ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, December 15, 1996 TAG: 9612160071
SECTION: NATIONAL/INTERNATIONAL PAGE: A-3 EDITION: METRO
DATELINE: WASHINGTON
SOURCE: Associated Press
Suddenly, a side of your body goes limp. Or maybe sight dims in one eye. Perhaps you can't speak or understand speech. Maybe there's a severe headache or an unexplained dizziness.
If any of these happen, medical experts say, you've got three hours to get help. Without quick action, a few million brain cells may turn to mush and you could suffer the effects for a lifetime. You could even die - 145,000 Americans did last year.
The disorder is commonly called stroke. Until now, doctors waited for the stroke to run its course, then worked on rehabilitation.
But a new philosophy of care - and development of a new drug to treat the problem - says ``brain attacks'' should be handled as a sudden emergency with all the urgency and concern of a heart attack.
More than 400 medical professionals, led by the National Institute of Neurological Disorders and Stroke, are drawing up new treatment guidelines that will reduce death and crippling caused by stroke, now the third-leading cause of death in the United States.
``There is a sense that we are on the edge of a revolution in the treatment of stroke,'' said Dr. Zack Hall, director of the institute, which is one of the National Institutes of Health.
Strokes occur when blood flow to the brain is blocked or reduced. Brain cells are shocked, stunned, starved and eventually killed. Whatever function those cells controlled - such as speech or walking - is gone.
About a third of the 500,000 stroke patients die within a short time. Many of the rest suffer permanent damage - partial paralysis, loss of speech or sight, crippling, even the ability to swallow.
Eighty percent of strokes are ischemic attacks - when an artery to the brain narrows or is clogged, impeding blood flow to the brain. Less common hemorrhagic strokes occur when a vessel bursts and there is bleeding into the brain or into the space around the brain.
In the past, stroke was treated with a ``wait and see'' attitude. Not much could be done; therefore, little was done.
``There was no sense of urgency about stroke, because there was little treatment available,'' said Dr. Rodman Starke, senior vice president for science and medicine of the American Heart Association.
Stroke patients were put to bed and their symptoms were treated while physicians mainly waited for the brain storm to end so rehabilitation could begin.
But all that will change because of a new clot-busting drug called tPA, approved in June.
Studies last year showed tPA will clear vessels and quickly restore blood flow to the brain - meaning ischemic stroke victims can avoid permanent injury.
But the drug must be administered within three hours. After that, brain cells affected by a stroke have died and softened, and tPA can make a stroke worse. The drug cannot be used on hemorrhagic strokes, because it aggravates the brain bleeding, so patients need a quick CT scan, an imaging system that lets doctors know what kind of stroke it is before tPA is administered.
Suddenly a disorder treated for decades with ``wait and see'' now requires ``hurry, hurry, hurry.'' Much of the nation's emergency medical personnel will need new training, and new hospital stroke teams have to be organized.
``It is a matter of a whole new attitude,'' Starke said.
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