In Stroke “Time Is Brain”

A stroke is an interruption in blood flow to the brain. It is typically caused by a blood clot in vessels within or leading to the brain. When it comes to stoke “time is brain.” Brain cells cut off from blood (and oxygen) during stroke start to die.

Once in progress, the death of brain cells from stroke proceeds rapidly. This is why all physicians are taught that “time is brain” when it comes to stroke. The typical stroke patient loses 1.9 million neurons each minute during which a stroke remains untreated. [1] That is, every minute stroke treatment is delayed means million more brain connections lost, and more brain function is lost.

Accordingly, the medical organizations have created guidelines intended to define for physicians, and hospitals treating stroke when certain critical activities should be performed.[2]

The mainstay of treating most strokes is a “clot buster” medication known as “TPA.” TPA is dramatically effective to dissolve clots causing stroke and restore blood flow. [3] This treatment has a limited “time window” in which it can be given (during which it is most effective). In many cases, TPA cannot be given if more than 4.5 hours from stroke onset.

And even within the 4.5 hour time window, in almost all cases, TPA is best given sooner rather than later. That is, a suitable patient receiving the medication at 1 hour from his stroke will lose far less brain tissue (and function) than a patient receiving the medication at 2 hours.

The difference between prompt treatment, and late treatment, can often be all the difference between someone having a mild impairment such as mild weakness on one side, as opposed to an individual left unable to speak at all, or completely unable to care for themselves.

One, critical standard is called “door to needle time.” This standard is often summarized that a stroke patient, eligible to receive TPA, should receive that medication within 60 minutes of their first arrival to a competent Emergency Room. This is also known as the “60-minute door to needle” rule. [4]

To meet the standard, a hospital must have an organized stroke team ready as standard practice. This includes providing an early Neurology consult and CT scan. These standards are accepted by almost all medical societies and are usually incorporated into the policies of hospitals that treat strokes.

If you have questions whether a loved one received adequate and prompt stroke care, you deserve to have your questions answered. We have the expertise to unravel the records, and timeline of care to get the answers. And, if proper care was not rendered, we have the experience, and world-class experts, to prove your case in Court.

[1] “Time is Brain” (Stroke, vol.37, No.1 2006).
[2] Notably, the American Heart Association and American Stroke Association.
[3] Severe stroke patients timely treated with TPA twice as likely to recover with less disability than if not timely treated. Stroke, vol. 44, No. 11 (2013).
[4] The American Heart Association began its “Target Stroke” program in 2010. It is described by the AHA as a “national quality improvement initiative focused on improving acute ischemic stroke care by reducing door-to-needle times for eligible patients being treated with TPA.”