Neurological disorders are medically defined as any abnormality that affects the brain and nervous systems found throughout the body. A wide range of symptoms can be caused by structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves. Among other neurological disorders, stroke is ranked as one of the major causes of death worldwide. In addition, its incidence and prevalence have continued to rise continuously. Current medical evidences have strongly affirmed that not only the elderly, stroke can also attack anyone at any age, including teenagers and working-age groups. People aged 18-50 are at risk of developing stroke with different contributing factors or causes. Besides an accurate diagnosis and effective treatment, awareness towards warning signs and symptoms of stroke is crucial in order to seek medical attention in timely manner. There are two main types of stroke: an ischemic stroke (blocked or obstructed artery) and a hemorrhagic stroke (leaking or bursting of a blood vessel). If left untreated, disrupted blood flow can substantially cause permanent brain damages that might eventually lead to long-term disability or even death.  

BEFAST: Warning symptoms of stroke

If you or someone with you may be having a stroke, additional attention must be paid to the time the symptoms began since treatment options are most effective when given immediately after a stroke attacks. Warning signs and symptoms, BEFAST include:
  • B – Balance: Trouble walking, a loss of balance or a loss of coordination, sudden dizziness or virtigo
  • E – Eye: Visual disturbance e.g. blurred vision or blackened vision in one or both eyes or sudden double vision
  • F – Face Drooping: Facial droop or numb face, uneven or lopsided smile
  • A – Arm Weakness: Sudden numbness, weakness or paralysis in arm or leg. This often affects just one side of the body.
  • S – Speech Difficulty: Difficulty speaking e.g. slurred speech or difficulty understanding speech
  • T – Time to Call: If the person shows any of these symptoms above, call emergency medical services and go to the nearest hospital immediately.

 

The magic number 4.5 hours – The golden hour of stroke.

Every minute counts. The longer a stroke goes untreated, the greater the potential for permanent brain damage and long-term disability. Emergency treatment for stroke depends on its type whether it is an ischemic stroke or a hemorrhagic stroke. Standard treatment guidelines have firmly indicated the importance of the “golden hour” since stroke patients have a much greater chance of surviving and avoiding permanent brain damage as well as reducing other complications if treatments can be given within 4.5 hours after symptoms begin. To treat an acute ischemic stroke, the effectiveness of intravenous thrombolytic or fibrinolytic therapy – a recombinant tissue plasminogen activator or rtPA is time dependent.  Emergency therapy with intravenous fibrinolytic drugs that can break up a clot in the blood vessel has to be given within 4.5 hours after symptoms first started. The sooner these drugs are given, the better outcomes. An IV injection of rtPA, also called alteplase is the gold standard treatment for an ischemic stroke. An injection of rtPA is usually administered through a vein in the arm. Its mechanism of action is to restore blood flow by dissolving the blood clot causing blocked or obstructed vessel that leads to an ischemic stroke. By quickly restoring blood flow to the affected area, this medication can significantly result in a full recovery after a stroke attack. However, it is highly recommended for patients who have an ischemic stroke without the evidence of bleeding (brain hemorrhage).  Certain risks related to thrombolytic therapy such as potential bleeding in the brain will be thoroughly considered in each patient prior to administration. In case that patients with large clots arrive at the hospital later than 4.5 hours but not longer than 24 hours after the symptoms are first noticed, rtPA administration might not be able to dissolve the clots completely and emergency endovascular procedures are further required.  These clots in the brain can be removed by using a stent retriever. During this procedure, a neurosurgeon or an interventional neurologist uses a device attached to a catheter to directly remove the clot from the blocked blood vessel in the brain. This procedure is often performed in combination with IV rtPA administration. Due to this procedure involves certain risks, it must be conducted by highly experienced specialists in order to achieve the best possible outcomes while minimizing side effects and undesired complications.  Additionally, perfusion imaging tests can help determine how likely it is that someone can benefit from endovascular therapy.  

Emergency treatment of acute stroke

To treat an acute stroke, apart from the administration of IV fibrinolytic drugs (e.g. rtPA) and the removal of a blood clot under image guidance (endovascular thrombectomy), Biplane DSA or Biplane Digital Subtraction Angiography is an advanced imaging technology that can be deployed for both diagnosis and treatment of stroke. Defined as Minimally Invasive Procedure, Biplane DSA can be used for angioplasty and stents. Instead of opening up the skull, in an angioplasty, a neurosurgeon threads a catheter to arteries through an artery in the groin and a balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery. In severe cases with critical brain damages, stereotactic neurosurgery might be potentially considered. Stereotactic neurosurgery refers to the use of a three-dimensional coordinate system combined with an imaging technique, such as computed tomography (CT) and magnetic resonance imaging (MRI) to precisely pinpoint targets deep within the brain before surgery begins. As a result, a neurosurgeon is able to conduct  a brain operation only in the affected area with high degree of accuracy and precision while preserving surrounding areas in the brain. In some cases, brain surgery can be performed through a small incision, sized only 1-2 cm., resulting in less pain, minimized post-operative complications  and reduced chance of disability as well as faster recovery.

