Introduction:

• Stroke is the third leading cause of death in US after heart disease and cancer.
• It is the leading cause of serious long term adult disability.
• Activase (Tissue Plasminogen Activator), better known as TPA has been used for treatment of acute heart attack for years now. Its benefit in reducing the damage from heart attack is established.
• TPA can help to reduce the long term disability from a stroke.

Stroke is more complicated than a heart attack:

• Strokes are not as easily identified as a heart attack.
• Awareness of stroke being an emergency is low.
• Brain tissue is more sensitive to lack of blood flow than the heart.
• Bleeding into the brain from weakened blood vessel is a major concern.
• For TPA to work for stroke, patient needs to receive the medication within 3 hours after the symptoms begin.
• After 5 hours, TPA is not only ineffective, but may be dangerous.

Quick questions to establish whether patient has a stroke

• Sudden onset neurological deficit.
• Stroke came on all of a sudden. It may get worse after it started.
• If a neuro problem came on gradually, it is usually not a stroke.

Establishing time of onset of stroke

• It is very important to establish the time of onset of stroke.
• If the time of onset cannot be reasonably established, patient is not a candidate for TPA.
• Questions for patient/family about symptom onset time
  • Last time patient was completely normal ?
  • How do you know the time ?