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Why Minutes Matter

January 04, 2016

"Time is Brain." Minimizing the time between the onset of stroke and the beginning of treatment is critical. Time elapsed is one of the biggest determining factor in how much damage a stroke does to the brain. Every minute a stroke goes untreated, roughly 1.9 million brain cells die, which can lead to long-term disability and even death. Strokes should be treated with the same urgency as a heart attack.

Roughly 9 out of 10 strokes are caused by a clot blocking the flow of blood in one of the arteries feeding the brain. (This is known as an ischemic stroke.) Deprived of oxygen, brain cells begin to die. Function is lost in the part of the body controlled by that region of the brain. This can result in paralysis, inability to speak, vision loss, or emotional problems.

Fortunately, there is a type of drug designed to break up the clot. It is known as tPA, short for tissue plasminogen activator, and it can be highly effective in dissolving life-threatening blockages and reversing stroke-related disability. However, there's only about a four-and-a-half-hour window within which this drug may be administered. One of the key metrics in evaluating hospital stroke programs is how swiftly they administer tPA to patients upon arrival.

Sometimes, a stroke is caused not by a blockage but rather a ruptured artery that bleeds into the brain. This is known as a hemorrhagic stroke, and these patients will require emergency measures and may even need surgery to survive. Again, needless to say, time is of the essence.

All incoming stroke patients are also considered for neurointervention, where treatment is delivered from within the blood vessels. Neurointervention requires a special angiography machine that allows for two simultaneous viewing angles to gain a 3D perspective. These procedures have offered new hope to patients who previously would have had no further treatment options. The benefit of neurointervention has been proven in eight clinical trials recently.

There are many risk factors that contribute to the likelihood of a stroke. Arguably the three greatest factors are age, high blood pressure, and previous incidence of stroke. Stroke can happen to anyone anytime, but for people at significant risk (or for their loved ones) it's especially important to recognize the signs of stroke, of which there are several. The most common are sudden speech difficulty or weakness/numbness on one side of the face or arms. Even if the symptoms go away, it is imperative to call 9-1-1 immediately.

Dr. Asad Chaudhary is a Dignity Health neurologist in Sacramento, California helping stroke patients at Mercy General Hospital, Mercy San Juan Medical Center, Mercy Hospital of Folsom and Methodist Hospital of Sacramento.

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