When to Hurry for Help
The ambulance, siren wailing, rolled up to the fourth hole at Twin City Country Club in Tennille, Ga., early in the afternoon a few months ago. It was a warm May day, and Ike Bevill was drooping--but not because of the heat. Something terrible was happening to his brain. "I was keeping score, and all of a sudden I couldn't get my fingers to work right," says the 77-year-old retired railwayman. "And my mouth was kind of drooping down." His golfing buddies noticed and called 911. Ike Bevill was having a stroke.
Because his friends acted so fast, Bevill is alive today. "Time lost is brain lost," says Larry Goldstein, a neurologist and director of the Duke Stroke Center in Durham, N.C. A large clot had blocked the supply of blood to the left side of Bevill's brain, and brain cells were beginning to die. The ambulance rushed him to a nearby hospital, where he got a clotbusting drug. "I tell you what; that shot saved my life, " Bevill says.
Proper care. It also could have killed him. The drug, TPA, works wonders for strokes caused by clots. But it can be deadly for people with bleeding vessels, a less common stroke type; it makes the bleeding worse. Quickly telling the difference between the two is one of the major advances in stroke care during the past several years. Last year, qualifying American hospitals started to be accredited as stroke centers, staffed by specialists who can make that distinction and treat patients with speed.
Spotting stroke trouble--which kills more than 62,000 men per year--still has to start with the victim or the people around him. Sudden numbness or weakness of a limb or the face, especially on one side, confusion, and trouble seeing or walking are all warnings and a call to get to the nearest hospital.
Bevill did this but also got help from far away. A stroke specialist 70 miles distant in Augusta, at the Medical College of Georgia, looked at Bevill through a TV camera and examined a CT brain scan that was zapped to him over the Internet. "That local hospital isn't a stroke center, but we have one here, and we have a telemedicine connection," says Robert Adams, a neurologist at the medical college.
Of course, it's better not to have a stroke in the first place, by reducing risks. First is bringing down high blood pressure--a particular problem for men, Goldstein says, because they don't go to the doctor to get it checked regularly. And cut out the bad habits: smoking, drinking, a fatty diet that leads to obesity, and not exercising. Atrial fibrillation, an abnormal heart rhythm, can create a clot but can be treated with medication. There are other risks you can't control, such as a family history of stroke, but at least awareness can heighten watchfulness.
One other risk factor for a big stroke is a little stroke, a transient ischemic attack. About 1 in 10 people who have these spells has a major stroke within three months. The signs are similar, but "the trouble is they come and go so quickly that people tend to dismiss them," says Goldstein. "That's the exact wrong thing to do."
On the Horizon
New brain-saving drugs and devices are being evaluated:
A clotbuster called Desmotoplase may be effective in ischemic strokes for up to eight hours versus the three-hour limit of today's main clotbusting drug, tPA.
Ultrasound used with tPA and directed at a clogged vessel may be even more effective than the drug alone at breaking up blood clots.
A coagulant known as Factor VII is being tested for hemorrhagic stroke, when a blood vessel bleeds into the brain. It may stop vessel bleeding when used within four hours. -J.F.
This story appears in the September 26, 2005 print edition of U.S. News & World Report.
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