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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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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