Stroke is one of the leading causes of death and long-term disability in Thailand. Statistics show that every year approximately 150,000 Thais suffer from stroke. The prevalence of which is estimated to be 1.88% amongst adults 45 years of age and older. However, if the general public makes an effort to understand stroke, its causes, as well as its implications, then prevention and treatment will become more efficient.
Dr. Chanpong Tangkanakul Director of Bangkok Neuroscience Center at Bangkok Hospital indicates that stroke occurs as a result of an abnormality in the blood supply to the brain. There are two types of stroke that cause the brain to stop functioning abruptly, namely ischemic stroke (lack of blood supply) and hemorrhagic stroke (bleeding in the brain). 70% of stroke occurs as a result of lack of blood supply to the brain. This is caused by 3 major factors: 1. Blockage of blood vessels due to the deterioration or hardening of arteries 2. Blood clot from heart from arterial wall of the heart travels to the brain and clogs blood vessels 3. Blood pressure reduces to the point that it is unable to supply adequate blood to the brain.
The other 30% of stroke causes are a result of hemorrhagic stroke; which can be classified intoIntracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH).
Factors that contribute to stroke are everyday factors that are preventable such as smoking, lack of exercise, obesity, taking contraception, stress. At a higher risk are individuals with coronary artery disease, peripheral arterial disease, the elderly, and people with a pre-existing heart condition, diabetes, hypertension, and atrial fibrillation.
Dr. Chanpong further indicates that the symptoms and severity of stroke can be divided into 3 stages according to time period, the position of stenosis (where and which blood vessels have narrowed, and the size of the artery.
“Patients in the first stage will display minor symptoms, such as being unable to speak clearly; the side of the mouth may droop, feel weariness in arms and legs but still able to walk. It usually does not have accompanying headaches and if provided with proper treatment and care early, the patient can be expected to recover within 2-4 weeks.
The 2nd group of patients are in the middle stages and may experience sudden changes in symptoms that may include weakness to the point where the patient is unable to move or speak. This stage requires urgent medical attention and treatment to prevent further complications as a result of stroke. Recuperation for this group will start becoming evident in the 3rd week, however full recovery is unlikely at this point. The patient may still have difficulty moving and communicating; he/she will require consistent physical therapy and may need other equipment for support such as a wheel or crane.
The last group is considered to be in the critical stages, and can deteriorate rapidly within 24 hours. This is most common in older patient with major arterial blockage in the brain (ischemic). These individuals often have a pre-existing heart condition, diabetes, or have been paralyzed previously, which increases the chances for complications to occur”.
Dr. Chanpong has provided information regarding the evaluation of stroke patients in accordance with the B.E.F.A.S.T. model. The B.E.F.A.S.T. model emphasizes the following
- B – BALANCE : Loss of balance or or unsteadiness, sudden dizziness or a loss of coordination
- E – EYES : A sudden blurred or blackened vision
- F – Face : facial deformities i.e. shape
- A – Arm : weakness in arms and legs
- S – Speech : slurred speech or inability to speak at all
- T – Time : prompt medical attention required
“Apart from the principles of B.E.F.A.S.T. Bangkok Hospital emphasized treatment planning of stroke in emergency situations (ischemic stroke) to prevent severe damage that may occur such as paralysis or death. Generally, if the patient has experienced symptoms for no more than 4 and a half hour and has been properly diagnosed the medical team will begin treatment by medication (Actilyse) which can be effective in restoring the patient’s health. Furthermore, the medical team will require approximately one hour diagnosing, analyzing blood test results, and inspecting CT scans or MRI and similar test before deciding on a treatment method. However, it is important to note that the medication has a 6 percent chance of leading to brain hemorrhaging, and once given medication approximately 1 in 8 patients fully recover. As such, hospitals that provide this medication must have the expertise to handle any possible complications that may occur. In cases where the patient receives medical attention more than 4.5 hours but not more than 6 hours after stroke and diagnosis reveals that brain cells have not died then Mechanical Thrombectomy will be used inserted through the artery to remove components contributing to clots such as Snare, Merci, Prenumbra, and Solitaire. Mechanical Thrombectomy is considered an effective method in reducing the effects of stroke and increasing the chances of full recovery. Not many hospitals to provide treatment with this method; however Bangkok Hospital is one such hospital,” Dr. Chanpong revealed.
Bangkok Hospital founded the Bangkok Emergency Services (BES) to provide critical care to patients in an emergency situation. The service involves cooperation between several public and private hospitals and has 13 centers throughout Bangkok. EMS is staffed with experienced doctors and nurses supported by advanced medical technology that have been internationally certified. These technologies include the mobile ICU, GPS navigating System, BES Motorlance, BES Dispatch. Call 02-716-9999 available 24 hours to provide care and refer stroke patients to the nearest hospital within the network to receive treatment as soon as possible.
Furthermore, Bangkok Hospital uses several advanced medical technology in the diagnosis and treatment of stroke patients that helps to increase accuracy and efficiency. This include: computerized tomography scan (CT Scan), Magnetic Resonance Imaging or MRI, Gamma Knife, and the RoboDoctor. The Robodoctor is used exclusively by Bangkok Hospital to facilitate processes and save time. Doctors are able to provide care through the Robodoctor from a Control Station at the hospital and will be able to see and speak to the patient whilst exchanging important information with the on-site team.
Effective treatment of stroke requires an efficient medical team in all processes from beginning to end such as the emergency unit at Bangkok Hospital. A combination of network advantages and advanced technology such as Telestroke via RoboDoctor, Thrombectomy by specialists, and BES help get patients that require immediate care to the help they need, with in the time it is needed. Once at the hospital the patient will receive treatment at the Stroke Prevention Clinic which is ready 24/7 to provide comprehensive services in primary stroke care through pathways that are certified by the Joint Commission International from the United States”. Dr. Chanpong concluded.
With significant financial investments in personnel, medical equipment, and the clinical “Stroke Pathway” at the Bangkok Neuroscience Center Bangkok Hospital, patients can rest assured they will receive quality care.