Postoperative care

After brain surgery, postoperative care and rehabilitation are vital for achieving effective treatment outcomes. In the first 3-5 days after brain surgery, complications that might arise usually include bleeding in the brain, re-occlusion or early recurrent ischemic stroke, brain edema, increased intracranial pressure (growing pressure inside the skull) and brain infection. The other common secondary brain injuries after brain surgery also include brain hypoxia (insufficient oxygen supplied to the brain) and convulsion which often leads to further brain damages. To closely monitor these severe complications, postoperative care in an intensive care unit (ICU) remains important, allowing for an immediate treatment if any abnormal condition inevitably develops. More importantly, postoperative care significantly reduces the mortality rate and long-term disability in stroke patients . Reboot your bain กู้สมอง ฟื้นฟูแบบองค์รวม

Smart ICU for neurological care

Smart ICU at Bangkok International Hospital is an integrated intensive care unit specialized in neurological disorders. Supported by the latest technology and advanced medical informatics, our smart ICU addresses all essential processes involved in utilizing and maintaining infrastructure and system for critical care. In order to promptly monitor each patient under critical conditions, smart ICU has been designed to collect, organize and analyze real-time patient’s data and relevant medical parameters, covering vital signs, oxygen level in the blood, fluid balance (intake and output), intracranial pressure, electrocardiography (EKG) to monitor heart functions and electroencephalography (EEG) to monitor electrical activity of the brain. Smart ICU devices are equipped with various sensors to measure and compare these parameters at all times, allowing for appropriate and timely treatments. If patient’s conditions suddenly alter, treatment can be adjusted accordingly based on “precision and personalized medicine concept”. In addition, Real-Time Data Collection and Integration of Information in smart ICU can facilitate telemedicine wherever and whenever treatments are required. Reboot your bain กู้สมอง ฟื้นฟูแบบองค์รวม

Emergency medical evacuation of acute stroke patients

Time lost is brain lost. The more time that passes between the onset of a stroke and treatment, the more likely that brain functions are permanently damaged. Since every second counts, an emergency medical evacuation is crucially important, aiming at preventing further damages to the brain during medical transportation. In order to preserve brain functions and minimize the chance of additional brain injuries, emergency medical evacuation of acute stroke patients involves multiple systems and further care, including:
  1. Respiratory system: Oxygen supply to the brain and carbon dioxide levels must be maintained and ensured that brain edema or damage will not further develop.
  2. Circulatory system: Most of critical situations, blood supply to the brain significantly reduces, particularly to the affected area. Thus, sufficient blood supply to the brain must be provided.
  3. Brain and nervous system: The alterations of brain activities e.g. brain electrical impulses need to be closely monitored at all times. If any change is detected, an immediate care must be given.
  4. Prevention of additional brain cell damages: To prevent additional brain damages, it is crucial to maintain brain activities and eliminate trigger factors that cause brain to consume more oxygen e.g. fever, convulsion and agitation.
  5. Environmental adjustment: The patient’s head and neck must be suitably adjusted in comfortable and safe positions.
  6. Timely diagnosis and treatment: After an emergency evacuation completes, diagnostic tests must be immediately conducted, enabling the accurate diagnosis to be obtained, leading to timely treatment before brain cells are permanently damaged and the chance of full recovery becomes limited.

BDMS Medevac Center

BDMS Medevac Center provides a full range of medical evacuation services around-the-clock. Services cover any part in Thailand and neighboring countries. Evacuation coordinators stand by to coordinate with a multidisciplinary team to reach immediate attention for patients in critical conditions through all transportation routes e.g. ground ambulance and sky ICU. Supported by advanced medical devices for air evacuation, our sky ICU is well operated by highly experienced and well-trained flight physicians and nurses specialized in aeromedical care. Our service quality meets international standard of International Civil Aviation Organization and The Commission on Accreditation of Medical Transport Systems (CAMTS). To ensure the best possible outcomes for evacuation, our on-board facilities include portable devices for intensive care, vital sign monitoring system, ventilators, automated external defibrillators and extracorporeal membrane oxygenation (ECMO).

Neuroscience Center, Bangkok International Hospital

Neuroscience Center, Bangkok International Hospital offers a holistic care in neurological disorders and other related problems. Recognized as one of the best neurological institutes in Thailand, our multidisciplinary team comprises of neurosurgeons, neurologists, neuro-intensivists, rehabilitation specialists, physiotherapists, nurses, pharmacists, dieticians and other medical personal specialized in neurological care. Supported by cutting edge technology in advanced neurological diagnostics and surgical treatments, our broad spectrum of comprehensive services cover preventive program, accurate diagnosis, effective treatment and rehabilitation therapy. The ultimate aim is to treat individual patients at the cause of their diseases and to minimize the risk of recurrence while taking into a consideration of patient’s needs and quality of life under the concept of SMART: S: Specialists for particular neurological diseases M: Modern care that is individually designed for each patient A: Advanced equipment in diagnosis and treatment R: Reputation retrieved from quality care and treatment outcomes T: Technology that increases accuracy, precision and safety Our standard in neurological care has been internationally assured by JCI (Joint Commission International), USA. In addition, Neuroscience Center closely collaborates with several hospitals in BDMS network and other alliance hospitals across Thailand. References: Dr. Nanthasak Tisavipat Director of Neurosurgery, Neuroscience Center, Bangkok International Hospital. Dr. Aprichart Pisarnpong Director of Neurology, Neuroscience Center, Bangkok International Hospital. Dr. Chanpong Tangkanakul Neurologist, Neuroscience Center, Bangkok International Hospital. Dr. Doungporn Ruthirago Neurointensivist, Neuroscience Center, Bangkok International Hospital Dr. Ekkit Surakarn Director of BDMS Medevac Center, Bangkok Hospital For more information, please contact Neuroscience Center, Bangkok International Hospital Tel: +662-310-3000 or 1719 (local call only) Email: [email protected]