The Window of Opportunity for Treating Stroke
Currently, stroke is the number one cause of disability and the third leading cause of death. At California Pacific, we want to change these disturbing stroke statistics. Through quick and aggressive stroke intervention we can greatly enhance a person’s chance of recovery. According to David Tong, M.D., medical director of California Pacific’s Stroke Care Center, "The good news is that nearly 50% of patients treated for stroke within a three-hour window experience little, and sometimes no, physical or speech deficit. As a Stroke Center, our goal is to streamline the process of getting patients to diagnosis and treatment within this window." Measuring this window of opportunity can be tricky. The clock starts ticking when the person was last seen in normal neurological condition.
Up to 85% of strokes are ischemic, usually caused by blood clots that cut off the brain’s blood supply. As in a heart attack, when heart muscle is deprived of blood and oxygen, heart muscle tissue dies, cutting off blood to the brain causes brain tissue to die. For many reasons, such as patient hesitation, unrecognized symptoms (often painless), or transportation delays, less than 2% of persons experiencing stroke actually fall into the three-hour treatment window.
Quick Response is Essential
In October of 2005 Dawn Hartman was one of the lucky stroke survivors. Enjoying dinner out with her parents, husband and young daughter, Dawn started to feel strange. She was too young for a stroke, just 40 years old, and the picture of health; she had never smoked, and her blood pressure and cholesterol were normal. She exercised regularly and was not overweight. So when she asked her husband to call 911 and get her to the hospital, her family reacted quickly. "There was no ignoring my symptoms, they were dramatic," reflects Dawn.
The ambulance arrived within minutes and Dawn’s speech was already slurring. By the time she reached California Pacific’s Davies Campus emergency department she was unable to form sensible words or put together a sentence. Fortunately for Dawn, the emergency room staff quickly recognized that she was experiencing a stroke and contacted Dr. Tong.
When patients experiencing stroke symptoms arrive at a facility with a dedicated Stroke Center, such as California Pacific Medical Center’s, dedicated stroke specialists follow a stroke treatment protocol providing appropriate treatment as quickly as possible. Through telemedicine capabilities, our physicians are able to study CT scans while a patient is still in the emergency room and the physician is en route. This capability conserves precious brain-saving time as physicians can begin stroke treatment with the assistance of the emergency room physician.
Because Dawn was diagnosed within the three-hour window, Dr. Tong was able to administer clot-busting thrombolytic therapy. By 6:00 a.m. the next morning Dawn had completely recovered the ability to communicate clearly again. Remarkably, Dawn was admitted to the hospital on a Friday night, and went home with normal speech function the following Monday afternoon. Since then, Dawn has returned to her normal busy lifestyle as a wife and mother caring for her toddler.
Ischemic strokes are treated with thrombolytic therapy using recombinant tissue Plasminogen Activator (rTPA). rTPA is a naturally occurring clot-dissolving enzyme .The body produces rTPA in smaller amounts, but when a stroke hits it is imperative that clots be dissolved as quickly as possible returning normal blood flow to the brain. Injecting rTPA can greatly decrease brain tissue death, but must be used within a short-time window to be effective.
Recognition of Stroke Symptoms Saves Time
Norita Lambert was relaxing with her husband watching football two days before Christmas 2005. Her husband left the room for a few minutes. When he returned, Norita’s speech was nonsensical. Her husband realized something was wrong and called a friend who was a registered nurse.
She told him to call 911 immediately. "I’m a walking miracle," Norita stated, "I barely made it within the three-hour window. I’m lucky I ended up at California Pacific Medical Center and even luckier Dr. Tong was there to take care of me."
Norita Lambert 3-months after her
Time is of the essence in stroke care. The established window of opportunity to treat patients with ischemic stroke is only three hours from the time the individual was last seen feeling and acting normal. While some people may receive alternative treatments up to six or even eight hours after symptom onset, the probability of success substantially decreases with time. Therefore, it is imperative that if a person experiences stroke-like symptoms, medical attention be sought immediately.
Upon arrival to the Emergency Department, Norita received a CAT scan evaluation to rule out intracranial bleeding and was quickly started on rTPA. 15% of strokes are hemorrhagic, caused by bleeding within the brain, and administering rTPA to a person with a hemorrhagic stroke can result in severe consequences. Hemorrhagic strokes are often associated with pain.
By the time she was admitted to the Intensive Care Unit (ICU), just a few hours later, she was able to speak some words clearly. She walked out of the hospital four days later with normal speech function thanking everyone for the remarkable recovery she had experienced.
The signs and symptoms of stroke can be different in each patient. Norita’s symptom was her inability to speak coherently; she had no pain, headache, or limb numbness. Norita says, "People can’t believe I had a stroke."
Patients who arrive outside the three-hour window have limited options. A variety of endovascular surgical techniques, most of which are investigational, are available at most major Stroke Centers, including California Pacific Medical Center’s. Endovascular interventions are surgeries performed from inside the blood vessels, through a tiny puncture in the leg. Sophisticated imaging equipment is used to see inside the patient. Endovascular techniques have changed the nature of vascular neurosurgery and stroke neurology alike. Fueled by advancing computer and materials technologies, the techniques are evolving very rapidly. Treatments available for stroke today, and the philosophy of stroke treatment, are very different from in the past.
Learn the Signs and Symptoms
Who is at Risk?
Most patients are 70 years or older when having a stroke, although stroke can happen at any age. You can’t change your age but there are many risk factors that you can control through medication or diet to decrease your risk for stroke.
Stroke Risk Factors:
- High blood pressure
- Heavy alcohol use (more than 1 or 2 drinks a day)
- Physical inactivity (less than 30 minutes exercise a week)
- Diet high in fat and sodium