One Stroke: Two Very Different Results
A) Time Lost Forever
8:05 a.m.
You're chatting on the phone with your best friend. Or maybe you're savoring a quiet morning. What you don't know is that a clot is traveling in a narrowed artery that feeds your brain. It will get lodged, cutting off oxygen and nutrition to a segment of your brain. It could affect the brainstem-your eyelid will droop, you'll have trouble swallowing or become dizzy or have double vision. Or maybe it will affect your cerebral cortex-you'll appear confused, unable to speak or understand language. Either way, you are having an ischemic stroke.
8:45 a.m.
Your vision is blurred and you've lost your balance. Still, you pass it off and think, "Oh, it will go away. It's nothing, I'm sure." But as time passes, you still can't move your left leg. Seconds, minutes tick on as brain cells continue to die; 1.9 million a minute*. Two minutes, three minutes, 12 minutes: A pea-sized portion of your brain has died, while surrounding cells struggle for survival.
9:15 a.m.
Your brain has lost 420 billion synapses, the vital intersections between neurons; and nearly 225 miles of myelinated fibers, those intricate webs your thoughts pass through. Still you wait, afraid or unable to call for help.
12:45 p.m.
The three-hour golden window has passed. Your brain has aged 14.4 years and it may be too late for doctors to administer valuable clot-busting drugs. The cells that have already died are lost forever.
6:45 p.m.
The stroke has run its course and your brain has lost 1.2 billion neurons; 8.3 trillion synapses; 4,470 miles of myelinated fibers. It is destined to form a hole in your brain the size of one-and-a-half ping pong balls. Your brain has aged the equivalent of 36 years.
B) Road to Recovery
Let's Change the Story
You call 911 within the first few minutes of symptoms and paramedics rush you to a hospital with
a primary stroke center like the one at the University of Virginia Health System. Within minutes, the emergency stroke team evaluates your stroke, scanning your head before administering the clot-busting drug tPA (tissue plasminogen activator). The team determines if your stroke is ischemic or hemorrhagic. In an ischemic stroke a clot blocks an artery to the brain; in a hemorrhagic stroke there is too much blood flowing into the brain from a ruptured vessel and tPA could be deadly.
Yours is ischemic. The tPA is administered. It begins breaking down the clot; re-establishing flow to the brain. The cells surrounding the core live and your chance for complete recovery significantly improves.
Stroke Is a Medical Emergency
Every minute you wait hoping your symptoms will go away, you lose nearly 2 million brain cells.
"The most important thing is to recognize the signs and symptoms of a stroke and call 911 quickly," says Nina J. Solenski, M.D., a neurologist and stroke expert at UVa Health System. "The core of a section of the brain dies in the first few seconds, but surrounding cells may just be stunned. If we see a person within three hours of the onset of an ischemic stroke, many times we can help them significantly recover." She adds, "Even if a patient does not qualify for a clot-busting treatment, he or she may be a candidate for other treatments." For example, UVa's stroke team can start treating complications of a stroke to help patients avoid aspiration pneumonia. They can also monitor patients for uncontrolled high blood pressure or irregular heartbeats. "There is so much we can do to help patients return to the life they enjoyed before the stroke," Solenski adds, "but only if they get here as quickly as possible."
*Time-related damage statistics from a study by Jeffrey L. Saver, M.D., published in Stroke: A Journal of the American Heart Association.
24/7 Specialized Stroke Care at UVa
Because every stroke is unique, diagnosis and treatment requires a specialized team. Such a team is available 24 hours a day at the University of Virginia Health System-one of only several primary stroke centers in Virginia that is certified by the Joint Commission on the Accreditation of Healthcare Organizations. This means a stroke patient who comes to UVa will find:
- An acute stroke team and laboratory services available around-the-clock.
- Emergency medical services and personnel trained in the diagnosis and treatment of all types of stroke.
- Neurologists and neurosurgeons who specialize solely in the assessment and treatment of acute stroke available 24 hours a day.
- Specialized neurointerventional radiologists trained at removing brain clots.
- A stroke unit with specially trained nurses and therapists who provide frequent neuro-assessments and vital sign checks, cardiac monitoring, specialized strategies for preventing complications, early assessment for swallowing difficulties (common in stroke), early mobilization, avoidance of urinary catheters that can lead to infections, as well as family and patient education.
- Rapid specialized neuroimaging and physicians experienced in interpreting CT or MRI studies immediately.
Time Matters
Know the Primary Stroke Center nearest to you and your loved ones. Go to http://www.jointcommission.org/, look under "Certification Programs," and find Primary Stroke Centers listed by state.
Don't Ignore Mini-Strokes
With a mini-stroke also known as a transient ischemic attack or TIA, symptoms mimic a stroke but are transient, lasting usually only a few minutes. But just because symptoms go away, don't ignore a TIA.
It is a strong predictor of a stroke. "Studies have shown that there is up to a 15 percent chance of a stroke in the next three months," says Heather Turner, care coordinator for the Stroke Service at the University of Virginia Health System.
Don't wait, call 911 if you or a loved one is suddenly experiencing any of these symptoms:
- weakness, numbness or unable to move a certain part of your body
- blurred or fuzzy vision
- very painful headache
- trouble talking or understanding others
- dizziness
Source: American Stroke Association