Friday, September 23, 2016

Stroke Treatment: Why Every Second Counts

Each passing second after someone suffers a stroke means greater risk of permanent damage or death, so it's critical to get a diagnosis and treatment as fast as possible.

The first few seconds of a stroke may be confusing, both to a witness and the stroke patient. Signs may be subtle — someone just isn't quite normal, seems tired, confused, or uncoordinated. But the quicker you spot the initial signs of a stroke, the faster stroke treatment can be given. Once a stroke starts, you've got just three hours before the window of opportunity for the most successful stroke treatment closes.

Stroke: What Happens

"It's important for people to understand that not all strokes are the same,” says Mark Alberts, MD, professor of neurology at the Northwestern University Feinberg School of Medicine and director of the stroke program at Northwestern Memorial Hospital in Chicago.

There are two distinct types of stroke. Roughly 85 percent are ischemic strokes in which blood flow to the brain is blocked by a blood clot. The rest are hemorrhagic strokes, in which there's bleeding in or around the brain due to a burst blood vessel. "Even though hemorrhagic strokes are less common, they are more deadly and cause more damage,” says Dr. Alberts. “The number of people who die from ischemic strokes might be around 10 percent; those who die from hemorrhagic stroke might be 40 or 50 percent."

Stroke: The Damage

The rates of disability for both types of stroke are significant. Alberts says that 20 to 30 percent of patients will be significantly disabled following an ischemic stroke; those numbers rise to 40 to 50 percent of patients with hemorrhagic stroke. Disabilities range from problems with communication and mobility to issues so severe that the patient needs nursing home care.

"Strokes are sort of like real estate — it all depends on location and size, on where in the brain they occur and how large they are," Albert says. "Those two factors determine how much damage there will be. A small stroke in a critical part of the brain can cause a lot of damage, while a large stroke in a less important part of the brain may not cause as much."

Stroke: Fast Action is Important

To have the greatest chance of being effective, one of the best treatments for ischemic stroke, tissue plasminogen activator, or t-PA (Activase), has to be administered quickly.

Alberts emphasizes that "t-PA has to be given within three hours of stroke onset. Everything shows that ‘time is brain,’ and every second you delay treating someone the patient is losing tens of thousands of brain cells. The overriding concept is to treat patients as soon as possible."

A medication that is given by injection, t-PA is a clot buster. It is a very powerful agent that eats away at the blood clot in the vessel that's causing the ischemic stroke, says Alberts. “It begins working pretty rapidly, and we have certainly seen cases where it chews away the blood clot within an hour or two of being administered. But that isn't typical. Sometimes, t-PA isn't successful at destroying a clot; other times, it may take much longer to destroy the clot and fully restore blood flow to the brain.

That narrow window for treating stroke patients with t-PA may be expanded in the future, but Alberts says that doesn't mean there's time to waste. For patients who have suffered a hemorrhagic stroke, treatment will depend on the cause of the bleeding in the brain. Two common causes of bleeding are aneurysms and arteriovenous malformations (AVMs). An aneurysm is a bulge in the artery wall; an AVM is an abnormal connection between arteries and veins that creates a knotted group of blood vessels prone to bleeding. Surgery may be needed to drain blood from the brain or to repair the leaking blood vessels. But as with ischemic stroke, time is of essence.

Stroke: Call 911

Don’t waste time calling a doctor if you suspect someone has suffered a stroke or think it could be happening to you. Call 911 to request emergency medical help, so that treatment can be started immediately and brain cells can be saved.

Read Diana Rodriguez's article at

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