Time is brain when it comes to stroke response
By Darlene Boyce, ANP-BC, ANVP-BC

Stroke is the fifth leading cause of death and the number-one cause of serious long-term disability in the United States. Every 40 seconds in this country, someone has a stroke. Every three to four minutes, someone dies from stroke. While the majority of strokes occur in people over the age of 65, the incidence of stroke is growing fastest – at a rate of 44 percent since the turn of the century – among young adults age 25 to 44.

But two of the most troubling statistics are these: 80 percent of those strokes could have been prevented in the first place, and at least two-thirds of stroke victims wait too long to get themselves to the hospital for a treatment that could save their lives or dramatically reduce disability from a stroke.

A stroke, sometimes called a “brain attack,” occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so brain cells die. 

In a stroke situation, time is brain. Every delay costs brain cells. Some 32,000 brain cells are lost each second; that’s two million brain cells per minute. So it’s critical to get treatment as quickly as possible. A patient who arrives at the hospital promptly with the onset of an ischemic stroke (by far the most common form of stroke, caused by an arterial clot), may be given a tissue plasminogen activator or t-PA, a drug that has the potential to quickly dissolve the blockage and halts the stroke.  

Since 2015, the American Heart Association/American Stroke Association has recommended an additional treatment option for select patients using a clot retrieval device to remove blood clots obstructing a large artery supplying blood to the brain. Doctors can use a catheter to reach the blocked vessel in a matter of minutes.

However, both of those treatment options are available only if the patient arrives at an emergency room quickly and are deemed appropriate candidates. Again, only one-third of stroke victims today are doing so.  That’s why we continue to communicate as loudly and broadly as possible, the importance of recognizing the signs of stroke, calling 911 and getting to the hospital on time. Emergency-response personnel are trained to quickly evaluate and communicate with the emergency room when they have an acute stroke patient being transferred so that the patient receives the fastest care possible with the best trained staff available, thereby reducing the time to receiving potentially life-saving therapies and preserving valuable brain cells. 

To get that message across, we use the simple acronym F.A.S.T.

• F - Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile.
• A - Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S - Speech Difficulty: Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly?
• T - Time to call 9-1-1: If the person shows any of these symptoms call 9-1-1 and get them to the hospital immediately, even if the symptoms go away.

So don’t shrug off those symptoms (as so many stroke victims do) and go to bed thinking you can sleep it off. Your life depends on it. 

The best medicine, of course, is prevention. The risk of stroke can be greatly reduced through lifestyle choices: maintaining a healthy weight, following a healthy eating plan, staying physically active, not smoking and not abusing drugs and alcohol. Carefully managing medical risk factors such as high blood pressure, high cholesterol, diabetes, atrial fibrillation (AFib), and circulation problems also are key to avoiding stroke. 

So think smart and act FAST; remember Time is Brain!!!

Darlene Boyce, an Adult Nurse Practitioner, and Board Certified Acute Neurovascular Practitioner, is the Neurology Service Manager and Stroke Program Coordinator with Berkshire Health Systems.