Revolutionary New Concept of Acute Stroke Care

• Brain attack: 
  

  Since both stroke and heart attack are caused by vascular diseases of various causes. Modern medicine and Stroke Neurosurgeon nowadays consider stroke as ‘brain attack’ its care, either preventive or emergency treatments are similar to that of heart attack.

• Not an Accident can be Prevented and Controlled: 
  
  Nowadays, stroke is not considered to be an accident (cerebrovascular accident), actually with recent medical advances, all stroke can be prevented and controlled.
• Stroke risks screening program and stroke prophylactic treatments. 
  
  

  Given the disease burden of strokes, prevention is an important public health concern. As Stroke Neurosurgeons, we do not want to treat acute stroke, due to much higher risks are involved in emergency settings. However we are forced to do so in order to save lives of patients who are suffering from  acute stroke. Actually we want to prevent stroke by promoting stroke risks screening program and stroke prophylactic treatments.

• Stroke can be Cured and Stroke Survivor can be a normal person: 
  
  If being treated within Golden 3 to 8 Hours, all stroke symptoms may be reversible and stroke can be cured; leaving stroke survivors to live a normal life without suffering from any permanent neurological deficit.
• Early Proactive Treatments to Rescue Brain Cells before patients’ Deterioration:
  
  Traditional stroke treatments were mainly focus to treat stroke’s complications, not to urgently rescue our brain cells in terms of seconds & minutes. With traditional manner, treating stoke were just involving “wait and observe” until patients’ conditions deteriorated; so called “late and passive” traditional stroke treatments. Nowadays Stroke Neurosurgeons prefer a more “proactive” manner to treat stroke patients, immediate after their symptoms onset, to rescue brain cells urgently in terms of seconds & minutes, starting intervening treatment much earlier before patients’ delayed deterioration, so as to minimize brain damage and delayed brain swelling. 
  
  
• Search and Treat the Real Cause of Stroke to Prevent Further Stroke within short period of time: 
  
  With traditional stroke treatments, most treatments were just empirical medications, without searching for the real cause of stroke; nowadays Stroke Neurosurgeons prefer high quality MRI angiogram or cerebral angiogram to search for the real cause of stroke and treat accordingly; so as to prevent stroke from recurring within short period of time.

Cervical Spine Surgery

Cervical spine surgery may be indicated for:

1. Neural decompression
2. Spinal stabilization
3. Tumour excision

Anterior Cervical Discectomy and Fusion is a common surgical procedure used to treat neck problems such as bulging, herniated disc, degenerative disc disease and spinal instability etc. Discectomy is the removal of the disc and any fragments between the vertebrae. After the disc is removed, the space is filled with a bone graft, the goal is to help the bones to fuse together into one solid bone. This is known as fusion. In order to provide stability during fusion, the doctor may reinforce a metal plate screwed into the vertebrae (cage, screw and plate).The expected outcomes of this operation are to treat for symptoms due to cervical spondylosis aims to relieve pain and prevent further permanent damage to your nerves. Your mobility of neck will be reduced after fixing the disc.

The operation is performed under general anaesthesia. The approach to the cervical spine may vary with individual patient. It can be accessed from the front or from the back. X-ray may be used in the operation room to confirm the level of operation.

Risks and Complications

1. Injury
   1. Larynx , the nerves to the larynx (recurrent laryngeal nerve) causing vocal cord paralysis and a hoarse voice. This is usually temporary.
   2. Carotid artery, which can cause a stroke resulting in permanent paralysis.
   3. Spinal cord resulting in temporary or permanent quadriplegia (paralysis of arms and legs).
   4. Nerve root causing upper limb weakness, sensory loss, or pain temporary or permanent.
2. Infection in the wound causing redness, pain and possible discharge or abscess.
3. Failure of fusion on the bone.
4. Persistent pain

After the patient is awaken from the anesthesia, oral feeding may be started. A normal diet may be resumed as instructed after recovery from anaesthesia. Make sure there is no difficulty in swallowing when resuming normal diet. After general anaesthesia, you may experience discomfort in the throat after tracheal intubation. The side effects of anesthesia including feel tired, drowsy, nausea or vomiting. Inform the nurse if symptoms persist or worsen. You should inform the nurse of wound pain. Proper pain relief treatment by injection or oral medication may be prescribed by the doctor.

Patient would be discharge in 1-2 days when the patient can take oral food and pass urine by himself / herself with health condition.

Advices on Discharge

1. Prescription pain medication may be taken as needed.
2. Recovery time for the wound generally takes 4 –6 weeks. Recovery of neurological symptoms started before surgery varies, depends on cause and severity of the symptoms.
3. You should avoid bending the head forward or backward.
4. Do not lift any heavy objects.
5. You may gradually return to normal activities. You should avoid sitting for long periods of time, walking is encouraged.
6. You usually wear a neck collar in the postoperative period, to hold the neck still in order to let the bone heal and fuse.
7. You may shower after discharge unless otherwise instructed. The dressing must be kept clean and dry. The stitches or staples will be removed during subsequent follow-up visit
8. You should immediately return to the doctor in the event of severe wound pain associated with redness and swelling, secretion of pus, massive bleeding or high fever over 38°C.
9. Any follow-up consultations should be attended as scheduled.

In special patient groups, the actual risk may be different. Other complications may occasionally occur. For further information please contact our spine surgeon.

Stroke symptoms and warning signs:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding, memory impairment.
• Sudden trouble seeing in one or both eyes, or visual field cut.
• Seeing double images, or drooping of one eyelid, or red and pulsating eye.
• Sudden dizziness, loss of coordination or balance, trouble walking.
• Sudden severe headache, with or without neck pain and back pain with no known cause.
• Sudden loss of consciousness
• Transient ischemic attacks (TIAs)

Transient ischemic attack (TIA)

Transient ischemic attack (TIA) is "warning stroke", is the strong predictor of a major stroke. It (TIA) is also often known as "minor stroke" that produce stroke-like symptoms but of no lasting brain damage. It is also caused by a mini-clot that cause transient blockage to blood vessels. As the blockage is transient, unlike a major stroke, there is no permanent damage to the brain. Nevertheless, TIA is an important signal of a major stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. And 1/3 of people with TIAs experience a major stroke in the same year. Therefore recognizing and treating TIAs can reduce your risk of suferring a major stroke. TIA should be considered as medical emergency. It is essential to grasp TIA’s symptoms and followed up immediately with a stroke neurosurgeon, and should be treated in the same way as a stroke.

Lumbar spinal stenosis
Sacroiliac joint pain
Low back pain
Cervical Disc Hernia or Degeneration