Genesis of BRAINS
With the increasing life expectancy as well as the increasing number of brain problems that happen with age and otherwise, there has been a tremendous upsurge in brain disorders. Both brain, spine, as well as mind-related disorders are increasing a lot in both the paediatric and the adult populations.
Now, after COVID, for specific reasons, stroke in young people and many conditions like brain fog, epilepsy, degenerative conditions, and autoimmune conditions have significantly increased.
Now, this apart, I realised that the brain is one single organ that takes care of the entire body. So the brain, the mind, and the body complex need to be healthy all through.
And there are very few centres that are totally dedicated to the brain. So, this is the reason I thought we’d put all the possible things under one umbrella, where the brain, spine, and mind can be treated together with state-of-the-art facilities. And a lot of research is happening. So many gadgets are coming. We need to incorporate these not only for today but also for tomorrow. So that is the purpose we thought we’d start with the BRAINS.
BRAINS actually stands for Bangalore Regenerative Advanced Institute of Neurosciences. So, the whole purpose is to see that we take care of brain health completely in totality so that it takes care of our body and our societal needs.
The striking difference is my 35 years of experience in neurosciences. The second thing is the hand-picked technology, you know, what is useful for providing the best outcomes for the patients. Third is the best diagnostic facilities and highly skilled, competent consultants. And teamwork, you know, where many brains can work together and solve the problem because most neurological diseases are complex, and we need to have a comprehensive service. And it’s not only medical treatment, surgical treatment or critical care treatment; it’s also a comprehensive treatment starting from emergency care, pre-hospital care, critical care, rehabilitation, and all the support services and long-term follow-up.
In addition, we also envisage that advocacy, awareness, and education are very important so that people will become aware of the brain as well as brain disorders, so that they come at the right time, so that they get the right kind of treatment, so that they go back with the right kind of results as well as the right kind of functional activity.
What is a Stroke?
Stroke is a catastrophic event that occurs suddenly, resulting in paralysis of the limbs, loss of speech, loss of sensation, loss of balance or loss of memory, suddenly disabling the individual temporarily or permanently. So, this happens for various reasons. The main reason is the sudden loss of blood supply to the brain. So this is called an ischemic stroke. This is something that is commonly known as stroke in the general population.
Brain stroke is related to its blood supply and the blood vessels of the brain. So, the risk factors are similar to that of a heart attack as well. So when we control all the risk factors, a brain attack and a heart attack can be totally managed and prevented as well as treated effectively.
So that is why we introduced this concept called brain attack, which includes four conditions. One is what we call an ischemic stroke, where the brain loses its blood supply suddenly because of the blockage in the blood vessel. Now, this common parlance is known as brain stroke or paralysis.
The second thing is brain haemorrhage, where a blood vessel of the brain will rupture and produce bleeding inside the brain. And this is usually because of hypertension, high BP. And this is called brain haemorrhage.
And the third one is called subarachnoid haemorrhage. You know, it’s called thunderbolt headache where people have never experienced such a severe headache, and they become unconscious. And this is basically because of abnormal enlargement of the blood vessel. We call it an aneurysm, which ruptures around the brain, so that in the area around the brain, there will be bleeding, and that can cause serious complications that will have to be treated very urgently.
And last but not least, the brain gets blood supply through the arteries, and all this blood will be drained back to the heart through the veins. We call them cerebral veins. These veins can get occluded, you know, particularly after delivery in women, after taking some of these drugs like hormonal pills, diarrhoea, or any kind of dehydration, people working in very hot weather, particularly in our country. They’re all prone to this condition called cortical venous thrombosis or cerebral venous thrombosis. So this also can cause symptoms similar to stroke, and it can cause seizures, it can cause paralysis, and it can cause behavioural disturbances.
So we have combined all four conditions together and put that as one entity as a brain attack. And we wanted to promote this concept to the people so that they realise the urgency and the need for emergency treatment at the right place, at the right time, what we call the golden hours. And when such a condition is treated in the golden hours, diagnosed properly, and treated effectively, the results can be pretty good, and we can reduce the disability. Incidentally, this brain attack is the leading cause of disability in the world today.
