TOPICS > Health

Stroke Relief

August 22, 1997 at 12:00 AM EDT


ELIZABETH FARNSWORTH: Now, a promising new treatment for stroke, the third largest cause of death in the United States. Lee Hochberg of Oregon Public Television reports.

LEE HOCHBERG: In January, Orvin Anderson was rushed to a California emergency room. He had fallen down and the left side of his body wasn’t working.

SPOKESMAN: He doesn’t see well to the left. He has a weakness of the left side of his face. He’s clumsy with his left arm, clumsy with his left leg, doesn’t quite feel it.

LEE HOCHBERG: Anderson had suffered a stroke, suddenly impaired blood circulation to its brain. It’s the No. 1 disabler of adults in this country, and there has been no emergency treatment for it. A half a million Americans have strokes every year; 2/3 never recover, and 150,000 die every year.

SPOKESPERSON: You need the tubing over here with the drug and the pump. Yes, now.

LEE HOCHBERG: But Anderson may recover fully from his stroke because of a new drug. Dr. Richard Atkinson of Mercy Sacramento Hospital.

DR. RICHARD ATKINSON: We’ve seen people get better while we’re giving the drug. I mean, we know that that can happen. We’d love to see it in the next half an hour.

LEE HOCHBERG: The drug is called Tissue Plasminogen Activator, or TPA. It’s been used for years to dissolve blood clots related to heart attacks, but it’s now being used on clots in the brain that cause stroke. Half of the patients who’ve received it have recovered fully within three months.

MARY DOMREIS, Stroke Patient: I’m just fine. I don’t have any residual from the stroke that I know of at all.

LEE HOCHBERG: Seventy-five-year-old MARY DOMREIS walks a mile and a half through her Portland, Oregon, neighborhood every day, only months after she suffered a severe stroke while driving.

MARY DOMREIS: At the intersection, there was a police car coming from the–on the right side. He was parked, ready to turn. And that’s all I remember until I woke up in my car just a few minutes–a minute or two later with a policeman outside the car trying to open the door, and I couldn’t talk.

LEE HOCHBERG: Paramedics rushed Domreis to the stroke center at Oregon Health Sciences University.

MARY DOMREIS: My son explained it to me the next day. He said that my mouth was all twisted to one side.

LEE HOCHBERG: She received TPA, and within 12 hours she could speak almost normally. She progressed so well she was released that week and never even went through rehabilitation.

MARY DOMREIS: I’d always thought that after you had a stroke you’d have to be bedridden probably and would not be able to talk. It feels to me that somebody didn’t think I needed to die yet.

LEE HOCHBERG: Despite success stories like this, TPA is only being used on about 3 percent of stroke patients. That’s because the drug needs to be administered within three hours of the onset of stroke. If it’s used later than that, it may cause bleeding into the brain. And administering it within that three-hour time window is proving difficult. Oregon Stroke Center neurologist Dr. Helmi Lutsep says its rare that patients even get to the hospital within three hours. While many Americans recognize full-blown stroke symptoms, like paralysis and impaired speech, only half can identify the immediate, more subtle signs.

DR. HELMI LUTSEP, Neurologist: People can develop minor symptoms like subtle numbness, for instance, or loss of vision, which they may not recognize as indicating a stroke.

LEE HOCHBERG: Domreis says she was lucky a police officer, who saw her veer off the road, got quick help.

MARY DOMREIS: That’s the reason I’m still here probably because if the policeman hadn’t been on the corner immediately–I’m just really lucky that they were there.

AD SPOKESMAN: It used to be called stroke. Today we call it a brain attack.

LEE HOCHBERG: The National Stroke Association is trying to speed up public reaction to stroke and generate more of a crisis response by giving stroke a new name.

AD SPOKESMAN: Explosive headache. A brain attack is a medical emergency.

LEE HOCHBERG: Experts say faster response could enable 1/3 of stroke patients to be treated with TPA. But they add it’s not just the public that needs to respond faster. Doctors and hospitals have to too. Lutsep says most emergency rooms are unprepared to process stroke patients quickly.

DR. HELMI LUTSEP: The patient may sit there–you know, presumably, they could sit there for an hour or two while they’re waiting their turn.

LEE HOCHBERG: Even a stroke patient.

DR. HELMI LUTSEP: Even a stroke patient. The trouble has been in the past that we didn’t have emergent therapies for stroke, so stroke cases were considered to be, you know, sort of further down the line in terms of acuteness of their care. And they may not have been brought to the attention of a physician very quickly.

