October 29 is World Stroke Day. This year's theme is "Early Stroke Recognition, Better Treatment Outcomes".
Stroke, also known as stroke, including ischemic stroke and hemorrhagic stroke, refers to a group of organic cerebrovascular diseases caused by narrowing or occlusion of blood vessels in the brain and rupture of blood vessels.
In recent years, with the aging of the social population and the acceleration of urbanization, and the change of residents' living structure, the global stroke disease has generally shown a trend of high incidence, high disability rate, high mortality rate, high recurrence rate and many complications. There is no doubt that stroke is a serious threat to the physical and mental health of people around the world.
Acute ischemic stroke, also known as "cerebral infarction", accounts for about 87% of all strokes. As the main clinical type of stroke, acute ischemic stroke refers to a clinical syndrome in which cerebral blood flow is blocked due to cerebral thrombosis, cerebral embolism and other cerebrovascular lesions, local blood supply disorders of brain tissue, ischemia and necrosis, and then sudden appearance of nerve dysfunction such as weakness or numbness of one limb and slurred speech. It is a major contributor to the increasing burden of stroke in mainland China.
Early recognition of stroke symptoms
"Time is the brain" is the "golden rule" to improve the long-term prognosis of patients with cerebral infarction. Early detection, early diagnosis and treatment can minimize the degree of brain tissue damage of patients, so that most patients can avoid death and lifelong disability.
In clinical practice, we often use the "last normal time" to calculate the patient's treatment window, i.e., the time when the patient has not yet exhibited the relevant neurological deficit. Unfortunately, only about 12% of patients present within 3 hours of onset and only 50% within 24 hours of onset, so we need to re-emphasize the importance of early identification and early medical attention.
There are several commonly used formulas (scales) in clinical practice that can help people identify stroke symptoms early, which is especially critical for residents with stroke risk factors, such as advanced age, and underlying medical conditions such as hypertension, diabetes, and atrial fibrillation.
Taking "BE-FAST" as an example, the mantra mentions five symptoms, namely difficulty balancing (B), difficulty seeing (E), face abnormality (F), arm irregularity (A), speech inability (S), and emphasizing the importance of time (T).
Among them, difficulty in balance refers to the sudden difficulty of walking due to the loss of balance or coordination; Blurred vision refers to sudden changes in vision, difficulty seeing; Facial malfunction refers to sudden facial asymmetry and crooked corners of the mouth; Arm irregularity refers to sudden weakness or numbness in the arm, mostly on one side of the body; Speech is a sudden appearance of slurred speech, difficulty in understanding, or inability to understand other people's language. Once the above symptoms appear, you need to be alert and go to the hospital as soon as possible.
In short, rapid identification and timely medical delivery are the primary prerequisites for achieving active treatment and improving prognosis. If you have a stroke, don't wait for the symptoms to go away on their own, but go to the hospital or call "120" immediately for medical help.
A golden window of time for stroke care
"Time is the brain" is not only manifested in pre-hospital early identification, but also has important guiding significance for in-hospital diagnosis and treatment.
In view of the fact that cerebral infarction is mostly caused by cerebral vascular occlusion, reperfusion therapy with timely opening of blood vessels and restoration of cerebral blood perfusion is still the best treatment option for cerebral infarction. Patients with a high suspicion of cerebral infarction can be treated with intravenous thrombolysis within 4.5 hours of onset of illness after evaluation by a medical professional and exclusion of contraindications.
Thrombolytic drugs can restore blood flow, save brain tissue, and improve the probability of a good prognosis by 30% by dissolving the embolus that blocks the blood vessels. With advanced imaging guidance (including head and neck CTA, CT perfusion imaging, magnetic resonance imaging, etc.), the time window can be further extended to 9 hours after onset.
Patients with cerebral infarction within 6 hours of onset can receive endovascular therapy if there is indeed a large vessel occlusion after receiving relevant imaging evaluation. Endovascular therapy can restore vascular recanalization by removing the embolus with a thrombectomy device, increasing the probability of a good prognosis by 50%, so that the patient can completely or basically return to the daily state before the onset of the disease. If advanced imaging is further refined, the time window can be extended to 24 hours after onset.
Whether intravenous thrombolytic therapy or endovascular therapy, the sooner treatment is received, the greater the room for recovery.
Relevant studies suggest that every 1 minute of time saved from onset to thrombolysis can increase the patient's ability to live independently by an average of 4.4 days, and every 1 minute saved from onset to endovascular treatment can obtain an average of 4.2 days of additional healthy life, and for every 15 minutes saved, the likelihood of patients regaining functional independence will increase by 0.91%.
Conversely, for every 1-hour delay from arrival to endovascular therapy, the probability of successful restoration of cerebral blood perfusion decreased by 22%, which was not conducive to patient outcomes. For patients receiving bridging therapy (intravenous thrombolysis followed by endovascular therapy), the probability of not being able to walk home unaided increases by 1.12 times for every 15-minute delay in receiving intravenous thrombolysis.
In short, "time is the brain" throughout the entire process from symptom recognition, hospital visits, and treatment, and the less time delays, the more likely the patient is to achieve a good outcome.
(Source: Healthy China)