When it comes to treating a stroke, every second counts. Yet time is lost when a patient ignores symptoms in the hopes they'll go away, or when a person sits in a waiting room as patients with more dramatic symptoms are admitted. As a result, a group of neurologists are promoting the term "brain attack" for a stroke, which emphasizes the urgency with which a stroke victim should be seen
Stroke victims need to be seen quickly because "time is brain," and with each passing moment, more brain cells might be lost. And doctors can't immediately administer treatment, either. They have the tricky task of deciding whether the symptoms are actually those of a stroke. About 25 percent of patients with stroke symptoms aren't having a stroke [source: Kolata]. Migraines are one condition with similar symptoms, and weakness in the body could also indicate a nerve injury or a brain tumor. Doctors also have to decide whether the stroke is ischemic or hemorrhagic because the treatment goals of the two are completely different. The most effective tool in diagnosing a stroke is a brain imaging test -- a CT scan detects hemorrhaging, while an MRI is used to spot clots.
To treat an ischemic stroke, doctors want to break up the blood clots and restore blood flow. The only drug approved by the FDA for this purpose is known as tissue plasminogen activator or tPA (you may also know it as Activase). The drug dissolves clots, hopefully restoring blood flow and minimizing brain damage. Yet only one in five stroke victims who would benefit from tPA receives it [source: Brody]. There's a three-hour window in which tPA has been shown to be effective, and many patients just don't make it in time. That's why every minute counts when stroke symptoms start.
There's another reason why doctors are hesitant to administer tPA. In testing the drug, about 6 percent of patients experienced excessive bleeding in the brain, and after three hours, the risk increases [source: Kolata]. If the patient is suffering a hemorrhagic stroke, tPA would only compound the bleeding in the brain. The decision to administer tPA has been further complicated in recent years as doctors learn more about microbleeds, or tiny drops of blood on the brain, leaked from blood vessels. Microbleeds may be present in as many as one in five people over the age of 60 [source: Kolata]. Administering tPA or any other anticlotting drug could unleash a hemorrhagic stroke, which is what happened to Israeli prime minister Ariel Sharon in 2005 [source: Kolata].
Other treatments for an ischemic stroke include controlling the patient's blood pressure, so that it's not so high that it damages organs, but also not so low that blood flow to the brain is slowed. Doctors will work to reduce any signs of fever, which increases the chance of brain damage. Anticoagulants, or drugs that ward off future clots, like heparin, may eventually be introduced, as well as drugs that could aid the heart's function, if the stroke was caused by an atrial fibrillation.
Surgery is rare in treating ischemic strokes, but it might be an option for hemorrhagic strokes. To treat a hemorrhagic stroke, the doctor's goal is to relieve pressure on the brain and stop the bleeding. The first step is lowering a patient's blood pressure so there's less opportunity for blood to build up in the brain. Then, the doctor administers drugs that reduce swelling and considers surgical options, such as clipping an aneurysm or draining a pool of blood.
That's the immediate treatment, but what are the long-term actions? Find out about stroke recovery on the next page.
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