From the publishers of the New England Journal of Medicine

Like heart attacks, most strokes are serious—and often deadly—complications of severe atherosclerosis, a condition in which blood vessels become clogged with cholesterol debris or plaque. Typically, heart attacks happen when plaque cracks and is covered by a small blood clot in a vessel to the heart. In the case of stroke, the blockage occurs in a blood vessel to the brain. But while most people realize the need for quick action with heart attack symptoms, that's not necessarily so for strokes, or "brain attacks" as they're sometimes called.

Until quite recently, there was no effective, approved treatment to lessen the disabling effects of a stroke, which can range from slight memory loss to complete paralysis on one side of the body. As a result, there was little incentive to rush stroke victims to the hospital—and little reason to launch widespread campaigns to promote that action.

Now, that's gradually changing, in response to studies that have shown a possible benefit of clot-busting drugs to treat acute stroke. One promising treatment, tissue plasminogen activator, or t-PA, has been used to treat heart attack victims for nearly 10 years. Last summer, the FDA approved the drug for use in ischemic strokes, the type caused by oxygen starvation from lack of circulation, which comprise about 80 percent of all strokes. The drug works by dissolving the blood clot and restoring blood flow, which helps minimize damage to the brain.

But because t-PA can have serious side effects (namely, cerebral bleeding), it may be appropriate only for low-risk patients. It cannot be used for hemorrhagic strokes, which occur when a blood vessel ruptures and bleeds in or around the brain.

In December, medical professionals in neurology, emergency medicine, internal medicine, radiology, nursing, and other fields were convened by the National Institute of Neurological Disorders and Stroke (NINDS) to create a national plan for rapid stroke treatment. While much of the discussion centered on the specific actions of health care professionals, the symposium also worked on plans to heighten public awareness of stroke symptoms and the need for fast action.

Successful treatment hinges on the stroke victim or a witness making sure the patient gets to an emergency room, since t-PA is most effective when it's used within three hours of the first symptoms.

One problem with early identification, however, is that someone having a stroke doesn't always recognize the symptoms immediately, because the organ responsible for recognition—the brain—may itself be injured by the stroke. That's why it's crucial for bystanders—often family members or friends—to know the early warning signs of stroke:

Or, just remember the simplified version: sudden, one-sided, can't see, can't walk, can't talk. Any one of the symptoms should trigger a call to 911, or the witness should get the victim to a hospital as quickly as possible.

Julie Corliss

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