A 53-year-old senior executive in Madurai woke up one morning with sudden dizziness. As he sat up in bed, the room seemed to spin momentarily. While preparing morning coffee, his steps felt unsteady, almost as if the floor beneath him had shifted. He held the wall for support, thinking his limbs were still sleepy. A few minutes later, as he tried to pour coffee, his vision blurred and he saw two cups instead of one. He blinked several times, expecting it to clear. “Probably exhaustion from the PPT of the night before or maybe low blood pressure,” he reasoned. Fact is he had already had a brain stroke, his third.
His walking slowed and he felt slightly weak in one arm. “The patient was experiencing a posterior circulation stroke, a type of stroke from choked blood vessels that affects the back of the brain responsible for balance, coordination and vision. Unlike more commonly recognised strokes, the warning signs can be subtle, say a sudden dizziness, loss of balance or coordination, difficulty walking, blurred or double vision and sudden weakness or numbness,” says Dr Vikram Huded, head of neurology and director of the interventional neurology programme at Narayana Health City, Bengaluru.
“He had been having a ‘stuttering stroke’ where symptoms appear, improve, then return again. It often happens when a blood vessel in the back of the brain is partially blocked and blood flow keeps fluctuating,” he explains. Because these symptoms can resemble minor conditions such as vertigo or tiredness, they are often dismissed, both by patients and sometimes even in clinical settings. “This delay can postpone critical diagnosis and treatment,” he warns.
Why you should not ignore dizziness
Posterior circulation strokes account for nearly 25% of all stroke cases, yet they are often misdiagnosed or overlooked. “Many patients ignore warning signs. Even recurring dizziness or imbalance should not be neglected. Timely medical evaluation and specialized care can prevent permanent damage or even save lives,” says Dr Hudad.
Imagine the probability considering that one in seven Indians suffers a brain stroke according to a study by the Indian Council of Medical Research (ICMR). “And in posterior circulation strokes, surgery to open up blocked blood vessels is a delicate call, which makes it all the more important to prevent it,” says Dr Hudad. Surgery involves operating in the posterior fossa, a narrow, deep space in the back of the skull that contains vital structures like the brainstem and cerebellum. These areas control essential functions, and even minor damage or manipulation during surgery can cause severe, irreversible neurological deficits. “That’s why we first administered medication to the patient but he wasn’t responding and getting worse instead,” says Dr Hudad.
A breakthrough that worked in the most difficult stage
The patient had a total blockage in his right vertebral artery, a major blood vessel that supplies the back of the brain. His left vertebral artery could not compensate for the loss of blood flow. Doctors estimated he had an 80–90% risk of a fatal stroke.
“We explored all options and found that surgical intervention could be a life-saver as it could restore blood flow. Such procedures had been done in similar cases outside India, though their numbers were very few. We chose precision intervention. We inserted a thin wire through an artery in the leg and carefully navigated it through the hand to the blocked vessel in the brain. Then we did a balloon angioplasty and put a stent,” says Dr Hudad.
Story continues below this ad
After surgery, the patient’s symptoms of dizziness and vision loss disappeared instantly. “He was able to walk out of the hospital just 24 hours later. His strokes have not recurred. And though he has a long way to go, his limb movements have been restored,” says Dr Hudad.
Good news is that brain strokes are highly preventable
Although advances in interventional neurology are expanding treatment options for patients who previously had limited hope, the truth is one doesn’t have to get there in the first place.
“Ninety per cent of brain strokes, particularly posterior circulation strokes, are usually painless. Only 10 per cent of patients may report pain. Follow the protocol called B.E.F.A.S.T. which is an acronym for Balance loss, Eyesight changes, Facial drooping, Arm weakness, Speech difficulties, and Time to call emergency services immediately. Earlier the treatment, the better the outcome,” says Dr Hudad.
Cut your risk factors that are common to all chronic illnesses. “Eliminate stress, alcohol, blood pressure, diabetes and cholesterol,” he adds.
Story continues below this ad
This awareness is low despite the fact that one in four people will have a stroke globally. “In India it could be more given the heavy burden of risk factors. In our country only 4.6 per cent get clot busting treatment in the golden hour (the critical treatment window that can save the brain) against Singapore’s 30 per cent. Now modern interventions mean the golden hour can be longer,” says Dr Huded.
He also feels that people with risk factors and family history should focus on preventive tests for the brain as they do for the heart. “The carotid doppler is like an echo, a non-invasive, painless imaging test that uses sound waves to evaluate blood flow through the carotid arteries in the neck. It can pick up blocks in the carotid artery and assess stroke risk. Similarly, brain aneurysms, ballooning of the blood vessels in the brain that can rupture and trigger a stroke, can be detected through an MRI scan without contrast dye and without radiation. Anybody with a heavy burden of co-morbidities and a family history should get this done once in five years,” says Dr Hudad.
In fact, he has helped patients by identifying their aneurysm before it could rupture. “We insert flow diverters, highly flexible, mesh-like stents via catheter to redirect blood flow away from the bulging artery. It’s a one-hour procedure and the patient can be discharged in two or three days. In a year, 95 per cent of the aneurysm will heal completely,” he says.
Never ignore subtle symptoms, they could be the brain’s early distress signal. Acting quickly can save lives.
