Stroke 2

Are you afraid to stroke? I am! So are millions of people.

My dad used to say: better to die of a heart attack than be disabled by a stroke. His wishes were fulfilled when he died peacefully at the age of 80. How many of us will be lucky like him?

Stroke, also called cardiovascular accident, is the third leading cause of death in Alberta and is the fourth leading cause of death within the Palliser Health Authority. When compared to rest of Canada, Alberta has the third highest rate of death from stroke.

In the last column we said that help is available for ischemic (lack of blood supply) stroke if we do so within three hours of onset of symptoms. This short window of opportunity is a significant barrier to successful treatment of acute ischemic stroke. And the second major barrier is the lack of public understanding of what the symptoms of stroke are.

Try to remember acronym MENDISH. This will help you remember the symptoms of stroke. M is for sudden memory loss. E is for eye problems like temporary loss of sight in one eye or double vision. N stands for numbness or weakness in the face, arm or leg. DI is for dizziness. S is for slurred or garbled speech. H is for recent onset of severe headache.

Dizziness and headache can be symptoms of many other problems. But if you have dizziness and headache in association with symptoms mentioned in earlier paragraph then you should call 911. Waiting for symptoms to resolve because they appear to be minor reduces your chance of receiving the clot busting drug tPA.

Is it safe to receive tPA therapy?

The chief hazard of tPA therapy is bleeding in the brain. In one study, 6.4 percent of the patients given tPA had bleeding in the brain compared to 0.6 percent of those given placebo. Death rate in the tPA and placebo groups were similar at three months (17 percent in the tPA group and 20 percent in the placebo group) and at one year (24 percent and 28 percent respectively).

Then what is the real benefit of tPA therapy?

The real benefit is prevention of paralysis and long-term disability. And the results are good.

“Of the patients treated with tPA, 31 to 50 percent had a complete or near-complete recovery at three months, as compared with 20 to 38 percent of the patients given placebo, and the benefit was similar at one year”, says an article in the New England Journal of Medicine.

Heart and Stroke Foundation has invested lot of money in finding treatment of acute stroke. It is one of the organizations helping Calgary Regional Stroke Program spearhead the development of resources to use thrombolytic (clot busting) therapy for acute ischemic stroke. Their three years of efforts has resulted in improved patient outcomes, shorter times from symptom onset to treatment and acceptable complication rates.

Now we have established similar treatment protocol in Medicine Hat Regional Hospital. It is for us to be vigilant and recognise symptoms early. The window of opportunity is short – only three hours! So, remember MENDISH and remember 911!

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