Home Forums Other Specialities Neurology & Neurosurgery Treatment of Stroke – Save a minute – Save a day

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    I am aware of the article posted by Raghu in January and commented by Mohammed ref – http://tnmgc.com/discus/viewtopic.php?f=13&t=271 . However I am compelled to write this following many articles I have seen recently about treatment of Stroke.

    The Times of London News Paper reported about a study done by the University of Melbourne where more than 2000 patients took part. The researchers measured the time from the onset of stroke to the administering of intravenous thrombolytic drugs to combat clots. This was then compared with the subsequent lifespan of the patients. On average each extra minute saved in treating a patient from the onset of symptoms led to 1.8 days extra healthy life. This was particularly marked in younger patients. So the message from the study was “Save a minute; save a day”

    The average in-hospital delays in Europe, USA and Australia are 70 to 80 minutes. In UK it is about an hour. Some hospitals are better. At the Stroke Services of the Royal London Hospital the response time is about 29 minutes.
    In USA stroke is the fourth leading cause of death and the number one cause of adult disability. Statistics indicate that a stroke occurs every forty seconds ie 795,000 per a year. The modern teaching is that when treating a patient with stroke every minute counts. Each passing second after someone suffers a stroke means greater risk of permanent damage or death, so it’s critical to get a diagnosis and treatment as fast as possible.
    The first few seconds of a stroke may be confusing, both to a witness and the stroke patient. Signs may be subtle — someone just isn’t quite normal, seems tired, confused, or uncoordinated. But the quicker you spot the initial signs of a stroke, the faster stroke treatment can be given. It was said that for the most successful treatment of stroke treatment must be started within a couple of hours.

    It is of course important to understand that there are two distinct types of stroke. Roughly 85 percent are ischemic strokes where the blood flow to the brain is blocked by a clot. The rest are haemorrhagic strokes where there is bleeding in or around the brain. Haemorrhagic strokes cause more damage and more people die from it. Two common causes of bleeding are aneurysms and arteriovenous malformations (AVMs). Surgery may be needed to decompress the brain or to repair the leaking blood vessels. Here again time is of essence when it comes to treatment and subsequent recovery.

    The mainstay of treatment for ischaemic stroke is the use of anticoagulants and thrombolytic agents. A drug called tissue plasminogen activator — tPA — dissolves clots and restores blood flow if given within 3 to 4 hours of the clot forming. But tPA also carries a 1-in-15 risk of causing intracranial haemorrhage that can be fatal. Although it is being used more and more now, some physicians are reluctant to use the drug because of the risk.

    A CT scan will differentiate between an ischaemic and a haemorrhagic stroke. Most hospitals geared to treating stroke patients should be able to get this done quickly before commencing treatment.

    The Public should be made aware of the following:

    1. Symptoms of confusion, trouble speaking, or understanding speech
    2. Numbness or weakness of the face, arm, or leg, especially if it occurs on one side of the body
    3. Trouble seeing in one or both eyes, or double vision
    4. Drowsiness, nausea, or vomiting
    5. Trouble walking, loss of balance or coordination, dizziness.
    6. Severe headache with no known cause.

    If any of these symptoms appear suddenly do not waste time calling a doctor. Call 911 or ** (or whatever number) to request emergency medical help, so that treatment can be started immediately and brain cells can be saved. It is also necessary for the paramedic and ambulance to know where they should transport the patient for immediate treatment. Most of the teams in a developed country know where to take the patient to.

    ‘Time is Brain’, and every second you delay in treating a patient, he or she is losing tens of thousands of brain cells.

    The overriding concept is to treat patients as soon as possible.

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