Breakthrough Strategies Help Prevent Death or Disability

If you have a stroke, one of the most common-and devastating-mistakes is failing to seek treatment fast enough. When blood supply to the brain is cut off by a clot (ischemic stroke) or there is bleeding in or around the brain (hemorrhagic stroke), damage starts within minutes. Getting help right away could save your life -or profoundly improve your recovery.

Is It A Stroke?

The onset of stroke symptoms is sudden and consists of episodes of neurological dysfunction. Transient ischemic attacks, or TIAs, are stroke warning symptoms that usually last 15 minutes to several hours and ate not associated with permanent damage. Approximately 10% of patients who experience a TIA go on to have a stroke within the next three months. If you think that you maybe having a stroke, call 911. Studies have shown that treatment may be delayed if you first call your doctor or hospital. While waiting for emergency help, lie down in a comfortable position that allows you to breathe freely.

Caution: It is not recommended that you take aspirin for a suspected stroke. While its clot fighting ability may help if you ate having an ischemic stroke (or heart attack), it could make things worse if you are actually having a hemorrhagic stroke.

The Right Diagnosis

At the hospital, brain imaging is one of the first tests performed to help diagnose a stroke and determine its type. Usually, this is done using a standard computed tomography(CT) scan. This painless, noninvasive test takes multiple detailed images of the brain.

A hemorrhagic stroke, in which blood pools in or around the brain, is easy to identify because blood looks different on a CT scan than brain tissue. In an ischemic stroke, the brain can appear normal on a CT scan if swelling or damage has not yet occurred. In this case, the scan rules out other causes, and ischemic stroke is diagnosed by a clinical history and exam. A follow-up CT scan is performed a few days later to confirm the diagnosis.

Ischemic Stroke

During the period immediately following an ischemic stroke, medication may be needed to stabilize blood pressure and heart rate. If the stroke patient has a fever, it is treated with acetaminophen (Tylenol) or a cooling blanket even a slight fever can worsen brain damage. Other treatments...

Medication. The clot-dissolving drug alteplase (Activase) is the most effective emergency treatment for ischemic stroke. Also known as a tissue plasminogen activator, or tPA, the drug works with the body's own chemicals to dissolve the clot that is blocking circulation to the brain. To be effective, tPA must be given within three hours of the first stroke symptoms. However, tPA also has risks. As a potent "clot buster," it can cause bleeding. Approximately 6% of the patients who receive it develop bleeding into the stroke damaged area of the brain, which can be fatal.

Latest development: Administering clot-busting drugs via an intra-arterial route through a catheter threaded up to the blocked artery itself may extend the treatment window to six hours. This approach requires special imaging, such as angiography, to pinpoint the blockage and can be performed only at centers that have such equipment and personnel trained in the technique. Although studies have shown this technique to be effective for some patients, the bleeding risk is higher (10% to 12%) than standard tPA.

Surgery. After a TIA or minor stroke due to a blockage of the carotid (neck) artery, other options include clearing the carotid artery to prevent another stroke. Called carotid endarterectomy, the blocked artery is opened and the clot is removed to restore circulation. Another option is angioplasty and stenting, in which a balloon is inserted via a catheter, and then expanded at the site of the clot to widen the blood vessel' A wire mesh framework, called a stent, is then placed in the artery to keep it open.

Latest development: Another new approach uses a corkscrew-shaped device called the MERCI (mechanical embolus removal in cerebral ischemia) Retriever. It is approved by the US Food and Drug Administration (FDA) for removing stroke-causing clots from brain arteries. The device looks promising, but it has not been definitively shown to improve the outcomes of patients. It also carries a risk of bleeding into the brain.

Hemorrhagic Stroke

Hemorrhagic stroke treatment first focuses on stabilizing the patient-using a ventilator if-necessary, to restore breathing and treating life-threatening heart problems that have been caused by the stroke, such as heart rhythm disturbances (fibrillation). Other treatments...

Medication. Blood pressure needs to be brought down quickly to prevent additional bleeding in other parts of the brain. Blood pressure medications are often administered intravenously so they can rake effect rapidly.

Bleeding in the space between the inner layer and the middle layer of the tissue covering the brain (subarachnoid hemorrhage) is usually caused by a ruptured aneurysm-a burst bubble in a brain artery. your doctor may prescribe nimodipine(Nimotop), a calcium channel blocker that prevents arteries from going into spasm and causing more damage. After the first hemorrhage, rebleeding can occur unless corrective steps are taken.

Surgery. The standard treatment for a brain aneurysm is clipping-a surgical procedure in which a small clip is placed at the base of the aneurysm to close it off from blood flow. It is the preferred form of treatment for aneurysms in certain areas of the brain, particularly in medically stable patients.

Latest development: For aneurysm patients who are not medically stable, a new technique known as coiling may be the best form of treatment. In coiling, a catheter is guided up through a blood vessel to place a collection of tiny platinum coils in the aneurysm. This causes a clot to form within the aneurysm. The procedure is less ,invasive and safer than clipping, but some aneurysms cannot be completely treated using this technique. The risks of both procedures include rebleeding from the aneurysm.

Ongoing Care

Perhaps the most frustrating aspect of stroke recovery is waiting to determine the extent of brain damage. During this time, an antidepressant may be needed if there are signs of depression.

For most stroke survivors, physical and/or occupational therapy over a period of months or indefinitely-is essential to optimize functions, such as speech and the physical capacities that were impaired by brain damage.

Latest development: Nutrition has only recently been fully recognized as an important factor for stroke patients. In a 2OO5 update, the American Stroke Association recommended assessing and correcting nutritional problems, such as malnutrition, in stroke survivors.