STROKE PARALYSIS

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NEUROLOGY
NEUROLOGY
ORTHOPEDICS
ORTHOPEDICS
GENERAL DISEASES
GENERAL DISEASES

STROKE PARALYSIS

A clinical syndrome in which there is rapidly developing clinical signs of focal (or global in case of coma) disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin. In simple words, due to lack of blood supply in any part of the brain (which can be due to block or hemorrhage) causing death and loss of functioning of the brain cells in the affected area. It is one of the leading causes of death and disability in the world.

In Ayurveda Pakshaghata and Ardhitam refers to hemiparesis and facial paralysis conditions. The concept of srotho dushti like – Sangha, Atipravruthi, sira granthi, and Vimargagamanam all can happen in disease manifestation of Pakshaghata. It can be due to Avarana as well as dhathu kshaya. It is explained in Vatavyadhi chikitsa.

TYPES

Three types of CVA based on the cause

1. Ischemic – Due to block in blood vessels – thrombosis/emboli

2. Hemorrhagic – Due to the rupture of blood vessels

3. Transient Ischemic attack – the cause and symptoms resolve themselves in a few minutes.

Note – The most common types include -Cerebral infarction, Intracerebral hemorrhage, Subarachnoid hemorrhage, Cerebral venous thrombosis

The TOAST classification denotes five subtypes of ischemic stroke:

1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) stroke of other determined etiology, and 5) stroke of undetermined etiology.

Stroke Paralysis, rehabilitation
Stroke Paralysis

Signs and Symptoms

A stroke usually affects one side of the brain and the opposite side of the body is affected. It means if the left side of the brain is affected then weakness etc seen on the right side of the body.

Numbness weakness or paralysis –  hemiplegia or hemiparesis of hand/leg/face

  • Speech  – slurred/completely affected
  • Vision  – Blurred /completely lost
  • Altered consciousness – Confusion/coma
  • Severe headache
  • Vomiting

Difficulty in breathing and swallowing can occur in some cases.

Causes of stroke

Ischemia – It can be from embolism due to endocarditis, recent MI, arrhythmia, cardiac valve disease, etc. It can be from thrombosis due to arterial dissection, atherosclerosis, vasculitis, thrombocytosis, etc. It can be from small vessels causing lacunar infarct.

Hemorrhagic – It can be due to HTN, Aneurysm, use of anticoagulants, trauma, etc

In Ayurveda, the causes can be explained based under samanya Vata vyadhi nidana and it is mostly the causes which will do the vata prakopa. It includes specific food products, abnormal dietary patterns, abnormal sleeping patterns, lifestyle issues, mental factors like excess anger, fear, stress, etc, and trauma.

Stroke Paralysis

Diagnosis

FAST – check Face, Arms, Speech – if affected – no Time to waste.

The main aim is to diagnose the cause – Ischemic – thrombus or emboli or hemorrhagic as soon as possible.

Blood tests, CT, MRI, Cerebral Angiogram, Echocardiogram, Carotid Ultrasound, etc are used

Risk factors

  • Sedentary life style – lack of exercises
  • Obesity
  • Alcoholism, addictions
  • Smoking
  • Uncontrolled hypertension
  • High cholesterol levels
  • Uncontrolled diabetes
  • Cardiovascular diseases
  • Family history and history of the previous stroke
  • Old age
  • Sleep apnea

AYURVEDIC TREATMENT FOR STROKE

Stroke Paralysis kerala

Maurya Stroke rehabilitation program is tailor-made based on the presentation of symptoms in various patients. Ayurveda external treatments stimulate the external receptors of the nerves – all types. The special treatments for the stimulation of the nerves also play a vital role in the stroke patient treatment like Nasyam (nasal medication), Thalam, Thalapothichil, Shiropichu, Shirovasti, Shirodhara etc. Udwarthanam (herbal powder massage) also helps to improve the circulation, stimulates the nerves. Vasthi with medicated oils helps to improve nerve strength by controlling the vata prakopa. Marma therapy similar to acupressure treatments also helps in stimulating the nerve endings. Most of the treatments in Ayurveda helps to relax the mind of the patient thereby helping to combat depression if any. The hot Kizhi and Dhara help in reducing any pain in the body – neurological or due to joint stiffness.

Combination of ayurveda along with other treatments therefore speeds up the recovery of the patient.

Treatment  of Stroke

It is of two phases – Acute management and stroke rehabilitation

Acute management -The faster the treatment is made available better the prognosis. So the main aim is to maintain the vitals, diagnose fast the type of stroke, and initiation of treatment. The first few hours within 3 to 6 hours after the onset of symptoms is a very crucial time to avail the treatment.

Emergency management of ischemic stroke includes  – (thrombolysis/thrombectomy) administering IV clot-dissolving medications, or delivering the same medicine directly into the affected area, removing a clot with a stent retriever, carotid endarterectomy, angioplasty /stents, etc combined or alone. There is a rare chance of bleeding and complications post thrombolytic treatments. A craniotomy is done in some cases with too much edema.

Emergency management of hemorrhagic stroke includes – to counter if blood-thinning medications taken if any, maintain low blood pressure, preventing seizures, craniotomy, surgical removal, clipping, coiling, or stereotactic radiosurgery of artery.

 Stroke rehabilitation

Irrespective of prognosis every stroke patient requires a treatment plan. Even though a patient with severe stroke features and possibly not expected to make any recovery, still the patient requires a treatment plan which usually includes passive movements, Orthotics, diet advice, proper nursing care to prevent bedsores, muscle wasting, stiffness, and deformities, etc.

Stroke Paralysis

Complications and its prevention

Recurrent chest infections leading to pneumonia in patients especially with swallowing difficulties – Proper positioning while food intake, a planned diet with consistency semi-solid/solid/liquid, NG tube, PEG feeding, etc.

Bedsore if lack of proper nursing care – use of air bed, water bed, changing position of sleep, use of moisturizing agents for the skin, maintaining proper hygiene.

Risk of Fall, osteoporosis, and Fractures – proper supplements, active and passive movements, diet modification, use of supporting devices like walker, tripod, stick, etc

Muscle wasting, – active or passive exercises.

Joint stiffness and Flexion deformities – use of orthotics like splints, active or passive movements.

Depression and other emotional issues – religious/family/psychiatric counseling

Neurological pain – with medications and counseling

Loss of memory or thought process – medications can help to an extend

Recurrence of stroke – maintain proper medications, avoiding the risk factors as explained before.

“Prevention is better than cure”

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FREQUENTLY ASKED QUESTIONS

The primary moto of treatment is to Relearn the lost skills

Electric stimulations like NMES, FES. Motion exercises passive - manual, CPM devices, robotics. Semi Assisted and active exercises, Gait training -hydrotherapy/suspended gait training, Speech therapy, Acupuncture, etc. Counselling, Diet modification, and Proper nursing care.

It depends on the severity of the stroke and other factors. Some cases recover very fast while others will require months and years of treatment when they make slow progress. Such cases are advised to have an intensive course of rehabilitation admitted in facilities like ours and then discharged after educating the patient and bystanders for home exercises and care; then to readmit after some time. Such courses of treatments to be repeated. Some cases which do not progress will also require continuous care and treatment to prevent complications.

Patient cooperation Family or bystanders support Comorbidities - like diabetes, HTN, hyperlipidemia, cardiac diseases, or any other systemic, musculoskeletal, neuro diseases

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