood days swimming in the village pond or riding cows in the paddy fields, when they were not busy fighting among themselves.

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