Getting early diagnosis and swift treatment can be life-saving for stroke sufferers | Updated: 2023-11-03
A stroke, also known as a cerebrovascular accident, can be classified into two categories: an ischemic stroke and a hemorrhagic stroke. It refers to a group of organic cerebrovascular diseases caused by cerebral vascular stenosis or occlusion, as well as vascular rupture. Its main clinical characteristic is sudden onset and rapid appearance of neurological dysfunction.
In recent years, strokes have seen a high incidence rate, high disability rate, high mortality rate, high recurrence rate, and multiple complications globally, with the accelerated process of population aging and urbanization, as well as changes in people's lifestyles.
Acute ischemic strokes, also known as "brain infarctions", account for approximately 87 percent of all strokes. This disease is the main cause of the increasing burden of strokes in China.
In clinical practice, we often use the "time last known well" to calculate the treatment time window for stroke sufferers, which refers to the time before the patient shows any relevant neurological symptoms.
Unfortunately, research data suggests that only about 12 percent of patients seek medical attention within 3 hours of symptom onset, and only 50 percent do this within 24 hours of symptom onset. Therefore, it is important to emphasize the importance of early identification and early medical treatment.
There are several commonly used mnemonics (scales) that can help in the early identification of stroke symptoms. This is especially crucial for people with stroke risk factors such as advanced age, as well as underlying conditions like hypertension, diabetes, and atrial fibrillation.
Taking "BE-FAST" as an example, this mnemonic mentions five symptoms, which are: having trouble keeping Balance (B), Eyes not seeing clearly (E), Face drooping (F), Arm weakness (A) and Speech impairment (S). The last letter "T" emphasizes the importance of Time.
Specifically speaking, B refers to a sudden difficulty in walking due to loss of balance or coordination ability; E refers to sudden changes in vision, making it hard to see objects; F refers to sudden facial asymmetry, with one corner of the mouth drooping; A refers to sudden weakness or numbness in the arm, often occurring on one side of the body; S refers to sudden unclear speech and the inability to comprehend others' language. Once any of these symptoms appears, the sufferer must seek medical attention as soon as possible.
Once someone has had a stroke, do not let them wait for the symptoms to disappear on their own. Instead, immediately send them to hospital or call "120" for medical assistance. Patients highly suspected of having an ischemic stroke can receive professional medical evaluation within 4.5 hours after the onset of symptoms. If there are no contraindications, they can undergo intravenous thrombolysis treatment.
Thrombolytic drugs can dissolve clots blocking blood vessels, restoring blood flow and salvaging brain tissue, resulting in a 30-percent increase in favorable prognoses. With advanced imaging guidance — including head and neck CTA, CT perfusion imaging and MRI, the time window can be further extended to nine hours after onset.
Patients suffering from an acute ischemic stroke within six hours of onset, once confirmed with large vessel occlusion after relevant imaging assessment, may undergo endovascular treatment.
Endovascular treatment uses thrombectomy devices to remove the clot, restoring vascular patency and increasing the probability of a favorable prognosis by 50 percent, which allows patients to fully or partially recover their pre-stroke functional status. With further improvement in advanced imaging, the treatment time window can be extended to 24 hours.
Whether it is thrombolytic therapy or endovascular treatment, the earlier one receives treatment, the greater the potential for recovery.
Relevant research indicates that for every one-hour delay in receiving endovascular treatment, the probability of successful restoration of cerebral blood flow will decrease by 22 percent; for patients receiving bridging therapy (intravenous thrombolysis followed by endovascular treatment), every 15-minute delay in receiving intravenous thrombolysis will increase the probability that they are unable to walk home independently by 1.12 times.
In conclusion, the rapid identification and assessment of a patient's condition and their timely medical treatment are the primary prerequisites for achieving proactive treatment and improving prognosis.