Stroke

Dear Dr. B: What is meant by “brain attack”? Is it something to do with acute stroke? Is there a treatment for acute stroke in Medicine Hat? Yours, Afraid to Stroke (ATS).

Dear Mr. ATS: When blood supply to the heart is cut off then it is “heart attack”. When blood supply to the brain is cut off then it is “brain attack”!

One of the common reasons for a heart attack is a clot in coronary artery. One of the common reasons for a brain attack is a clot in one of the brain arteries.

Many lives have been saved by administrating clot-busting drugs to a heart attack patient within the six hours (window of opportunity) of starting the symptoms of chest pain. Similarly, the window of opportunity for brain attack is three hours.

Brain attack, if not recognised or treated early, will lead to stroke (paralysis). As many of us know, stroke leads to significant disability, dependence, complications and sometimes death.

Until recently, there was no good treatment for acute stroke. But in the last three to four years, significant work has been done to show that if clot-busting drug (tPA) is given to patients within three hours of starting the symptoms of paralysis, then the chances of full recovery are significantly improved.

The problem is, when a person experiences sudden weakness or numbness in the arm or leg, or has sudden visual disturbance then he will wait, hoping that it will improve. Sometimes it does – called transient attack. But quite often it may not and by the time he calls the paramedics it is more than three hours. Sometimes a day or two has gone by. Then that person is not eligible for clot-busting treatment.

So it is important for an individual, his family, friends or co-workers to recognise symptoms of stroke, call an ambulance and rush to the hospital emergency within couple of hours of starting the symptoms. Otherwise we lose that window of opportunity.

Do we have treatment (clot-busting medication) for acute stroke in Medicine Hat?
Yes. A protocol for the treatment of patients with acute stroke, who show up at the hospital within three hours of onset of symptoms, was established recently at the Medicine Hat Regional Hospital. So far three patients have been treated successfully. These patients would otherwise have been paralysed and institutionalized for long-term rehabilitation.

Is this a well-established and safe treatment?

Some people think this is still controversial. But a recent review article (September 7) in the New England Journal of Medicine says: “Safe and effective treatment is now available for patients with acute ischemic (where blood supply is cut off) strokes. Intravenous thrombolysis (clot-busting) with tPA is safe and improves outcome if treatment is initiated within three hours after the onset of symptoms”.

Nothing in life is hundred percent safe. Every treatment has likely complications. But two things are important: early recognition of symptoms of stroke and rushing to the hospital emergency within three hours. Otherwise, you do not benefit from clot-busting treatment.

In the next column, we will explore this subject little further, explain the symptoms, look at the likely complications of the treatment and examine the work done in Calgary with the help of Heart and Stroke Foundation.

So Mr. Afraid to Stroke, help is there if you seek it on time!

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