Changes

===Stagewise management of disease===

===Stagewise management of disease===

====Ⅰ. Acute condition'''====

'''Ⅰ. Acute condition'''

Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion. Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered  . [D1] Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure. Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

Treatment of acute ischemic stroke (AIS) consists of a multidisciplinary approach. Early detection and early intervention can reduce the severity of neural damage. Therapies to arrest intracerebral hemorrhage and reversal of anticoagulation shall be initiated as early as possible. Neurological Institutes of Health stroke scale and several other scales are used to assess stroke severity. Arterial occlusion evaluation scale can be used to measure the degree of occlusion of large blood vessels. Neuro imaging using non contrast CT can be done. Non contrast CT scan can be used to find the Alberta Stroke Program Early CT Score (ASPECTS) which is designed to assess the severity of infarct in middle cerebral artery. CT angiography can also provide useful information about large vessel occlusion. Revascularization and limitation of neuronal injury are the next steps in acute ischemic stroke management. IV thrombolysis is used for the removal of clots, and endovascular therapy is used for revascularization. Supplementation of oxygen is required if oxygen saturation drops down to 94%. Current AHA/ASA guidelines recommends permissive hypertension with a blood pressure goal of less than or equal to 220/120mg Hg for the first 24-48 hours, until or unless acute interventions such as intravascular tissue plasminogen activator administration or endovascular interventions are administered  . [D1] Anti-hypertensives should be administered only beyond this level to prevent hemorrhage. Glycemic control must be at 140-180 mg/dl and monitored frequently to avoid hypoglycemia, which may worsen the outcomes. Managing cerebral edema associated with large infarcts in the middle cerebral and internal carotid arteries is very important as it can enhance neurologic deterioration. Decompressive hemicraniectomy must be done to manage raised intracranial pressure. Early rehabilitation is also thought to have better outcomes in stroke patients. The etiology of stroke must be understood to take steps for secondary prevention. Antiplatelet therapy is a well-known and established way to prevent stroke and transient ischemic attacks. Statins, the drugs for dyslipidemia, are also used to seize the atherosclerotic progress.<ref>Franziska Herpich, Fred Rincon. Management of Acute Ischemic Stroke. Crit Med. 2020 Nov; 48(11): 1654–1663. doi: 10.1097/CCM.0000000000004597 PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

An observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20) has shown similarity in safety profiles of classical Ayurveda and conservative western biomedicine in AIS.<ref>J Aarthi Harini, Avineet Luthra, Shrey Madeka,et al. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study. Glob Adv Health Med. 2019; 8: 2164956119849396. PMCID: PMC7540624 PMID: 32947473.</ref>

====Ⅱ.Chronic condition====

'''Ⅱ.Chronic condition'''

Multidisciplinary rehabilitation and the drugs for secondary prevention come under the management of post-stroke patients. Physiotherapy, modified constraint-induced movement therapy, and the use of various assistive devices such as brace chains. Wheelchairs and walkers are advised for the improvement of motor function, cognition, speech, and quality of life. Mental imagery and electrical stimulation for the movement of muscles are also combined with the above. Ayurvedic management can be done at this stage. A systemic approach in the management of pakshaghata is explained in classical textbooks. [Cha.Sa. Chikitsa Sthana 28/100] [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" /> [A.Hri. Chikitsa Sthana 21/44]<ref name=":0" />

Multidisciplinary rehabilitation and the drugs for secondary prevention come under the management of post-stroke patients. Physiotherapy, modified constraint-induced movement therapy, and the use of various assistive devices such as brace chains. Wheelchairs and walkers are advised for the improvement of motor function, cognition, speech, and quality of life. Mental imagery and electrical stimulation for the movement of muscles are also combined with the above. Ayurvedic management can be done at this stage. A systemic approach in the management of pakshaghata is explained in classical textbooks. [Cha.Sa. Chikitsa Sthana 28/100] [Su.Sa. Chikitsa Sthana 5/19]<ref name=":1" /> [A.Hri. Chikitsa Sthana 21/44]<ref name=":0" />