Early Symptoms
Usually, many people do get some warning signs. We call them Transient Ischemic Attacks (TIAs). You know, people get a sudden loss of vision or blurring of vision, or one half of the vision is lost and then suddenly recovers. And then you lose sensation in one half of the body and then recover. Sudden weakness in the hand or the leg and recover back.
Then there is Transient Global Amnesia, where suddenly they can’t recollect anything. You suddenly go blank. All the memory is lost and then regained gradually. Usually, these symptoms will not last more than a few hours, and invariably, a complete recovery happens within a day.
TIA is a definite warning sign for an impending stroke in the future. But many ignore this because they’re not aware. Number two, they try to give explanations: I didn’t eat properly, I didn’t sleep properly. I was tired. They have these hundred reasons to explain and not to get examined. So this is one of the things we need to be aware of.
And soon after that, suddenly, you know, they can get into this kind of a problem where suddenly the hand and a leg are paralysed, their vision is lost or imbalanced, or they’re not able to walk. Whereas the haemorrhage usually gives a severe headache along with that. Whatever brain haemorrhage, either subarachnoid haemorrhage or intracerebral haemorrhage, will also have an associated severe headache. And because of that, of course, they will seek medical help. Whereas ischemic strokes can be very silent. They can most often occur in sleep, early in the morning. We never know what time it really happened. In the morning, they realise that, you know, they are paralysed.
And then that’s the time they have to rush to the hospital. But because it is painless, people generally ignore it, and then they don’t ever come to the hospital in the golden hours.
The Age Factor
Yes, normally it is supposed to happen in elderly people because the blood vessels will get aged, they undergo some changes, they become narrow. There are atherosclerotic changes, cholesterol deposits happen inside, making the blood vessels narrow, reducing the blood supply to the brain. But it can happen at any age, particularly today with India being the capital of diabetes, and hypertension being very common in people. So it’s happening at all ages.
Surprisingly, after COVID-19, its virus has a special predilection for the cerebral blood vessels, apart from the lung. So as a result, very many young people who had had COVID-19 in the past are developing strokes as well as heart attacks. So sudden strokes in young people have become common, and children are not exempt from stroke either. They also can have certain diseases like moyamoya and vasculitis, autoimmune diseases. All of them can lead to strokes.
Apart from that, there can be developmentally abnormal blood vessels within the system. And there are many systemic conditions that can also cause stroke, like, for example, uncontrolled diabetes, uncontrolled hypertension, uncontrolled kidney disease, polycystic kidney disease, and anything related to the blood vessels themselves. Or there are conditions related to the blood itself, for example, polycythemia. Such conditions can also lead to stroke. So when you say stroke, there are so many things we need to look into.
So it is better if any such warning signs come early, we can investigate systematically for all these conditions and then we can address them. That is the reason we have developed a stroke centre where all these conditions for all age groups, depending upon the criteria, we evaluate, investigate, and find out all the risk factors. So what is important is that when a stroke occurs once, people think that is the end of it. It will not happen again. It’s not true. Many times it can happen again and again in their lifetime.
Especially, the younger the people are, the more risk there is in the sense that we need to manage their blood vessels for a longer period of time during their lifespan. So they need to be evaluated thoroughly for all the underlying conditions, and they need to be controlled and kept controlled all through, apart from the routine treatment for the present stroke. So this is the main aim of the stroke centre at Brains Hospital.
Role of Family
When a stroke strikes, particularly, you know, even the patients themselves, most of the time they’ll be conscious. Very few become unconscious immediately, except in brain haemorrhage. When they are conscious and they realise that they’re not able to move their hand or leg in the night, especially early morning, they should immediately alert the family and the family doctor or the hospital at the earliest.
As soon as they detect any variation, you know, slight deviation of the face, or they’re not able to utter their name or words properly, they’re losing balance or swaying to one side, or a hand or leg is not moving or they’re complaining of numbness, or there is a problem with their vision, any such earliest change in any elderly people or anybody in the family member, it should be picked up immediately, and they should not think, “Let’s wait and see, give them some food, give them some juice and wait and see.” Such a thing should not be there. They should be rushed to the hospital. The earlier they come, the better.
