Brain Stroke Needs Heart Attack-Like Urgency: Experts

Ignorance may not always come at a price, but when it comes to strokes, it can cost millions of brain cells — and often a lifetime of disability. As a large section of the population remains unaware that uncontrolled diabetes, hypertension, smoking, obesity and unhealthy diets significantly increase stroke risk, health experts have stressed that recognising symptoms and reaching a hospital within the "golden window" can mean the difference between recovery and permanent disability.

Marking World Brain Day recently, neurologists and neurosurgeons have urged people to treat stroke as a "brain attack", much like a heart attack, requiring immediate medical attention.

"Just as we speak of a heart attack, a stroke can be considered a brain attack. Every minute of delay results in the loss of nearly 1.9 million brain cells, increasing the risk of permanent disability," said Dr. Rajat Chopra, Head of Neurology, Yatharth Super Speciality Hospital, Model Town, Delhi.

Stroke occurs when blood supply to the brain is blocked or when a blood vessel ruptures, causing bleeding inside the brain. In both situations, brain cells begin dying within minutes, making early diagnosis and treatment critical.

Dr. Sunil Baranwal, HoD Neurosurgery, Yatharth Hospital, Model Town, Delhi, explained that the first four-and-a-half hours after the onset of symptoms constitute the "golden window" for administering clot-dissolving medicines in patients with ischaemic stroke. In carefully selected patients, mechanical thrombectomy — a minimally invasive procedure to remove large clots — can be performed up to 24 hours after symptom onset based on advanced brain imaging.

"The sooner the patient reaches a stroke-ready hospital, the greater the chances of recovery. Timely diagnosis and intervention can significantly reduce neurological damage and long-term disability," Dr. Baranwal cautioned.

The warning comes at a time when India is witnessing an alarming rise in stroke among younger adults. Neurologists said hospitals are increasingly treating patients below the age of 45, with lifestyle disorders emerging as the principal drivers.

"Another worrying trend is the rising incidence of stroke among younger adults. A condition once largely associated with old age is increasingly affecting people in their 30s and 40s because of uncontrolled hypertension, diabetes, obesity, smoking, chronic stress, sedentary lifestyles and poor sleep," said Dr. Madhukar Bhardwaj, Director and Head of Neurology at Aakash Healthcare.

Among the modifiable risk factors, uncontrolled diabetes and hypertension remain the biggest contributors, he added, advising people with diabetes to maintain HbA1c levels below 7 per cent, take medicines regularly and undergo periodic health check-ups.

While many risk factors can be controlled, the doctors cautioned that non-modifiable factors like age, family history and genetic predisposition also play an important role.

"Individuals with inherited risk should be especially vigilant about controlling diabetes, blood pressure and cholesterol," added Dr. Baranwal.

He cautioned against relying on indiscriminate laboratory investigations to predict stroke risk.

"There is no single laboratory test that can accurately predict who will develop a stroke. Prevention depends largely on controlling established risk factors rather than indiscriminate testing," Dr. Baranwal said.

Doctors also identified irregular heart rhythm, particularly atrial fibrillation, as an important cause of stroke because blood clots formed in the heart can travel to the brain.

Given the seriousness of the disease, the World Health Assembly last week formally recognised stroke as a global public health priority for the first time, reflecting growing concern over one of the leading causes of death and disability worldwide.

Globally, nearly 12 million people suffer a stroke every year. More than six million die, while millions of survivors continue to live with permanent disabilities affecting speech, movement, memory and independence.

This shows that timely access remains a challenge. Doctors said only about one in five stroke patients reaches hospital within the therapeutic window, resulting in preventable deaths and lifelong disability.

The neurologists also strongly warned against taking blood-thinning medicines without first confirming the type of stroke.

"There are two major types of stroke — ischaemic stroke caused by blockage and haemorrhagic stroke caused by bleeding. Their treatments are completely different. If a patient with bleeding inside the brain is mistakenly given blood thinners, the consequences can be life-threatening," Dr. Chopra said, stressing that a CT scan is the minimum essential investigation before initiating stroke-specific treatment.

Doctors said advances in high-resolution MRI, CT imaging, neuronavigation systems and modern neurosurgical techniques have substantially improved outcomes for stroke and other neurological disorders.

However, they emphasised that prevention remains the most effective strategy. “Strict control of diabetes and hypertension, regular exercise, balanced nutrition, adequate sleep, smoking cessation, moderation in alcohol intake and stress management remain a key to keeping the stroke at bay.”