Stroke afflicts nearly 800,000 people each year and is a major cause of death and disability in our nation. While today’s advanced treatments are significantly improving stroke patient outcomes and mortality, time is always of the essence when it comes to this disease. The earlier treatment is initiated after symptom onset, the less damage to the victim’s brain and the more likely he or she will recover fully from the episode with few or no long-term functional deficits.
According to Dr. Mouhammad Jumaa, Medical Director of the UTMC Stroke Network, both stroke and the medications and surgical techniques used to treat it are highly time sensitive. “With stroke, injury to the brain gets progressively worse with the passage of time,” he says. “If only minutes pass before the patient reaches us for help, it’s much easier to treat the stroke successfully than if several hours have elapsed.”
Jumaa further explains that there are two distinct types of stroke. Ischemic strokes, which are the most common, are caused by a blockage in a blood vessel that delivers oxygen to the brain. Hemorrhagic strokes, on the other hand, occur when a blood vessel bursts and causes bleeding in the brain. “These two forms of stroke have the same risk factors but are treated very differently. They’re almost opposite conditions,” he says.
Several groundbreaking stroke treatments have been studied and approved over the past few decades, and these, too, are highly time sensitive. For example, the clot-busting drug TPA must be administered within four and a half hours of symptom onset, and neurointerventional surgical techniques, involving the use of a catheter and various devices to retrieve clots from small blood vessels in the brain, have a time window of up to 12 hours. Surgical interventions for hemorrhagic stroke must be performed within the first few hours of symptom onset as well.
The signs and symptoms of stroke are varied and oftentimes subtle, which can make it challenging for victims or bystanders to recognize the emergency and take prompt action to get help. The good news is, there is an acronym developed by the American Stroke Association that can assist people in determining whether they or someone they know could be having a stroke so they can seek treatment in a timely manner—BE FAST.
Jumaa urges everyone to become familiar with this acronym, which stands for:
Balance—Sudden loss of balance or coordination or difficulty walking.
Eyes—Vision problems in one or both eyes.
Face—Numbness, tingling, weakness, or drooping. (Ask the person to smile to see if one side of the face droops, causing an uneven or crooked smile.)
Arm or leg—Numbness, tingling, or weakness in one or more extremities.
Speech—Slurred or garbled speech or the inability to speak. (Ask the person to repeat a simple phrase.)
Time—If you observe any of these symptoms, it’s time to call 911 immediately. Also, if known, note the exact time when the symptom(s) started.
In some cases, Jumaa notes, the only symptom stroke patients experience is dizziness, which is a very important sign because it suggests that the part of the brain that controls equilibrium has been affected—and the long-term loss of equilibrium can be very disabling.
Jumaa also emphasizes that bystanders should not attempt to transport stroke victims to medical care. Nor should stroke victims attempt to self-transport. Instead, they are urged to call 911 to bring EMS directly to the scene. “Stroke care begins in the field,” he states. “EMS personnel are the first to communicate with the patient and family. They know what questions to ask and the importance of establishing the patient’s ‘last known well,’ or when he or she last felt normal. In addition, many of the EMS people we work with are trained to recognize the severity of a stroke and to determine whether it’s best to transport the patient to the nearest hospital or to a tertiary facility that is able to provide specialized treatments.”
In addition to BE FAST, perhaps the most important message with respect to stroke is, “Time is brain.” The more time that elapses between the onset of symptoms and the start of treatment, the more brain tissue is damaged and the greater the risk of permanent disability or death. So if you or someone else experiences any of the symptoms listed above—even if only temporarily—don’t hesitate to seek medical care. ❦