Stroke team at Jehangir Hospital, Pune
Pune (Maharashtra) [India], July 11: Stroke is a disease that affects the arteries leading to and within the brain. It is becoming a leading cause of premature death and disability in countries like ours, largely driven by demographic changes and increasing prevalence of the key modifiable risk factors. This can happen to anyone, most commonly to people between the ages of 40 to 60 years and above. The good news is that now effective treatments can help prevent disability from stroke. Jehangir Hospital provides a comprehensive range of diagnostic as well as therapeutic services for patients with any neurological ailments.
Jehangir Hospital’s Neurosciences department provides efficient 24/7 services and is renowned for treating stroke patients during the critical Golden Hour. The first 4.5 hours after a stroke are crucial because 2 million neurons are lost per minute. Patients who receive clot-dissolving injections within this timeframe have a higher chance of survival and avoiding long-term brain damage. In acute ischemic stroke cases, treatment should be administered within 60 minutes of the patient’s arrival.
Dr. Sandeep Borse, Neurologist at the Jehangir Hospital says, “Majority cases that we see are the patients from age group of 60 years and above. There are many cases from the age group of 30-45 years too. This is because of the lifestyle that we are leading nowadays. However, a brain stroke is also hereditary in nature.” He further added, “When an acute stroke patient comes within the Golden Hour in the Emergency room, a CODE STROKE is activated. Then a rapid neuro examination, CT scan and MRI is done in no time, following which the decision for IV Thrombolysis is taken. If the CT scan shows major vessel blockage then, to remove the clot neuro intervention can be done in time. We have achieved Thrombolysis in 13 minutes (DTN) from arrival which was the fastest thrombolysis done. At Jehangir hospital, all the hospital staff is trained, ensuring rapid and effective treatment for a patient suffering from a stroke.”
Jehangir hospital offers top-quality multidisciplinary care and has a dedicated neuro team. They have implemented the Acute Stroke Care-Pathway system for systematic documentation of patient records, facilitating better guidance during follow-ups. The hospital also provides comprehensive epilepsy care for patients who have experienced strokes or other brain injuries. Advanced diagnostic tools such as EEG, video EEG telemetry, MRI, and PET scans aid in rapid assessment and adjustment of antiseizure medications.
Pediatric Neurological services like Clinical Neurology, Neurogenetics disorders, Neuroendocrine tumor and accessibility of various major tests like the EMG/NCV, BERA are also available. The hospital has a world class infrastructure with the state-of-the-art PICU and NICU for all pediatric neurological emergencies such as brain trauma, brain infections, autoimmune disorders and status epilepticus and acute pediatric stroke.
Neurological Services :
1. Acute stroke thrombolysis
2. Neuro intervention (mechanical thrombolysis, aneurysm coiling, carotid stenting, AVM embolization)
3. Carotid endartrectomy
4. Separate Neuro ICU care
5. Advance care for GB syndrome, myasthenia grains and neuropathy
6. Pediatric Stroke management
Hospital on Wheels:
Jehangir hospital pioneered fully equipped Specialty Care Ambulances in 2003, offering 24/7 emergency services for strokes, cardiac issues, and trauma. Ambulances are dispatched within 5 minutes with trained medical staff, ensuring rapid intervention and communication with the hospital. Call 8888881066 for assistance.
Dr Soumya Chandrashekhar, Consultant – Accident and Emergency Department says, “The stroke team comprising the emergency physician, emergency department nurse, intensivist, neurologist, radiologist, interventional neurologist and neurosurgeon on call are alerted via this code. Within the first 4.5 hours of the onset of the stroke a patient may be eligible for fibrinolytic therapy. We ensure that through continuous quality monitoring, the time of arrival of a patient to the AED to the time of administration of the fibrinolytic agent is minimized to less than 60 minutes. When the patient is eligible for endovascular therapy, such as a mechanical thrombectomy, our interventional neurologist and radiologist, step in for immediate management.”
Jehangir Hospital implemented the CODE STROKE PROGRAM in 2015. Jehangir Hospital’s Emergency Department is a Level-1 tertiary care facility with standardized clinical systems, including the CODE STROKE, CODE CARDIAC, and CODE TRAUMA programs. The hospital has been recognized by the World Stroke Organization for their prompt treatment with door-to-needle times under 45 minutes.
CT and MRI study of Brain play important roles in acute stroke management. Dr Rajendra Chavan, Interventional Neuro – Radiologists at Jehangir Hospital says, “Stroke patients undergo brain CT or MRI to rule out other causes. Once these causes are ruled out, eligible patients receive clot-dissolving drugs intravenously to restore blood flow. Some patients may require additional imaging of blood vessels if they don’t show improvement. Patients with large blood vessel occlusions may undergo Mechanical Thrombectomy if specific criteria are met.”
Mechanical Thrombectomy is at the cutting edge of Acute Stroke treatment since the last decade. Dr Anand Alurkar, Consultant Interventional Neurologist at Jehangir Hospital and President – elect of Indian Stroke Association, says “This procedure is performed in the cathlab via the patient’s groin artery. This is a highly effective therapy and about 80% of patients benefit in the form of early and significant recovery. With recent developments in protocols and case selection, this therapy can be offered in the first 24 hours too, provided certain criteria are satisfied. In patients who have minor strokes or ‘Transient ischemic attacks’, a major stroke can be prevented with highly effective and safe procedures like ‘Carotid Stenting’ and ‘Intracranial Stenting’. Jehangir Hospital has all the necessary expertise, equipment and protocols in place for Stroke patients to benefit from these procedures.”
