The panel described six key links in ensuring a successful "chain of recovery" from stroke:

1) quickly identify stroke symptoms you experience or see in someone else,

2) get emergency help immediately,

3) get rapid transport to appropriate treatment centers,

4) receive rapid diagnosis and treatment at the centers,

5) receive specialized treatment for any complications or the problems that led to the stroke and

6) get appropriate rehabilitation when necessary.

The panel suggests stroke signs and the chain of recovery should be as commonly known as the early warnings of a heart attack.



A stroke, also called a "brain attack," occurs when the brain is injured, either by a blood clot that blocks blood flow (ischemic stroke) or by bleeding (hemorrhagic stroke). When blood flow is cutoff to parts of the brain, it is deprived of oxygen and other nutrients it needs to function properly. If blood flow is not restored, those parts of the brain begin to die, causing a variety of disabilities such as paralysis or loss of speech. Stroke is the leading cause of adult disability.

In recent years, research on strokes has revealed several important clues to understanding blood flow to the brain and its crucial role in the treatment of acute brain attacks. Scientists have observed what is called a "therapeutic time window" following a stroke during which proper treatment can restore blood flow and reverse brain damage once thought to be permanent. Researchers emphasize that a speedy response is critical: patients must be treated within three hours to benefit from the therapy.

"Current recognition and treatment of stroke patients is usually too slow to allow therapy within the 'time window,'" said Dr. James Grotta, a key speaker at the panel's meeting who is studying rapid stroke treatments at the University of Texas Medical School in Houston. His studies are funded by NIH's National Institute of Neurological Disorders and Stroke.

The panel also stressed another important key to increasing patients' chances of surviving a stroke--education. The more people--those at risk for stroke, their families and friends; doctors and other medical professionals, especially emergency caregivers; and emergency response team members (such as 9-1-1dispatchers)--who know the warning signs and what to do when seeing or hearing them, the better the patient's chances of fully recovering from brain attacks. The neurology institute will issue proceedings from the symposium in Spring.--an NIH HEALTHWise report, February 1997

Stroke Facts

• Stroke is the third leading cause of death after heart disease and cancer and a leading cause of serious, long-term disability.
• In 2002, stroke killed 162,672 people (61% of them women), accounting for about 1 of every 15 deaths. The death rate was 56 per 100,000 population.
• Stroke death rates are substantially higher for African Americans than for whites (2002 rates per 100,000 population: 82 for black men, 72 for black women, 54 for white men, and 53 for white women).
• For other racial and ethnic groups, 2002 stroke death rates per 100,000 population were 48 for Asians/Pacific Islanders, 41 for Hispanics, and 37 for American Indians/Alaska Natives.
• Approximately 50% of stroke deaths occur before the person reaches the hospital.
• Each year, about 700,000 people suffer a stroke (about 500,000 first attacks and 200,000 recurrent attacks).
• From the early 1970s to the early 1990s, the estimated number of noninstitutionalized stroke survivors increased from 1.5 million to 2.4 million.
• Medicare spent $3.6 billion in 1998 on stroke survivors discharged from short-stay hospitals.

Emergency Therapy for Stroke Approved

People who have the most common type of stroke but receive a newly approved drug for it within three hours of their first symptoms show little or no signs of disability after three months, according to results of a study funded by the neurology institute at the National Institutes of Health. The researchers found that quick recognition and diagnosis of stroke signs and rapid administration of the clot-dissolving drug t-PA was absolutely essential. The Food and Drug Administration approved t-PA for stroke last June.

A stroke, also called a "brain attack," is usually the result of a disease process that worsens over many years. A stroke occurs when the brain is injured, either by a blood clot that blocks blood flow (ischemic stroke) or by bleeding (hemorrhagic stroke). When blood flow is cut off to parts of the brain, the brain is deprived of oxygen and other nutrients it needs to function properly. If blood flow is not restored, those parts of the brain begin to die, causing a variety of disabilities such as paralysis or loss of speech. Stroke is the leading cause of adult disability.

Each year in the United States, about 400,000 brain attacks are due to blood clots and 100,000 strokes are caused by bleeding into the brain. t-PA has already been used effectively in people with heart attacks. Now, after a five-year study of 600 patients nationwide, the drug is also available for people who have ischemic brain attacks as well. Those treated with the drug under very specific conditions were at least 30 percent more likely than untreated patients to survive their brain attack with little or no disability.

The researchers stressed that several important steps are essential to optimize recovery using t-PA, which is not without serious risks, including bleeding in the brain. Chiefly, doctors must carefully evaluate brain scans of people experiencing signs of stroke to choose only the appropriate patients to receive t-PA. Also, giving the drug after the three-hour "treatment window" could be more harmful than beneficial, since t-PA could easily result in a much higher rate of bleeding into the brain and worsen the brain injury. See t-PA Treatment for Acute Stroke

Average Time Until a Person with a Stroke
Reports to Doctor: 6-24 hours

Maximum t-PA Start Time: 3 hours

Researchers supported by the National Institutes of Health have found a new treatment to lessen the impact of strokes, or "brain attacks." To be most effective, this treatment and others in the pipeline require rapid identification of stroke symptoms and immediate action by patients and emergency care specialists. If you have one or more of the following signs of a stroke, call a doctor or 911 right away!

Sudden weakness or numbness of the face, arm, or leg on one side of the body.

Sudden dimness or loss of vision, particularly in one eye.

Sudden difficulty speaking or understanding speech.

Sudden severe headache with no known cause.

Unexplained dizziness, unsteadiness, or sudden falls, especially with any of the other signs.

Warning signs may last a few moments and then disappear. They are signs of a serious condition that won't go away without medical help.

What Are the Risk Factors for Stroke?

There are some things you can do to reduce your chances of having a stroke:

• Treat your high blood pressure, either through diet and exercise or medication.

• Quit smoking cigarettes.

• Manage your heart disease. Your doctor may prescribe medication to help prevent the formation of clots.

• Control your diabetes. Treatment for diabetes can delay the complications that increase your risk of stroke.

• Get help at once for transient ischemic attacks. These "mini-strokes" are brief episodes of stroke's warning signs that then disappear.--an NIH HEALTHWise report, February 1997

National Institute of Neurological Disorders and Stroke
Attn: HEALTHWise
Room 8A16, Bldg. 31
Bethesda, MD 20892
Phone: 301-496-5751

Source & References:
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