A stroke is a devastating event that can result in major brain damage and death. A new study has reported that receiving aggressive treatment within 90 minutes gives the victim the best chance for a good outcome. The study was conducted by an international team of researchers and appears on August 22 in the journal Stroke.
According to the Los Angeles County Department of Public Health, strokes are the second leading cause of death, behind coronary heart disease, in the county. When a person experiences a stroke, time is of the essence. The faster physicians are able to administer clot-dissolving medications, the sooner blood flow to the brain can be restored; thus, reducing or preventing permanent damage.
The study authors previously reported an increased benefit and reduced mortality after ultra-early stroke thrombolysis (clot dissolving) in a single center. The new study was conducted at multiple facilities. It explored whether extra benefit of treatment within 90 minutes from symptom onset is uniform across predefined stroke severity subgroups, as compared with later thrombolysis.
The investigators prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 10 European stroke centers. (An ischemic stroke is one caused by a blockage of an artery in the brain; a hemorrhagic stroke is one caused by the rupture of an artery.) The study group comprised 6,856 stroke victims. The researchers conducted a statistical analysis of the data to determine the association between treatment delays, as well as excellent three-month outcome, and mortality. The association was tested separately in tertiles (thirds) of baseline National Institutes of Health Stroke Scale.
The researchers found that a shorter onset-to-treatment time was significantly associated with excellent outcome. Every fifth patient had an onset-to-treatment time of 90 minutes or less; in addition, these patients had lower frequency of intracranial hemorrhage. After adjusting for age, sex, admission glucose level, and year of treatment, an onset-to-treatment time of 90 minutes or less was associated with excellent outcome in patients with National Institutes of Health Stroke Scale 7 to 12, but not in patients with baseline National Institutes of Health Stroke Scale more than 12 and baseline National Institutes of Health Stroke Scale 0 to 6. Ultra-early treatment was not associated with mortality.
The authors concluded that intravenous thrombolysis within 90 minutes is, compared with later thrombolysis, strongly and independently associated with excellent outcome in patients with moderate and mild stroke severity.
Take home message:
The first crucial step for stroke treatment is recognition of the problem by the patient, relative, or even a bystander. The American Heart Association urges patients to remember the FAST acronym in order to spot stroke symptoms:
- Facial drooping.
- Arm weakness
- Speech difficulty.
- Time to call 911
In addition, if a person experience other neurological symptoms, such as an abrupt loss of vision, trouble walking, umbness on one side of the body, or a severe, sudden headache, they should immediately call 911 and request to be transported to a certified primary stroke center. In Los Angeles, that would be Ronald Reagan UCLA Medical Center.
A delayed diagnosis can occur even at a large medical center. Some years ago, my wife recognized that her mother had stroke symptoms, including drooping of one side of her face and slurred speech. Sadly, it took her several hours to convince emergency department personnel that her mother was suffering a stroke-in-progress. Her mother died within a month. Thus, if you are confronted with a similar situation, advocate aggressively for appropriate care. Yell and scream if necessary.