Q. What is Brain Attack or STROKE ?
A. The term 'Brain Attack' or STROKE implies loss of function of a part of the body. Right side of "big brain" or Cerebrum controls left half of body, left half controls right half of body and speech. Cerebellum controls balance on the same side. Brain stem controls many functions such as swallowing, speaking, hearing, balance, eye movements, limbs etc. on both sides. Loss of function could be due to 2 causes 1) Loss of blood supply, called ischemic stroke & 2) Hemorrhage. If the patient recovers within 1 hour and the MRI is normal it is called TIA or Transient Ischemic Attack. If the paralysis or loss of function persists beyond 1 hour it is called stroke. CT Scan is usually normal. MRI shows the exact site and size of the ischemic brain and MRA shows the blocked artery which is the cause of the stroke. The treatment for the two is exactly opposite - for ischemic stroke blood thinner, rTPA (Recombinant Tissue Plasminogen Activator) is given. rTPA, will kill if given to a patient with hemorrhagic stroke. Hence treatment can be only be started after CT Scan or MRI have ruled out a hemorrhage. If the hemorrhage is large and causing pressure on the brain emergency surgery for evacuation of the hematoma is mandatory.

Q. What is Fit/Seizure & what are the causes ?
A. Fits / Seizures/ Epilepsy : A seizure (from the Latin sacire, "to take possession of") is due to abnormal, excessive, electrical discharges brain cells. Depending on the severity of discharges, the various manifestations, range from dramatic convulsions with coma to other phenomena not readily discernible by an observer. So fits can be classified as 1)Major also called Grand Mal (GTC) Fits), 2) focal where only one side of the body convulses, 3) Complex partial seizures -loss of awareness of surrounding, visual or olfactory hallucinations and 4) minor called peit mal. Fits may be single or occur in clusters. Causes of fits or epilepsy are : 1.Brain hemorrhage may present itself as seizure. 2. Thrombosis of Brain Veins 3. Brain ArterioVenous Malformation 4. There are many other causes of Fits / Seizures e.g. : Acute CNS infection Metabolic disturbances (hypoglycemia, hypocalcemia, hypomagnesemia, pyridoxine deficiency), Drug withdrawal, Developmental disorders, Genetic disorders, Brain tumor, use of illicit drugs etc.

Q. What is Aneurysm & Subarachnoid Hemorrhage (SAH) ?
A. Aneurysms are abnormal bulges in brain arteries where they divide. They usually arise from the fork of dividing arteries. The bulge slowly enlarges over months and years and may sometimes attain giant size. These aneurysms are usually found at the base of the brain. The presentation of an aneurysm is: 1) After rupture with SAH, ICH, IVH; 2) Mass effect when they attain giant size and cause pressure on the brain; 3) As ischemic stroke when a piece of thrombus inside aneurysm breaks off and goes up with blood flow and blocks an artery and 4) As an incidental finding on CT or MRI scan done for some other reason.When an aneurysm bursts blood collects in spaces around the brain which have water called CSF (Cerebrospinal Fluid). This space is called subarachnoid space and the hemorrhage is called SAH. Sometimes it bursts into the brain resulting in intracerebral h'age (ICH) or into the cavities called ventricles (IVH). Sometimes the ICH may be large and may cause pressure on the brain. Urgent life saving operation to evacuate clot may be necessary. The cavities (Ventricles) may enlarge acutely and require urgent drainage of blood and CSF.

Q. What is Brain ArterioVenous Malformation(BAVM) ?
A. In Human beings, arteries supply blood to tissues and veins drain blood from tissues. Arteries break up into smaller and smaller arterioles then form capillaries and from capillaries start small veins called veinules which join to form veins. In ArterioVenous Malformation the capillary bed is missing and arteries drain directly into veins. So, there is an abnormal cluster of vessels and blood will be shunted directly from Arteries to Veins. AVM may present as: 1) Hemorrhage into the brain; 2) Epilepsy major or minor fits; 3) Progressive weakness of hand or/and leg;4) severe intractable headache 5) migraine 6) incidental on CT or MRI scan done for other reason. Plain CT scan may not show the AVM. Contrast CT Scan and MRI show the AVM very well. Associated h'age is well seen on CT or MRI scan. DSA gives all information about AVM- site, size, arterial feeders, venous drainage, associated arterial or venous aneurysms and any anomalies like absence of deep veins.

Q. Why is SAH so dangerous ?
A. SAH is devastating because one third die immediately, one third are in very poor condition, only one third in good condition and can be treated immediately. 30% will have rebleed in first 3 weeks and 50% of these will die. 40% will have spasm or narrowing of arteries. In 20% narrowing will be so severe as to cause paralysis. Spasm is usually independent of any treatment. 10% will have collection of water in the brain - hydrocephalus requiring ventriculo-peritonesl shunt. Many will have salt and water problems. Causes : Commonest cause of SAH is Rupture of Aneurysm. Other causes of brain h'age : Rupture of Brain AVM , DAVF, venous occlusions head injury.

Q. What is brain hemorrhage
A. Brain hemorrhage is when h'age occurs into the substance of the brain and may spread into the cavities of the brain called ventricles. The most common cause in older patients is high blood pressure. In young patients the most common cause is AVM or arteriovenous malformation. The other cuases are AVF (Arteriovenous Fistula), brain tumour or other miscellaneous causes.