Researchers quantify effects of stroke treatment delay

(Bloomberg) — Diane Barbeler had a stroke on Monday last week. The next day, she walked out of the hospital with only minor sensory changes in her right hand and foot.

Barbeler owes her quick recovery to the tissue plasminogen activator, or tPA, that she received within 3 hours of losing strength and control in her lower limb, says Atte Meretoja, a neurologist who helped diagnose her stroke at Australia’s Royal Melbourne Hospital. Patients like Barbeler, 66, gain a month of disability-free life for every 15 minutes saved in getting the clot-busting drug, according to research by Meretoja and colleagues published today in the journal Stroke.

By quantifying the importance of speed, Meretoja and collaborators in Australia, Finland and the U.S. aim to inspire medical services to improve response time. The world’s fastest stroke services in Helsinki and Melbourne take an average of 20 minutes from the patient’s arrival at the hospital to start tPA treatment, Meretoja said. Most other centers in Australia, the U.S. and Europe take 70 to 80 minutes.

“The main delay in stroke is due to people not calling for help,” said Meretoja, the lead author of the study and an associate professor of medicine at the University of Melbourne. “We have now demonstrated that this is very harmful, and people lose on average a month of life for every 15 minutes they wait at home hoping that the symptoms will go away.”

Stroke is the fourth-most common cause of death in the U.S., and the leading cause of adult disability. It occurs when blood flow to the brain stops, according to the U.S. National Institutes of Health. Brain cells begin to die within minutes. Ischemic stroke, which accounts for about 87 percent of cases, is caused by a blood clot, while hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain.

Symptoms of stroke include sudden numbness of the leg, arm or face, confusion, problems with vision, abrupt severe headache, dizziness, loss of balance or trouble walking. The American Stroke Association advises people to call emergency medical services immediately if someone shows any of these symptoms.

Barbeler, who describes herself as a fit and active recent retiree, stood upright after leaning down to pick vegetables in her garden when she felt heaviness in her right foot, along with a loss of sensation and control, she said.

“I couldn’t tell my foot to move,” she said. “I could lift my foot, but I couldn’t tell where I was putting it. Then, my hand was a bit numb. ‘Have I pinched something in my neck?’ was my first thought.”

With help from her husband, Christopher, Barbeler returned to her house and finished a cup of tea while contemplating the cause of her sudden illness, she said. Meanwhile, Christopher called her family doctor’s office for advice.

“The nurse told him to call for an ambulance immediately,” Barbeler recalled in an interview yesterday. She was taken directly to the Royal Melbourne Hospital, where doctors used computerized tomography, or CT, images of her brain to rule out causes other than stroke for her symptoms, which had worsened slightly en route from her home in Lauriston, a small town about 100 kilometers (62 miles) north of Melbourne.

Subsequent, more detailed images identified a small offending clot, Meretoja said.