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By Jill Ross, HealthAtoZ contributing writer
If you suspect someone is having a stroke, quickly dialing 911 could mean the difference between that person winding up disabled or making a full recovery.
Only a small fraction of stroke patients get to a hospital in time to receive a drug that is the best hope for treating stroke. Often that is because they can't act for themselves or someone coming to their aid may not recognize the symptoms.
"Most of the time, stroke is an unmistakable event," said Steven Warach, M.D., Ph.D., a neurologist who is chief of the Section on Stroke Diagnostics and Therapeutics for National Institute of Neurological Disorders and Stroke (NINDS).
Symptoms come on suddenly, and include:
- Numbness or weakness of the face, arm or leg (especially on one side of the body).
- Confusion, trouble speaking or understanding speech.
- Trouble seeing in one or both eyes.
- Trouble walking, dizziness, loss of balance or coordination.
- Severe headache with no known cause.
Know stroke
The problem, Warach said, is that because stroke injures the brain, you may not realize that you are having a stroke. If you're a bystander, someone else having a stroke may just look unaware or confused.
Each year about 700,000 people experience a new or recurrent stroke. About 500,000 are first attacks, and 200,000 are recurrent attacks. Stroke accounted for 162,672 deaths in 2002 and 942,000 hospital discharges, according to the American Stroke Association. Fifty percent to 70 percent of stroke survivors regain some functional independence, but 15 percent to 30 percent are seriously disabled, with problems ranging from paralysis, difficulty with thinking and speech, according to NINDS.
The drug that could change the numbers, called tissue plasminogen activator (t-PA), has been shown to significantly reduce the debilitating effects and minimize permanent disability in ischemic stroke by at least 30 percent. Ischemic strokes, resulting from blood clots that block brain arteries, are the cause of 80 percent of all strokes. Hemorrhagic stroke, accounting for 20 percent of cases, occur when a blood vessel breaks and bleeds into or around the brain.
Clot-buster's benefits and risks
The drug t-PA works by dissolving blood clots. The key to the drug's effectiveness, though, is time. t-PA must be started within three hours of the onset of stroke symptoms.
"Earlier is always better. It's more effective, and there's less risk," Warach said.
The risk of t-PA is that it can cause bleeding in the brain. Therefore, exceeding the three-hour window not only means that the drug is less likely to be effective but that it could make a person's condition worse. As a result, not every stroke patient, particularly those experiencing a hemorrhagic stroke, can receive t-PA treatment.
"A doctor has to decide on the whole picture," Warach said, noting that what kind of stroke, the time since the onset of symptoms and a person's overall health and age are all factors to consider. Patients older than 70 tend to have more severe strokes and a higher risk of complications, according to Warach.
Don't wait, call 911
Although the window of opportunity to start treating stroke patients with t-PA is three hours, patients need to get to the hospital as soon as possible. Even if you aren't certain someone is having a stroke, Warach said, "don't waste a lot of time, call 911."
Furthermore, people shouldn't attempt to drive themselves or others in a stroke situation, Warach said. Arriving at the hospital by ambulance is preferred because it's faster, safer and increases your chances of getting prompt attention.
"Even if a person is not eligible for t-PA therapy, even if no one discovers that it's a stroke until four or six hours later, it's still important to get to the hospital," Warach said.
"There are other things that we know can improve the person's outcome," he said.
Managing a stroke patient's blood pressure and blood sugars, for example, is critical. If a person's neck artery has become partially blocked, surgery might be needed. Experimental drugs may be given in an attempt to improve blood flow and to protect brain tissue. Getting a person rehabilitation services also can be important.
"The main issue in hospitalization after the first few hours is to find out why a stroke happened and to get the best therapy to prevent another stroke," Warach said.
Experts say the best treatment for stroke is prevention. If you smoke, quit. If you have high blood pressure, heart disease, diabetes or high cholesterol, making sure you keep them controlled will greatly reduce your chances of having a stroke.
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External Sources
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National Institute of Neurological Disorders and Stroke
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American Heart Association
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This article was reviewed and updated June 2007.
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