Stroke Specialists

By Christine Gorman

With all the promising research that has been coming out lately on stroke, it's more important than ever that you and your doctor know what to do before you or a loved one is affected. Stroke occurs when part of the brain's blood supply gets cut off. Three years ago, researchers showed that physicians can, in many cases, prevent death or permanent disability from stroke if they give the victims a drug called TPA within three hours of the first symptoms. Last week investigators using another drug therapy proved that the treatment window can be stretched to six hours. Yet most emergency rooms aren't set up to treat a stroke that quickly. And most stroke patients wait an average of 13 hours before seeking medical attention.

Are you a smoker? Overweight? Over age 55? Do you have diabetes? Heart disease? High blood pressure? If so, you face a higher risk of suffering a stroke. Save yourself and your family a lot of grief by identifying now which hospitals in your area are best suited to treating stroke. And learn the warning signs: sudden weakness, dizziness or falls; numbness or paralysis (especially on just one side) of the face, arm or leg; difficulty speaking; sudden dimming or loss of vision.

Strokes afflict 600,000 Americans each year. In 80% of cases the culprit is some kind of clot that obstructs the flow of blood through an artery. But for a variety of reasons, blood-starved brain cells don't die right away. If the offending clot is broken up quickly enough, normal blood flow is restored and the brain is spared.

Enter an experimental drug called recombinant pro-urokinase. In a clinical trial of 180 patients presented at a meeting of the American Heart Association last Thursday, researchers reported that 40% of patients who received the drug within six hours of the start of their stroke made a dramatic recovery, in contrast to 25% in the control group. Dr. Anthony Furlan, a stroke specialist at the Cleveland Clinic who led the study, says the recovered patients "could return to work, take care of their finances, drive a car."

One reason the drug works so well is that doctors inject it into a catheter, which they thread through the arteries of the brain to deliver treatment directly to the site of the clot. So far, the therapy has been tested only on clots in the middle cerebral artery, which is the site of perhaps a third of clot-caused strokes. It's conceivable, Furlan says, that as many as half of such strokes can be treated in this way.

There are risks. Recombinant pro-urokinase, like TPA, increases the chances of dangerous bleeding in the brain. And the treatment requires a doctor with great skill at threading a catheter into the brain.

When you evaluate a hospital's treatment of stroke, make sure it offers TPA. Find out what experimental trials, like the pro-urokinase study, it participates in. Does it enroll just two patients a month or 20 in these studies? How much experience do its doctors have threading catheters into the brain? Then, if stroke occurs, don't forget to act. Most stroke patients who got treated in time did so because they or someone nearby recognized the symptoms and got them to the hospital in a hurry.

For more on stroke, including hospitals in the pro-urokinase study, visit time.com/personal E-mail Christine at gorman@time.com