A few days ago at the Medical Center Erebouni specialists had not only save the life of the patient with a stroke but helped him to avoid invalidization. This case was discussed with the endovascular neurosurgeon Dr. David Sahakian.
– Dr. Sahakian, please provide the details of the case.
– The 62-year-old man admitted to the Medical Center of Erebouni with impaired speech, strongly expressed weakness of the left arm and left side of the face muscles. As a result of neurological examination it was also revealed that the patient is unable to move the eyeballs to left and hold them at the right side, he does not see the left side of his field of view, and hardly feel the left side of his body. The relatives of the patient had indicated that the symptoms suddenly have appeared 2 hours before of admission.
-– Could you explain please what an ischemic stroke is?
– Ischemic stroke is damage of the brain tissue as a result of circulatory disorders. Basically, this is due to a blood clot, which blocks the blood vessel. Brain tissue is very sensitive to oxygen deficiency and a lack of nutrients. So in a few minutes after the cessation of blood supply to the nerve cells they begin to die. The first sign of it is the fact that nerve cells cease to send nerve signals and this is causing the certain symptoms. If we succeed with restoration of the blood supply before the nervous cells completely have been destroyed, it is possible that they will recover. But, as I said, in absence of blood supply to the nerve cells they die within a minutes. Fortunately, in the brain exists so-called bypass blood circulation from neighboring arteries and in the case of a blockage of one of the arteries the blood flow to this part of the brain occurs partly from the adjacent pools. This feature is playing very important role in nervous tissue survival.
Thus, immediately after the blockage of arteries in the brain it is formed two main areas - a large area, where there are still viable, but ceased by function nervous cells (this area we call the penumbra) and the central zone or core of already dead brain cells (see Figure). With the course of time the core increases in the size, until completely capture the penumbra. In this case the lost nerve function of the patient is no longer can be restored. Therefore, in the case of stroke it is paramount important the restoration of blood supply to the brain tissue.
– Let's just once more accentuate the main symptoms in the presence of which are necessary to urgently seek medical advice.
– Among these symptoms are the following: the distortion or numbness of the face, weakness or numbness in the legs, speech disorder, sometimes there are dizziness, nausea or vomiting, blurred vision, distraction. With the emergence of these symptoms it is necessary immediately seek a specialized center dedicated to the treatment of cerebral stroke.
– What can be done by doctors in this case?
– For the treatment of ischemic brain stroke it is of great importance latest medicine "Alteplase". It is tissue plasminogen recombinant activator and after administration aggressively dissolves blood clots, including those that leading to stroke. In this case, the goal of treatment is a speedy resolution of the thrombus, the restoration of blood supply and rescue the penumbra (still viable tissue), stop the growth of the core (area of dead tissue). For this reason, the effectiveness of the drug is largely dependent on how early and quickly treatment has been done. On the basis of numerous studies it has been developed reference, according to which maximum effectiveness Alteplasa should be administered for a 3-4.5 hours after stroke symptoms occur. Intravenous injection of Alteplase during this period of time significantly reduces the probability of death and disability of the patients, accelerates rehabilitation process and increases the recovery degree of the patient up to normal life style.
However, the use of the Alteplase is also associated with certain risks, the most important of which is the hemorrhage. Therefore, Alteplase should be used only in specialized medical centers and under the supervision of high-quality professionals.
– Let's go back to the above-mentioned patient with ischemic stroke. What procedures are performed after his arrival to the clinic?
– After the reception of the patient with suspected stroke first of all has been performed computed tomography (CT). It is the fastest and most reliable method to distinguish ischemic stroke from cerebral hemorrhage, which also can have a similar clinical symptoms, but it should be treated in very different way. The next examination which has been conducted to explore the vascular system of the brain was computer angiography. After the completion of the necessary examination tests the relatives of the patient was informed about the patient's condition, treatment options and associated risks. After obtaining the consent of the relatives of the patient, the patient was transferred to the intensive care unit, where under the strict monitoring was carried out intravenous injection of the Alteplase.
The whole process lasted about an hour, after which was restored complete movement of the hands, eyeballs, and recovered the sight and speech. 24 hours after injection was performed control CT scan which founds only a small area of damage in brain tissue. The patient was transferred to the ward, and on the same day began to walk. Four days after the detection of stroke he was discharged from the clinic.
– What treatment is necessary to carry out in the future?
– In the treatment of brain stroke it is similarly important rehabilitation treatment and treatment aimed to the prevention of stroke. Unfortunately, not always is possible to completely cure the patient, even after the use of Alteplase and other necessary procedures. This is mainly due to the very rapid damage of the brain tissue as a result of delayed attendance of the patient to the clinic. In this case the greater role in patient's recovery plays the rehabilitation treatment, which enables to restore some neurological functions of the patient using saved tissue. In this case, the recovery process can last several months and often may be inadequate.
The great role belongs also to the measures aimed at primary and secondary stroke prevention. Each stroke is preceded by some pathological changes in the body. The detection and correction of these changes is significantly reduces the risk of stroke.
The Erebouni Medical Center is now equipped with the necessary, technology and medicine including Alteplase, and has high qualified specialists that allow providing a versatile and full medical care in the case of cerebral strokes. In our center we pay great attention as to emergency treatment of stroke as to rehabilitation treatment and preventive measures.
– Is this new method of treatment accessible for the large masses of the population?
– Unfortunately, in financial terms this treatment may not be accessible to the large masses of the population, as it is in all over the world, because it has already set high cost. The medicine is cost around 80,000 drams. Currently, in Armenia the steps are carried out on making the cost of treatment accessible for large masses of the population.
It should be noted that in result of numerous studies it was found out that the total cost of the treatment with the use of Alteplase is much lower than if take in consideration other treatment without use of Alteplase, because in this case the rehabilitation therapy alongside with medicinal totally will much more expensive than treatment with Alteplase. Moreover in the use of Alteplase the percentage of disability is reduced, which makes it possible for people to return to work and most importantly is that reduces mortality and people are returning to their families.
I urge everyone to know about the symptoms of stroke occur suddenly (weakness, speech impairment, blurred vision, dizziness, and headache) and with their appearance immediately consult a doctor. For every lost second in stroke, we are paying by the brain tissue.10/30/2014