Occlusion of blood vessels supplying the brain causes significant ischemic damage, leading to Malignant Cerebral Infarction. Severe brain damage and midline shift indicate a life-threatening condition. Without surgical intervention, mortality is around 80%. Decompressive craniectomy is the only available treatment, reducing mortality but often resulting in disability.
The decision to perform decompressive craniectomy requires careful assessment by physicians and surgeons, considering factors such as the patient’s condition, potential benefits, and predicted quality of life post-surgery. Interdisciplinary collaboration is essential for managing this complex decision-making process. Recovery from decompressive craniectomy can take 4 to 8 weeks.
Post craniectomy, the bone is replaced once the swelling subsides and the patient has a good recovery. In some cases, we use 3D printed titanium mesh. This procedure is called Cranioplasty.
Brain surgical services:
- Microsurgery for Brain Tumors
- Endoscopic Brain Surgery
- Skull Base Surgery
- Brain Trauma Surgery
- Congenital Cranial Deformity
- Craniofacial Surgery with FMS (Facio-Maxillary Surgery)
- Brain Surgery for Abnormal Blood Vessels
- Brain Surgery for Epilepsy
- Brain Surgery for Removal of Blood Clots
- Stereotaxic Brain Surgery for Tumor and Functional Neurosurgery
- Interventional / Neuro-endovascular Therapy for Cerebro-vascular Diseases and Tumors
- Pre-operative Embolization of Brain Lesions
The rehab team at Jehangir Hospital provides comprehensive cognitive and physical disability assessment and therapy for a wide range of neurological disorders such as stroke, traumatic brain injury, hypoxia, brain infections, epilepsy, neurosurgery, Parkinson’s disease, multiple sclerosis movement disorders, ataxias etc.
A WHO Sustainable Development Goal suggests: “Ensure healthy lives and promote well -being for all at all ages”. In keeping with the WHO guidelines Neurorehabilitation at Jehangir Hospital is based on high-quality integrated care, Individually tailored, Evidence-based, Multidisciplinary teamwork, Early intervention is essential, and Clinical Care Pathways.
Physiotherapy and Functional Rehabilitation
Expert physiotherapists plan goal-oriented therapy based on detailed assessments. Functional rehabilitation includes: Early interventions during the critical care period, Neurofacilitation techniques for neurological disorders, Tailored therapy for restoring functional ability and independence, Training for balance, coordination, mobility, and agility, Discharge planning and support for level of care required at home, Training for transferring patient management skills outside of rehabilitation setting, Assessment of work/home environment and adaptations, assistive devices, Strength and endurance training, and Focus on long-term community integration: improving participation for return to appropriate levels of work, study, hobbies, leisure or daily living.
Holistic approach to cognitive rehabilitation is followed. This includes: Detailed cognitive assessment, Cognitive rehabilitation strategies to help overcome problems like memory, attention and concentration, perceptual, neglect and other such difficulties, Memory aids clinic, Assistive technology/Virtual reality based cognitive rehabilitation, Teaching cognitive strategies to improve optimal daily functioning, recommendations and suggestions for return to work after stroke, Goal setting, establishing daily and weekly routines, simulation of everyday activities, Psychological counselling for emotional problems like depression, fear, anxiety and anger, Education on understanding stroke, preventing another stroke, Caregiver training for implementing rehab strategies at home, Counselling and guidance for caregivers experiencing depression, anxiety or stress, and Dementia diagnosis and rehabilitation clinic.
The neurorehabilitation team at Jehangir Hospital also offers a wide range of support services for people after stroke. These include:
- Post stroke follow-up: with physicians and rehabilitation specialists
- Virtual Reality based rehabilitation (Cognitive + Physical Rehabilitation)
- Geriatric cognitive and physical stimulation programme
- Cardiac Rehabilitation
- Multi-disciplinary program for management of stroke risk factors like diabetes, hypertension, obesity, cholesterol etc.
- Wellness Centre
- Resources: Relevant websites, adaptive equipment, education booklets on a range of topics related to stroke and its management
- The rehabilitation department is spacious and well-equipped with specialized and relevant technological equipment in order to achieve the goals of independence and community integration. Education material is also provided on a range of relevant topics.
Unique features of Neurorehabilitation at Jehangir Hospital:
- Team of experienced and talented rehabilitation professionals
- Inputs from different rehabilitation departments under one roof such as Physiotherapy, Neuropsychology, Speech/Language therapy and Physician
- Utilizing advanced technology in rehabilitation where appropriate
- Cost effectiveness compared to international neurorehabilitation centres.
Prevention is better than cure
The incidence of stroke and stroke-related dementia is increasing in India due to lifestyle-related risk factors like diabetes, hypertension, high cholesterol, poor sleep, and smoking. Stroke cases among young people have risen by 12%, causing long-term neurodisabilities. Jehangir Hospital’s rehab department takes a holistic approach to preventive treatment, offering awareness sessions, physical fitness testing, stress profiling, and lifestyle modification programs. They also educate about cardiac risk factors as part of their Cardiac Rehabilitation Program. These efforts aim to optimize brain health and reduce the impact of stroke.
“In 2021, I experienced a stroke without warning signs. Despite feeling normal, I noticed my grip weakening and objects slipping from my hands. It was only when my wife noticed changes in my face and speech that we realized it was a stroke. My family rushed me to Jehangir Hospital where Dr. Sandeep Borse and his team provided timely care. The suddenness of the stroke emphasized the importance of quick medical intervention. I consider myself fortunate to have received prompt treatment at Jehangir Hospital, where I was pulled out of danger with compassionate care.” says Shankar Travadan.
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