Stroke: Three Golden Hours

Doctor Viewing Film of MRI scans“Stroke” has gone by many names – apoplexy, apoplectic seizure, cerebrovascular accident.

The Greek name means – a “striking down with violence.” And it is the second leading cause of death world-wide.

People usually thing that strokes happen to older people; but when suffered by Vice President Joe Biden’s 41-year-old son, Beau Biden (attorney-general for the State of Delaware), it gained recent notoriety.

The causes, treatments, and preventions of stroke are similar to that of heart attacks. Let’s imagine how Beau might have been cared for, to outline the important points concerning this “brain attack”.

In the first minutes of the stroke, Beau probably noticed slow muscular function on one side. People around him would have noticed slurred speech and sagging on one side of his face. These first symptoms of a stroke are the only signs you get that something is wrong.

Although Beau might have tried to shake off the funny feelings in his leg and hand, his friends would have rightly insisted that he go to the hospital. Hopefully, at least one of his friends would know that he has only three hours to get treatment before the effects of a stroke will become permanent.

Arriving at the hospital, the medical personnel would check the function of his nerves – in his face, hands and arms, legs and feet. They would ask him to hold up both arms and notice that one arm is slower to rise and gradually falls down. He can’t hold it up. They would also notice his sagging face and slurred speech. While lab techs draw blood for tests, the doctors and nurses would ask about medical history: high blood pressure, diabetes, alcohol use, trauma, previous stroke history, irregular heart rhythms, high cholesterol, drug use, etc. Others will check him physically, run an EKG, and get an IV started. They see he is not overweight and his blood pressure and pulse are normal. They hurry, knowing that his three hour deadline has already ticked past 30 minutes.

Since he has no headache and hasn’t passed out, they think he has had a clot instead of a bleed in his head. But they can’t be sure, so they have to do a CT scan to make sure he isn’t bleeding in his head before they can give medicines to break up any clot in his brain circulation. Giving him “clot busting” medicines if he has a bleed could be fatal. He is sent with an escort to the CT scanner with orders to do it right away. Another ten minutes has gone by.

Within a half hour the CT scan is done and has been read by the radiologist. There is no evidence for head bleeding. Back he goes to the ER where tPA, the “clot buster,” is put into his IV. He’s hooked up to the EKG monitor again. The medicine is started with only one hour left to go.

The brain can only burn sugar and oxygen. No other fuel is sufficient. If the brain goes without blood flow with vital nutrients for more than three hours, it begins to die. That’s why time is so important.

While the medicine flows in and the nurses monitor his vital signs, the doctor is checking lab results. Breaking up the clot is only the beginning of Beau’s treatment. The doctor has to know what caused the clot in order to avoid a repeat stroke. This will take several days but it starts now while the medicine begins to break up the clot. Beau notices that his arm is getting feeling back in it. The nurses notice that the sag in his face is going away.

Just like 30% of strokes, the doctors can’t find a cause for Beau Biden’s stroke. They will start him on blood thinners and continue to monitor him for the next several months. A second stroke can easily follow the first one if it isn’t prevented. But – this time – Beau Biden has recovered all of his normal nerve functions, thanks to his friends’ quick actions to get him to the hospital in that magical first three hours.

If the symptoms of drifting arm, sagging face, slurred speech begin, don’t deny it is happening to you. Don’t wait. Go as quickly as possible to the nearest full service Emergency Room where they can care for you within that golden three hour period.

Your brain, and your life, could depend on it.