It is known that
‘Time is Irreversible’
in Stroke, what does
it mean practically for
a patient?
An average brain has 22
billion neurons, and for each
minute of a typical stroke,
we’re losing 1.9 million brain
cells, i
.
e
.
each hour you’re
basically losing around 120
million brain cells
.
And if
nothing is done, by the time
a stroke is complete you
could have lost around 1.2
billion brain cells
.
In the
normal ageing process, you
lose around 1 neuron per
The public know that time is an important
factor in managing critical cases in
general, how far that is of importance in
handling Stroke?
Te thrombolysis treatment mentioned, you need to have
the agent given within 4 to 5 hours, so, you can imagine
the patient coming in, form the time they arrive in the
emergency room, it takes about an hour for us to do all the
tests to confrm that it is a stroke, so this leaves us 3 to 4
hours
.
What we notice in the trials is that even within that
3 to 4 hour time frame, patients to better with the drug
the quicker you give them the medication, so, if you get
the medication within an hour, you do better than within
2 hours, and in 2 better than 3, so, time is really critical in
treatment, and that’s why we’ve coined the phrase “time is
brain” for stroke
.
If the patient arrived
later than what is
recommended?
For thrombolysis, for all
patients treated within 4.5
hours, if you treat 9 people,
you’ll save one from being
severely disabled
.
If you treat
all patients within 90 minutes,
you only have to treat 3 to 4
patients to save one from being
severely disabled
.
So that’s why
the message needs to come
through
:
“time” is brain for
stroke
.
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What are the most
common risk factors
for stroke?
Te fve common risk factors
for stroke are high blood
pressure, diabetes, high
cholesterol levels, smoking,
family history and obesity
.
Te
less critical ones are things like
stress, which is not directly
related to stroke, but stress
can cause high blood pressure,
thus possibly indirectly leading
to stroke
.
second, so, afer completion of
a stroke compared to normal
ageing, it’s equivalent to 36
years of ageing
.
Tat’s why
it’s critical to arrive in time
and receive the thrombolysis
treatment and get the blood
fowing before losing a large
number of brain cells
.
And
unlike other cells like muscle
or liver for example, once
you’ve lost brain cells, they’re
gone, they do not grow back,
and there’s no treatment for
that nowadays
.
Te hope is in
the advancement in stem cell
technology in the future, not
just for stroke, but for many
other neurological diseases as
well
.
arrives in the right time, we
can give it intravenously
because it’s quicker
.
Tere
are some strokes where it
might be better to do through
angiography where there’s
a higher risk of bleeding for
example, or sometimes beyond
4 to 5 hours, we might be able
to give the treatment through
the catheter
.
Occasionally, with larger
blockages, in what we call the
proximal part of the artery,
where a big blockage appears
before the artery branches
into the brain, intravenous
doesn’t work as well, so we
use the catheter technology,
it’s called intra
-
arterial
thrombolysis
.
Te majority
would be getting intravenous,
just a small number of selective
cases would get intra
-
arterial
thrombolysis, because time is
critical, and it’s much easier to
give it in the emergency room
than to have to wait for the
catheter suite to be ready
.
What about
the available
medications in stroke
management? How
does time play an
important role in using
these medications?
Te treatment we give to
a typical blockage stroke
is aspirin, which basically
thins out the blood
.
For a
haemorrhagic stroke we don’t
give aspirin, because if we thin
out the blood then there will
be more bleeding
.
If the patient arrives within
4 to 5 hours we could give
thrombolysis treatment
where we give something
that would actually break
down the clot itself, which
would be more powerful
than aspirin
.
Generally we
can give thrombolysis either
through a catheter, and
introduce it straight into the
blocked vessel, or we can give
it intravenously
.
If the patient