Stroke: "Time is Brain"
It is has been some time since we wrote about stroke and some important things have changed during that time. One thing that has not changed is that the time from the very first symptom to treatment is still the one of the most important determinants of what the long-term consequences will be.
Strokes: What Are They?
Simply put a stroke is when the brain does not get the oxygen it needs to live and function. Like a heart attack that is a result of loss of blood supply to that important organ, when the brain does not receive blood normally it very quickly (in about three minutes) begins to lose function and if the blood supply is not reestablished, some of the brain cells will die and never regain function.
Types of “Strokes”
The word “stroke” is put in quotations here because there are three fundamental processes that can lead to loss of brain function due to loss of oxygen supply. The first is a transient loss of blood supply that returns and this event is called a “transient ischemic event” or “TIA.” A second type is called an ischemic stroke and is caused by the occlusion of a major blood vessel that supplies the brain with oxygen. This is similar to a heart attack since it is caused by a blood clot or thrombus or can be from an embolus of blood clot or other material. The third type of stroke is from an intracerebral hemorrhage or bleeding in the brain due to blood vessel rupture or trauma to the head.
Symptoms of Stroke
The sudden onset of numbness or weakness on one side of the body, with impaired speech or slurring of speech, confusion, double vision or blurred vision in one eye, dizziness, falling, or loss of consciousness are the signs of a stroke. Pain is often present in the head with a hemorrhagic stroke. If these symptoms occur then you or anyone around you should immediately call 911. Time is of the essence if you are having a stroke and the timeliness of treatment in a hospital is critical to the salvage of your brain.
Why is Time so Critical?
Time that the brain does not receive oxygen determines the extent of the brain damage: the shorter the time the less the permanent damage and the longer the time the more permanent or residual brain damage. Thus, treatment is aimed at getting the patient to a hospital and into a stroke treatment protocol as soon as possible. The first responders have Emergency Medical Technicians (EMTs) who are trained to evaluate potential stroke patients and to alert hospitals that they have a possible stroke patient. There are varying levels of preparedness for stroke patients at hospitals. Some hospitals are certified to care for strokes with full services and others are not. It is critical that the ambulance take a stroke patient to a hospital (if one is nearby) that can conduct a full stroke diagnosis and treatment. For example, the Medical University of South Carolina is the only local hospital certified by the American Heart Association with a Stroke Gold Plus Quality Achievement Award. A team is always ready to accept a patient for all stroke modes of diagnosis and treatment. To qualify for this certification the time from patient arrival to intervention with the latest technology must be more than 50 percent of patients within 60 minutes. This is fast!
The American Heart Association has just this year recommended a new therapy for all ischemic type strokes. This therapy involves two treatments after a radiologic determination has been made that it is an ischemic stroke and not an intracerebral hemorrhage. The first and previous only treatment is the administration of a clot dissolving medicine intravenously and the second to quickly have the patient taken to the “vascular lab” where a neuroradiologist passes catheters into the offending artery to extract the clot that is obstructing the blood flow to the brain.
The time-to-needle mentioned above is the time it takes a patient to be received in the emergency department, diagnosed with a brain scan, and then transported to the “interventional laboratory.” All this has to be done in less than an hour. This brand new recommended treatment of a stroke has proven effective and improved outcome in patients.
As we age our chances of having a stroke rise. Next month we will discuss the U.S. statistics about stroke and prevention; however, it is vital that you the patient, spouse, or friend of a stroke victim act fast. The brain is arguably our most important organ and if it is threatened we must call 911 and see to it that the ambulance goes to a certified stroke center. If on Seabrook or Kiawah, a helicopter should be considered as the travel time is markedly reduced by this form of transport. The most important thing is to recognize a stroke is happening and get help immediately.