LEE HOCHBERG: The Oregon Stroke Center has adopted new emergency room protocol to treat stroke patients faster. It gives them quick access to neurologists and radiologists and leaves gathering of some medical histories for later. Lutsup says the process can save a crucial hour.

DR. HELMI LUTSEP: I need to make sure when this started. Okay. When did the stroke start?

LEE HOCHBERG: Still, there are problems. Lutsup and a translator tried hard to determine if a Chinese woman had gotten her husband to the hospital within the three-hour time window.

TRANSLATOR: About 8:30. So we only have a few more minutes if we’re going to be able to give medicine if he needs it. So I’m going to have to go kind of quickly now.

LEE HOCHBERG: As if to emphasize how treating stroke patients quickly goes against the grain, even at the Stroke Center, even as the three-hour deadline approached, Lutsup had to hustle along an ER worker, who had other priorities.

DR. HELMI LUTSEP: We’ve only got 15 minutes if we’re going to get blood, so we’s going to have to wait. I’m sorry.

ER WORKER: He’s got an extremely distended bladder.

DR. HELMI LUTSEP: I know, but we can’t get the TPA in after 15 minutes from now.

ER WORKER: And I can’t put a catheter in after you put TPA in either.

DR. HELMI LUTSEP: A hospital can’t wait and take time in doing the next step. It needs to happen very quickly.

LEE HOCHBERG: There’s another barrier. The new drug can actually worsen the condition of some patients, even causing death. Though most strokes are caused by a blood clot in the brain and TPA works well on those, the drug can aggravate 15 percent of strokes that are caused by a brain hemorrhage. Doctors need to do a CAT scan quickly to determine which kind of stroke they’re treating. At most hospitals the wait for the CAT scan machine is lengthy. Oregon Stroke Center has tried to change that.

DR. HELMI LUTSEP: The stroke patient used to have to wait their turn to get on the scanner. And now we’ve got the advantage that the stroke patient is given, if not highest priority, very quick priority after some of more severe trauma cases.

LEE HOCHBERG: Quick access to a CAT scan is problematic at many smaller hospitals which often don’t have radiologists on call 24 hours a day. And Lutsep says even at some larger facilities doctors unaccustomed to treating stroke as an emergency are resisting the new demand of overnight calls. Stroke centers are also finding they need to retrain 911 dispatchers to make stroke a higher priority. They’re teaching dispatchers to call the ambulance that’s closest to the stroke patient. And ambulance services are being urged to transport patients to hospitals that have streamlined stroke protocols in place.

DR. HELMI LUTSEP: Insurance is starting to become problematic as well; that if a patient’s insurance dictates that they go to a particular hospital, that’s the hospital to which they go to.

LEE HOCHBERG: Whether or not that hospital has a CAT scanner?

DR. HELMI LUTSEP: That’s correct. And I don’t think right now that there’s a mechanism in place to send a patient to the one with a CAT scanner.

LEE HOCHBERG: Cost is yet another barrier to accessing TPA. A dose of the drug can run as high as $5,000. Even at that cost neurologists contend it will reduce expenditure on stroke by cutting the $30 million a year now spent on rehabilitation. Oregon Stroke Center neuroradiologist Gary Nesbit.

GARY NESBIT: Rehabilitation costs over a year anywhere from thirty to fifty thousand dollars, or even more. And so when you look at the cost effectiveness, if we can get patients out of rehabilitation hospitals, out of nursing homes and back home, not only will it make them better, but we also decrease costs.

LEE HOCHBERG: Oregon doctors are experimenting with drugs that might get around TPA’s problems. This man arrived at the Stroke Center last year practically brain dead nine and a half hours after his stroke. Dr. Wayne Clark injected a drug called Urokinase directly into the blood clot.

DR. WAYNE CLARK: By the next morning I still was not hopeful, but when we came in and saw, he was now moving his arms and was responding to verbal commands. So it–overnight, he had made a remarkable recovery.

LEE HOCHBERG: The man went home after six weeks of therapy. Patients at 50 hospitals nationwide have undergone this new treatment with three out of four able to return home. But doctors say using TPA in the first three hours, as they did with Orvin Anderson, is still the better course. Anderson’s home now in Sacramento, doing fine. The challenge is to remove the barriers that prevent many other stroke victims from similar recoveries.