It is a common disease, affecting almost the same people who have a risk of having heart attack. No age is immune, women of child-bearing age have a little less risk, which increases rapidly post-menopausally.

The major risk factors for stroke are modifiable: diabetes, hypertension, cholesterol, obesity,heart disease,smoking, alcohol, etc. as well as non-modifiable (age,gender,ehnicity-indians,african-americans,etc).

In a stroke, the person suddenly develops weakness of one side of the body, loss of speech, loss of vision, lack of sensation on one side of the body, etc. The sudden onset of the event is the most important clue. Sometimes it starts in sleep and the person may notice on awakening; sometimes it progresses over a few hours or days. It is different from the general weakness, listlessness, or lethargy which may affect someone who is ill from other diseases, or who is depressed or overworked and sleep-deprived. There may be complete weakness of limb or limbs on one side, with no movement, or there may be partial weakness, and in the latter situation, the potential of further weakness is very hign. Sometimes the weakness improves spontaneously over minutes or hours; this is not to be taken lightly. The sufferer should IMMEDIATELY attend his hospital, preferably see a neurologist, or if not available, at least his family physician. The reason for this urgency is that these strokes (or TIAs as they are called if the patient recovers within 24 hours) can recur, and the only treatment which can reverse the stroke can be given only within the first 3 hours (window period). This therapy is called THROMBOLYTIC THERAPY and this involves administration of a drug through the intravenous route. However, these cannot be administered anywhere and by just anyone, since there are several risks involved in this therapy, and only a hospital equipped with all the paraphernalia can tackle all the potential problems. Moreover, the patient has to be assessed for his suitability for the treatment which involves an urgent CT scan of the brain as well as some blood tests which have to be available 24/7. In fact the process of delivering thrombolytic therapy is a complicated one, requiring a lot of work to be done by a team of workers in the hospital; this team includes the emergency medical team, the neurologist, the neurosurgeon, the radiologists, lab technicians, physiotherapists and rehabilitation team. Very few centers are equipped with all these apparatus which are manned round-the-clock and so can deliver this treatment. There is an important reason for the 3-hour window; thrombolysis given (with tPA)beyond this period has  been found to increase the chances of bleeding. More recently, it has been found that tPA can be administered intra-arterially in the spot where the clot has blocked the relevant artery; this is called intra-arterial thrombolysis. Previously, based on some studies, only UROKINASE was being administered intra-arterially, within 6 hours of onset of stroke; now-a-days, with greater understanding of the situation, it has been realised that even tPA can be administered intra-arterially. At Apollo Hospitals, Jubilee Hills, Hyderabad, we have extensive experience with each of these thrombolytic therapies. We have had excellent results with this therapy, and the whole process of stroke treatment has become exquisitely stream-lined in our institution, so much so that recently, the hospital achieved JCI accreditation for the same (called disease specific accreditation).