If you have a stroke, time is not on your side.
In fact, there is only a three-hour window after a stroke for a patient to receive the most effective treatment -- tissue Plasminogen Activator (tPA), a clot-dissolving drug that can open blood vessels in the brain and resume circulation to brain tissue.
A sudden stroke led Annette Zink, 68, to the emergency room at Mercy Medical Center last May. Luckily, she arrived within the critical three-hour timeframe and was able to have tPA administered intravenously and eventually intra-arterially directly into the clot in her brain, thereby minimizing long-term damage from the stroke.
Neurologist Dr. Mark Young, director of Mercy's Stroke Center , saw Zink in the Emergency Department after being consulted by the ED physician. Intravenous tPA was started with no results. The decision was made to go Intra-arterially - directly into the clot in the blood vessel in the brain. Invasive Radiologist, Dr. Gregg Berg navigated a catheter from the femoral artery in her groin up to the blockage in her brain, where tPA was injected in and around the clot.
"The procedure took about an hour," says Dr. Young. "She had a very immediate response to the treatment - it worked exactly how it is supposed to."
Timing was everything. As soon as Zink arrived, she was evaluated at Mercy's Emergency Department. She had an EKG (an electrocardiogram records heart activity), blood sugar assessment, lab work and a CT (brain) scan. Within minutes of diagnosis, intravenous tPA was started. The clot area was rescanned every 10 to 15 minutes so doctors could monitor progress.
Prior to her treatment, Zink had profound weakness on her left side, marked speech impairment and lack of awareness of the left side of her body. If someone spoke to her from her left side, she could hear the voice, but not see the person. If she was asked to raise her left arm, she'd raise her right arm instead and did not recognize the difference.
"In less than five minutes after the Intra-arterial tPA was administered, she was moving the left side of her body, moving her eyes to the left and talking more clearly," he says.
Now Zink is almost fully recovered. "I feel fine. I drive - I do everything. I don't have a limp or anything - well, unless my high heels hurt," she says with a laugh.
Zink was very fortunate as she had a history of transient ischemic attacks (TIAs), sometimes incorrectly referred to as mini-strokes. A TIA begins just like a regular stroke, but symptoms disappear within a day and leave no lasting effects. During a TIA, oxygen supply is cut off to an area of the brain. Anyone having TIAs should seek immediate medical attention as they are at risk for having a stroke.
Zink, however, did not seek treatment even though she'd experienced TIAs for about 25 years.
"I had no idea what they were," she says. "I never consulted a doctor because they generally happened during the night. So, I'd get up in the middle of the night, go to the bathroom and go right back to sleep. I'd have maybe one a year. One time when I went back to bed, my head felt like it was spinning around. But I never had pain or headaches."
"One of our main public awareness battles is that people do not recognize stroke symptoms and do not come to the hospital." Dr. Young points out. "Many people have symptoms at night and just go back to sleep. It is critical to recognize stroke symptoms and seek medical help immediately."
Garbled speech, marked behavior changes, affected vision, vertigo (spinning sensations) and weakness on one side of the body are all indicators of TIAs and strokes. If you are around someone with these symptoms call 9-1-1.
Looking back, Zink can identify incidents where her behavior was unusual.
"One time I was trying to buy a suit in a department store," she remembers, "and I heard gibberish coming out of my mouth. The sales lady was just staring at me."
Currently, intravenous tPA is the preferred treatment for acute stroke in the United States. But for patients who seek medical assistance more than three hours and less than 6-8 hours after a stroke, other options such as the intra-arterial tPA (Zink's procedure) and an intra-arterial retrieval device exist. The intra-arterial retrieval device works like the intra-arterial tPA, guided directly to the clot and mechanically removing the clot in a matter of minutes. Drugs -- even those delivered via arteries -- may take as long as two hours to dissolve a clot.
Mercy recently began using a retrieval device for such cases. The FDA-approved Mechanical Embolus Removal in Cerebral Ischemia (MERCI) retrieval system looks like a delicate corkscrew held in a catheter tip. That tip shields the corkscrew from the artery wall until it is twisted into the clot. Then the device and clot are withdrawn from the artery - similar to uncorking a bottle of wine. This is a relatively new technology, notes Dr. Young.
Zink is back to leading a normal life, with occasional follow-up physician visits. Those visits generally help educate patients, like her, about lifestyle changes they can make to help prevent future strokes.
"She would have required total care without medical intervention," says Dr. Young. "Her case is a profound success."
Stroke WARNING Signs*
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
- Sudden confusion, trouble speaking or understanding.
- Sudden trouble seeing in one or both eyes.
- Sudden trouble walking, dizziness, loss of balance or coordination.
- Sudden, severe headache with no known cause.
Not ALL of these warning signs occur in every stroke. If one does, don't wait. Get help immediately. Stroke is a medical emergency - dial 9-1-1.
Key points to remember:
Reduce your chances of having a stroke by learning the risk factors and working with your doctor to help reduce your risk.
Recognize the warning signs of a stroke. Every second counts!
Respond by calling 9-1-1 immediately if you or someone close to you is having warning signs of stroke. Then check the time. When did the first symptom start? You'll be asked this important question later.
*From the American Stroke Association