Not too long ago when a patient arrived with stroke symptoms, there was very little to do. The extent of the stroke was determined by CT scan; labs were done to diagnose possible stroke mimickers (hypoglycemia) as well as risks for future strokes. In some cases an ultrasound of the carotids was completed to see if these arteries, which supply the brain had enough narrowing from plaques to justify surgery (endartectomy). Yet for the brain itself it was almost a wait and see.

Nowadays strokes are called brain attacks. Why? Time is brain tissue. Some strokes if treated within 3 or so hours from the onset of symptoms can actually be partially reversed. A clot buster called TPA is administered and the offending clot, which has cut off blood supply to a certain brain area is lysed.

This treatment has its drawbacks however. For one, it can only be used in strokes where there is no bleeding present. This is because the wonder drug itself can cause bleeding in the brain. It does not seem to work after 3 hours or so. This means for strokes of over this time or those which occur during sleep and the exact time of onset cannot be determined this drug cannot be used. There are many other conditions which would exclude use of this drug. Still, in some patients it can make the difference between walking out of the hospital or being discharged in a wheelchair due to one sided paralysis.

When a stroke occurs there is some brain tissue which is dead, some which has taken a hit but is still alive and some which is threatened. It is the latter two categories that researchers are interested in. Statin drugs such as Lipitor can stabilize plaques and perhaps prevent further bleeding. Other blood thinners such as aspirin or Plavix have been shown to help prevent further strokes. Research is underway using stem cells, which theoretically can become any type of cell including neurons. For clots in certain areas, a catheter can be inserted carefully through an artery in the neck and directed toward the small artery which is obstructed by a clot. The clot can be mechanically removed and voila! stunned neurons recover.

The future holds great promise for stroke treatment. Until then however, watch your weight, exercise frequently, control your blood pressure, pay attention to your diet and cholesterol levels and see your doctor. Remember: an ounce of prevention is worth a pound of cure.