Originally created 12/16/00

A stroke victim's three golden hours



People who have a stroke, or a "brain attack," sometimes can decide their own future. Will it involve months of rehabilitation to help regain the ability to walk, speak, see and live independently? Or will they leave the hospital quickly and return home with little or no disability?

Three golden hours may make the difference.

New studies show that most people never use that window of opportunity to avoid the worst consequences of a brain attack. Instead of seeking immediate emergency medical help, they overlook the symptoms, deny that anything so serious can happen to them, and wait.

The opportunity exists for the most common kind of stroke. It occurs when a blood clot plugs an artery carrying blood to part of the brain. Many heart attacks occur in the same way - when a clot plugs an artery in the heart. Health experts want people to think of strokes as "brain attacks," the counterpart of a heart attack.

In the brain, as in the heart, a clot cuts off blood supply to part of the organ. Oxygen-starved cells in the affected area start to die. Brain tissue that relies on that blood will die - unless the victim gets medical help.

For a stroke, that means treatment in the hospital with a drug that can dissolve the clot and allow blood to flow freely once again to brain cells. The most commonly used drug is known as tissue plasminogen activator (tPA).

Patients who get it have a 30 percent better chance of escaping paralysis and other stroke-related disability.

Clot-busting drugs, however, work only if given within three hours after the first symptoms of a stroke appear. Those are the three golden hours. Taking advantage of the opportunity is simple.

Recognize the symptoms of a stroke. Admit that, yes, this really can happen to you, as it does to 500,000 other people in the United States each year. Stroke is the No. 3 cause of death, behind heart attacks and cancer. It claims about 125,000 lives. Call for emergency medical help and get to the hospital quickly.

Few people do, according to new studies published in the November issue of Stroke, an American Heart Association journal.

One study of 1,207 patients in hospital emergency departments around the country found that people waited an average of four hours before getting help. Some waited eight hours or more.

The other involved 617 patients at emergency departments in three cities. These patients waited an average of 2.85 hours between their first symptoms and the call for help. Even the 2.85-hour delay was too much. It takes doctors in the emergency department about an hour to do a CT scan and other tests. The tests identify patients with the kind of stroke that clot-busting drugs can help.

Here are the warning signs of a stroke:

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

- Sudden dimness or loss of vision, especially in just one eye.

- Loss of speech, or trouble talking or understanding speech.

- Sudden, severe headaches with no apparent cause.

- Unexplained dizziness, unsteadiness or sudden falls, especially in combination with the other symptoms.

Symptoms that occur, and disappear, still need medical attention. They may be a "little stroke," or a transient ischemic attack (TIA). People who have a TIA are 10 times more likely to have an actual stroke.

There's one take-home message for people who notice the symptoms, and for family members and others who recognize them: Take full advantage of those three golden hours.