Why Rush? TIA is an Emergency

Updated:Nov 19,2012

Excerpted from “Why Rush?”, Stroke Connection January/February 2009 (Science update October 2012)

Even though the American Stroke Association and all healthcare providers emphasize that stroke is a medical emergency, Stroke Connection Magazine occasionally hears concerns like the following from one of its readers:

I question the urgency of getting to the emergency room spoken of in most articles about stroke. In the case of my husband Jim, the emergency room showed no concern when he arrived with stroke symptoms. He was examined, blood was taken and he was admitted to the hospital. However, the stroke itself was not treated that evening, nor for most of the next day! By the second day in the hospital, after scans and blood work, he was put on medication. He spent five days in the hospital, came home with meds and had physical therapy for a few weeks. About a year later, he had a second slight stroke in the middle of the night. He woke me and said his leg seemed paralyzed again, and I could see his mouth was affected. We raced to the hospital in a rainstorm. Once again he was tested, and it was ascertained he had had a second stroke, but again no meds or measures were taken in the emergency room. At the end of the second day, he was put on additional meds, and we connected with a fine neurologist.

He has had several tiny strokes, probably not even severe enough to be labeled TIAs. When we questioned the doctors about the “miracle” shot that could stop a stroke from getting worse, we were told that was almost never administered because if it is a bleeding stroke instead of a blockage one, the drug would prove fatal. We have never been given a definitive answer about why it is so important to get the person to an emergency room when no treatment is given when you get there! We are hoping you can address this.

Sincerely,

Barbara Thompson, grateful wife of survivor Jim Thompson
Wildwood, Missouri

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First and foremost, the reason to dial 9-1-1 if a person suspected of having a stroke is this — time lost is brain lost!

However, given her experience at her local hospital, it is easy to see why Mrs. Thompson would question the urgency if the hospital is not going to respond quickly. When it comes to the treatment of acute stroke, all hospitals are not created equal. That is why the American Stroke Association has joined forces with the Brain Attack Coalition to create the Primary Stroke Center Certification Program, which is implemented by The Joint Commission (TJC). This commission evaluates stroke care provided by hospitals. Hospitals that follow the “Recommendations for Primary Stroke Centers” (published by the Brain Attack Coalition and the American Stroke Association) are certified as primary stroke centers.

Primary stroke centers take stroke seriously and know how to treat it. They are adept at using tPA, the clot-busting “miracle” drug that Mrs. Thompson asked about in eligible patients. It is important to remember that this drug can only be used within three hours of the onset of symptoms, making it extremely important to note the time that the first signs of stroke occurred. For this treatment to be considered, there must be enough time to determine — through an imaging test like a CT scan or an MRI — whether the stroke is ischemic (caused by a clot) or hemorrhagic (caused by a bleed). Often tPA is not administered because patients do not get to the hospital within this crucial three-hour treatment window or are not eligible to receive TPA (example: persons with an intracerebral hemorrhage). This is yet another reason to rush to the hospital when stroke symptoms are observed.

There is generally at least one primary stroke center in each major metropolitan area in the United States. It is very important for stroke families to know where these centers are and to get their loved one to that facility, even if it is not the closest hospital to them. Research indicates that patients have better outcomes when treated at a primary stroke center even when tPA is not an option. Find the primary stroke center nearest you.

There is yet another factor for stroke families to consider in getting treatment: Recent research indicates that stroke patients who arrive at the emergency room in an ambulance are twice as likely to receive a CT scan as those who “walk” in.

And finally, when speaking to 9-1-1, say “I think this is a stroke” even if there is only one symptom, and even if the symptoms have gone away.

Learn more about TIA.



This content was last reviewed on 10/23/2012.