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• Striking Back Against Brain Attack

With a stroke or brain attack, timing is everything. It can mean the difference between life and death, or serious disability and almost total recovery. Until recently, no interventions were proven to stop the progress and minimize the damage of a stroke. Today, dramatic changes in emergency room treatments for early-stage stroke patients are making a profound difference in medical outcomes.

What is a brain attack?

A brain attack or stroke is a sudden disruption in the flow of blood that supplies life-sustaining oxygen and nutrients to the brain. Without effective early treatment, affected brain cells become damaged or die. Movement of limbs and speech can be temporarily or permanently impaired.

"Although considered a sudden brain attack, stroke usually develops over the years," explains neurologist Raymond M. Stephens, M.D., medical director of the Stroke Program at John Muir Medical Center, Concord Campus. "Deposits of fat, cholesterol and other substances accumulate on the inner walls of the arteries, causing them to become hard and constricted instead of supple. The resulting 'hardening of the arteries' is the cause of many forms of heart disease and the source of most strokes."

What actually triggers the stroke or brain attack?

Hardened and narrowed arteries are more vulnerable to a blood clot forming and completely blocking off the blood supply. When a clot breaks away from an artery wall and lodges in the brain, a stroke occurs.

What are risk factors for brain attack?

• A family history of stroke
• A diet high in cholesterol and saturated fats
• High blood pressure
• Heart disease
• Smoking
• Over age 55
• Physical inactivity
• Obesity
• Diabetes
• Excessive alcohol consumption

"Your risk of suffering a brain attack is strongly related to age," Dr. Stephens adds. "The incidence of stroke doubles in each decade after you turn 55, although nearly 30 percent of those who suffer strokes are younger than 65."

What are the statistics on brain attack?

Every year, about 700,000 Americans suffer strokes. Of those, nearly one-fourth die. Stroke is the third-leading cause of death (after heart disease and cancer) and the leading cause of adult disability in this country. As many as three million Americans are living with stroke's after-effects.

What are the promising new treatments?

"TPA is the primary treatment for acute stroke," says Dr. Stephens, a principal investigator in national stroke studies of new medications. "The prompt administration of this substance can decrease the size and severity of strokes. Time is of critical importance, since most damage occurs within hours of brain attack onset."

For a decade, TPA, or Tissue Plasminogen Activator, has been used to stop heart attacks. Now it is demonstrating great effectiveness during the early hours of a stroke. The Federal Drug Administration has approved TPA for patients experiencing stroke symptoms for three hours or less. In an investigative study, clomethiazole is being studied at both medical centers as a new drug to prevent a stroke from worsening.

What criteria are used for these drug treatments?

The decision to administer the intravenous medicines involves three aspects: the duration of the symptoms, the severity of the stroke, and overall health, according to Dr. Stephens. Patients arriving at John Muir or John Muir Medical Center, Concord Campus Emergency Departments are carefully and swiftly evaluated as candidates for these treatments.

Take brain attack symptoms seriously

"We need to look at a brain attack the same way we look at a heart attack," Dr. Stephens emphasizes. "Denial and delay may cause severe brain damage, prevent full recovery and, in many cases, result in death. If you act promptly, emergency department staffs can do much to minimize or prevent the potential disabling effects of a stroke."