I always tell my patients, "Time is brain." When they ask me what that means, I share the story of two patients I saw in one very busy week at my hospital's inpatient stroke service. The first was an 83-year-old man, the other a 53-year-old woman. If they had to guess, many patients would say the younger woman had the better outcome but in fact it was the older man.
Why? Because he arrived within one hour of his symptoms—drowsiness, severe weakness on the left side, drooping face, slurred speech, vision loss on the right side, and eyes looking off to the right—and was immediately administered intravenous tissue plasminogen activator (tPA), a medication that dissolves blood clots and restores blood flow to the brain—and must be administered within four hours of a stroke.
Meanwhile, the 53-year-old woman was transferred to our center nearly seven hours after her symptoms became apparent, well past the time for emergency medication or any other procedure.
Different Recoveries
After receiving tPA, the 83-year-old patient was transferred to our stroke center to undergo a procedure to remove the blood clot that was still in his major blood vessel. From there, he went to an acute rehabilitation center where he continues to work on his speech and motor skills.
The 53-year-old is able to communicate, but has very little strength on the left side of her body, and needs help with many daily activities such as getting in and out of bed, dressing, and toileting. Given her age and spirit, we hope she will respond well to intense physical and occupational therapy, designed to improve the weakness on her left, and to learn new skills with the right to compensate for limitations on her left side.
Time Is Everything so Learn FAST
These two cases are stark reminders of the importance of time in treating stroke. It can make the difference between a full recovery and a lifetime of partial or full disability. In fact, one study showed that an individual can lose 1.9 million neurons and 14 billion synapses (connections between neurons) per minute.
The best thing you can do for yourself or a family member is to memorize the FAST acronym
(F: face drooping; A: arm weakness; S: slurred speech; and T: Time).
If you see these signs, call 911 immediately, and remember that therapies are available to help treat stroke. Time truly is brain!
Dr. Song is an assistant professor of neurology at Rush University Medical Center in Chicago.