You know, earlier we used to recommend that they needed to come within three and a half hours to become eligible for thrombolysis treatment. Today, fortunately, it has been extended to six hours, as well as now, recent recommendations are up to 24 hours. It’s the greatest boon for people. But the earlier they come, the better. The earlier they come, the softer the clot is, and the better it gets dissolved with the medicine, and the quicker the recovery. So that’s why we recommend early treatment.
The moment they detect or even suspect a stroke, whether it’s true or not, it doesn’t matter. Because there are other conditions that will mimic stroke as well, but they need not be worried at the home level. They need to quickly bring him to the emergency department where a stroke facility is available.
And unfortunately, there are very few stroke-ready hospitals or stroke centres available in the country. But this is one of the aims to promote the concept of brain attack so that we’ll have more and more stroke units in the future in the country so that we can reduce the disability and diagnose this. At the same time, stroke is preventable, a highly preventable situation.
And we need to identify all the risk factors. That is why anyone beyond 25 years and certainly after 40 years needs a complete health check so that we can identify these factors very early and then they can be controlled so that we can prevent a possible stroke.
The Lifestyle Factor
People who are obese, very sedentary and those who indulge in excessive smoking, excessive drinking, lack exercise, and take drugs are highly prone to stroke. Apart from that, uncontrolled diabetes, uncontrolled hypertension, and emotional stress are also risk factors.
And one recent thing we have realised is snoring. People who snore at night when they sleep, you know, they are very highly prone to strokes as well as heart attacks. So, a sound sleep, what has been told earlier, is good for health. So those who make sound during sleep have to be investigated. A sleep study has to be conducted. If there is obstructive sleep apnoea when the oxygen levels to the brain come down significantly, it can cause a serious stroke. So these are the people who need to be watched and evaluated so that we can help them avoid developing a stroke.
Emotional Health and Strokes
Emotional well-being usually keeps a person very happy with good social relationships, very relaxed, enjoying, basically happy. So it is supposed to keep your blood sugars, high blood pressure, and immune system very healthy.
Now, if a person is very highly stressed, obviously, very frequently, they are releasing their own adrenaline and steroids within the body. So naturally, they are all produced in the body and get released when the person is getting angry, getting stressed, and shouting at small things. So what happens very frequently is they are getting exposed to these hormones, which are called stress hormones as such.
And they can increase the heart rate, put stress on the heart, they can increase the blood pressure, they put stress on the blood vessels. They also alter the cholesterol mechanism, and they also alter the coagulation mechanism within the body. So the platelets will increase. So suddenly, they all become prone to developing blood clots, and that can happen in the brain, which is a brain attack. It can happen in the heart, a heart attack. So this is a very, very, very common thing, and people do not realise this.
And people who have sleep disorders, people who do not sleep properly, are also prone to this. This is in contrast to people who are happy, with a very mentally healthy lifestyle, emotionally stable, are socially very interactive and calm and easy going. And that doesn’t mean that they don’t work; they can work, but they can work at ease. And those who are at ease with themselves first will obviously become at ease with others as well. And that gives an innate happiness that people will have an inherent stimulation of the vagus nerve.
And once vagus nerve stimulation increases, it relaxes the blood vessels, improves blood flow, keeps the heart rate under control, keeps the mind calm, their work efficiency is good, their immune system is better, and their coagulation system is fine. So, and all the organs need not undergo stress because the release of these stress hormones is kept in abeyance. So, because of these various reasons, physiological mechanisms, they will have good sleep. They are very calm, and still, they do a lot of work, such people. So, and they are definitely less prone to these strokes. But there are exceptions where such people also, if they have some underlying illnesses, you know, they need to be taken care of.
It doesn’t mean that just emotional wellness alone is the main thing, but it is one of the major factors. And in today’s world, this is becoming the major cause because there is so much unhealthy competition, and the world is going in a totally different direction. Interpersonal relationships are not there. People are becoming more and more individualised, nuclear, and there is a lot of stress in the family, in society, and at the workplace. And that’s what is causing this problem. So, many are resorting to various kinds of things, even to sleep, resorting to medications.
So, and in addition, because of work pressure, they don’t sleep properly, they don’t eat properly, they eat junk food, and they don’t exercise. So these are all adding to these emotional health problems, which invariably cause these diseases.
Top Opinions
Top Interviews
