Strokes cause brain damage in three minutes, report scientists

[kurth]

Strokes cause brain damage in three minutes, report scientists

VANCOUVER, Canada (AFP) — Strokes cause brain damage within three minutes, scientists reported Thursday, casting doubt on the common public perception that all strokes can be medically treated within three hours.

The findings show that prevention is the best strategy for one of the top killers in the developed world, said Dr. Tim Murphy, a neuroscientist at the University of British Columbia in this Western Canadian city.

"There's a lot of thinking, 'if I've had a stroke I've got to get to the hospital and I'll be OK as long as I get there in three hours," Murphy told AFP.

Some people can be helped within that time, but "I'm saying, there are structural changes that happen very early on, and so the best thing is to manage risk factors and alter lifestyle," Murphy said.

http://afp.google.com/article/ALeqM5gdY1n9W6Uzoc7BwW8Sj0yBFN-UWw

[TwilightGardener]

1. All together now: DUHHHH!!!

Deprive brain cells of oxygen and glucose, they die within minutes. I've always thought the goal with early treatment is not to REVERSE the effects of a stroke, but to PRESERVE as many nearby brain cells as possible by allowing perfusion (clot-busters) and oxygenation to the affected area of the brain, which will help stem damage from swelling related to CO2/metabolic waste buildup. I'm no doctor, but that was my understanding. It's sort of the same with heart attacks. The goal with rushing to the hospital is to help preserve what's LEFT--"time is muscle".

[acmavm]

2. I had 8 TIAs and 2 majors in 14 hours. And believe me, the powers of

concentration and memory ARE NOT AT ALL what they used to be. And I was told that they only had two hours to 'prevent' damage. Of course the treatment was what they called a 'clot buster'. And that in itself carries some big-time risks (like you can't tell by the name).



Administering clot busters is complex and usually done through an intravenous (I.V.) line in the arm by hospital personnel. Alternatively, clot busters may be administered directly to the site of the clot using a thin tube (catheter), allowing for a greater dose of the drug with fewer potential side effects. Paramedics are also increasingly giving these medications (under a physician’s direction) while a patient is en route to the hospital.

Although clot busters can save the life of a person having a heart attack or the most common type of stroke, there is also a higher risk of bleeding associated with clot busters than with anticoagulants. Clot busters are most effective when given within a few hours after the onset of symptoms. Therefore, it is important to recognize the signs and symptoms early.

http://yourtotalhealth.ivillage.com/clot-busting-drugs.html

[snot]

3. Am I remembering correctly that if the victim is conscious,

having them take an aspirin or two might help?

[TwilightGardener]

4. I don't know what they recommend now--I was an ICU nurse, and

aspirin has long been advocated for heart attacks/ischemia (chewed to speed absorption), but since strokes can be hemorrhagic as well as occlusive (clots), I don't know if there's a recommendation for pre-hospital aspirin--wouldn't want to exacerbate bleeding.

[acmavm]

6. Aspirin can be a big help in a heart attack. But by the time you're having

a stroke you need more than an aspirin. That's where these other drugs come in. But they carry their own dangers, the main one being 'tearing'.

Here's what I think you mean:

Early Aspirin Provides Quick Benefits For Acute Stroke Patients

ScienceDaily (Jun. 2, 2000) — An aspirin given to stroke patients immediately upon arrival at the hospital may help to prevent recurrent strokes in the high-risk time frame immediately following the first stroke, according to the results of a combined analysis of two large studies.

The study is in this month's Stroke: Journal of the American Heart Association.

While aspirin therapy has already been shown to reduce the long-term risk of a second stroke in survivors of ischemic strokes -- caused by clots blocking blood flow to the brain -- a combined analysis of 40,000 acute stroke patients finds that aspirin provides an immediate stroke-preventing benefit in the days and weeks following the stroke.

"Early aspirin therapy should be used much more widely," says the study's lead author ZhengMing Chen, M.D., D.Phil, Reader of Oxford University in England. "The message is: If someone comes to the hospital with acute ischemic stroke, start aspirin therapy as soon as possible and continue it long-term."

Chen headed a group of researchers who examined the data from two major stroke trials -- the Chinese Acute Stroke Trial (CAST) and the International Stroke Trial (IST) -- which studied 20,000 stroke patients each.

The analysis found that the risk of recurrent ischemic stroke is reduced by one third from just a few weeks of aspirin use, and the overall absolute benefit in preventing further stroke or death is about nine per 1,000 people within a month.

Aspirin works as a blood thinner, helping to prevent the further formation of stroke-causing clots. Early treatment is especially important because the likelihood of a recurrent stroke is highest immediately following an initial stroke.

"Preventing nine strokes or deaths out of 1,000 people may not sound like much," says Chen. "But if you consider there are several million strokes worldwide each year, by treating one million of those with one year of aspirin therapy, this will prevent about 20,000 strokes or deaths."

One of the main reasons why aspirin has not been given immediately to stroke patients is concern among doctors that it might cause bleeding in the brain. However, the study shows that aspirin is much safer than initially anticipated, and, according to Chen, benefits outweigh the risk for all types of patients studied.

In 773 patients studied who had a bleeding stroke and were inadvertently given aspirin, researchers found no great difference in the outcomes of patients who received aspirin and those who didn't.

"We can be confident that there is no great hazard in giving aspirin immediately to patients who have been diagnosed with ischemic stroke," says Chen. "Of course, there may be some groups who should not get aspirin, but even the results in those who had bleeding strokes are reassuring."

