Some Good News for Stroke Victims

It’s long been standard practice to limit the use of clot-busting drugs to the first 3 hours after a stroke’s first symptoms. After that time, it was considered useless, or even risky. Now, however, a scientific advisory from the American Heart Association and the American Stroke Association extends the possible time of use to 4½ hours after the first symptom. There are conditions, however; treatment up to the extended time limit should not be done if:

the patient is older than 80;

is taking oral anticoagulants with an international normalized ratio (INR) of 1.7 or lower;

has an NIH stroke scale score greater than 25; or

has a history of both stroke and diabetes.

The advisory emphasizes that starting treatment within 3 hours remains ideal, because “the opportunity for improvement is greater with earlier treatment.”

The importance of quick, expert treatment emphasizes the need for early recognition of a stroke. It should be remembered that almost half of all strokes that occur during the 7 days after a transient ischemic attack (TIA) happen within 24 hours, supporting the need for careful assessment of TIAs. In a study reported in the journal Neurology of almost 500 patients with a first TIA stroke, about 5% had a full stroke within 24 hours.

These findings reinforce the need for everyone to know the warning signs of stroke or a TIA. The usual TIA symptoms are the same as those of stroke, only temporary:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

Sudden confusion, trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden, severe headache with no known cause

If in doubt, call 911. A doctor should determine if a TIA or stroke has occurred, or if it's another medical problem with similar symptoms.