The American Heart Association's guidelines for treating acute ischemic stroke suggest that aspirin may be effective in patients with acute stroke, but that aspirin should not necessarily be used in conjunction with clot-busting thrombolytic therapy.

Imaging technology, such as a CT scan, will tell a neurologist if the stroke is the result of a clot or bleeding into the brain. Even if that is not available, researchers say there's no reason to withhold early aspirin treatment when ischemic stroke is suspected.

"Especially in developing countries where the CT scan is not widely available, this is important information," says Chen. "We must limit the number of hemorrhage patients who get aspirin, but it's also important to give the treatment to those who can immediately benefit."

Patients who arrived at the hospital within the first 48 hours of symptom onset were studied. In both trials, half of the patients were randomly allocated to receive medium-dose aspirin (160 milligrams per day for 4 weeks in CAST; 300 milligrams per day for 2 weeks in IST).

Researchers say overemphasizing the urgency of clot-busting treatment for stroke may lead to an underemphasis on prompt aspirin use. Even if people were to come to the hospital more than 48 hours after their stroke, researchers believe they would still benefit from receiving aspirin immediately.


Adapted from materials provided by American Heart Association.
http://www.sciencedaily.com/releases/2000/06/000602073156.htm

[Warpy]

7. It depends on the person and what drugs he's on

so run it by his doctor first. Aspirin can cause real problems with some drugs, especially long term anticoagulants, so if the person has a history of TIAs and is already on medication, you'll do more harm than good.

The thing to remember is that stroke is an emergency condition, just like heart attacks. Call the paramedics first, then start worrying.

[TwilightGardener]

5. Glad you're OK now, though, even if your memory is iffy--that's quite the ordeal.

I imagine they did a CT scan and did a pretty thorough assessment before the clot-buster--that was standard in our ER's--it IS very risky.

[acmavm]

9. I didn't get the clot buster. I got to the hospital after two hours were up. But

my whole ordeal was like a Chinese fire drill. I had the TIAs, then I had the 'big one', then I went for the MRI, and on the way down I had an even 'Bigger One' but no one noticed it.

So from Monday to Wednesday they were hauling people in to whack me with a mallet and fuck with me because they couldn't understand why I had the stroke after-affects on the same side of the body as I did the stroke.

Finally on Thursday I got another MRI and viola, mystery solved.

edit: Big point that I didn't mention. The Bigger One was on the opposite side of the brain.

[TwilightGardener]

10. Wow--that's awful--I honestly don't know if I would have caught

further strokes occurring in a patient that was already exhibiting effects from the first one, myself, especially wheeling someone down for an MRI, which is always a glorious cluster-fuck production where you may have the patient off the monitors and you're steering and dragging IV poles instead of looking at the poor person. I would hope so, and I used to have to do the obnoxious new "stroke assessment scale" (which I'm sure you were thrilled with) every four hours, but I just don't know. My memories of my nursing days, and my medical knowledge, are slowly fading now--I've been out of the action for 3 years, and I don't keep up with the continuing education and new protocols, but I have to laugh at your "Chinese Fire Drill" description--I've seen it happen many times, where everyone is clueless at the same time, or there's a chain-reaction fuckup, or nobody catches a problem until it's too late.

[acmavm]

11. Hell, all that was the fun part. They kept forcing me to take Aggrenox which

was literally killing me. I told them I couldn't take it, I begged them not to force me to take it. It wasn't until I guess I went into a fetal position and couldn't stand light, or smell, or movement, or noise, and I was in undescribable pain that they finally started to listen to me. Of course that was Thursday when they finally made me quit taking it.(Had the stokes on Sunday).

Compared to the medication thingey, the strokes were a picnic. Oh yeah - the hospital was participating in a study promoting the benefits of Aggrenox and that's why they just wouldn't let up. Until I think I was about to die. So all that kinda masked the symptoms of the second stroke anyway.

[TwilightGardener]

12. You guinea pig, you! They weren't going to let you go until they got some

results, I guess--I don't know enough about aggrenox to comment. I was in nursing just long enough to know I don't ever want to have to stay in the hospital. I saw the bad stuff, mistakes, even participated in some of it--but I will say that most of the folks I've worked with, in several different hospitals and in different states, were competent, professional, and had their hearts in the right place, even though we sometimes made our patients' lives a living hell while they were in our captivity! Sounds like you came through it for the wiser, even if you lost a few circuits in the process. :-)

[acmavm]

13. Thank you. I think that the result is that instead of being wired for 220,

I'm now running on 110.

[TwilightGardener]

14. LOL!

[shireen]

15. How are you doing? Any long-term effects?

This is really scary stuff -- brain traumas can change who you are, and that's the worst injury of all. I had a DVT 5 years ago this month (on Valentine's Day!), and was immediately put on heparin, then transitioned to warfarin. The clot was really big, from mid-calf to groin, and I was terrified that a piece of it would break off to cause a PE and affect major organs. Eventually, I was diagnosed with a blood coagulation disorder and have become a warfarin lifer. :(

My good wishes to you ....

[acmavm]

16. I'm okay. I have to check into the hospital soon for some tests but I work

and function. I'm tired a lot. Have to take medication for the rest of my unnatural life. But I'm okay.

[Warpy]

8. Right, the three minute window is unrealistic

because it takes longer than that to do the CT scan to rule out a bleed instead of a clot. Give clot busters or even an aspirin to somebody with a bleed, you've just killed him.