Stroke care's window of opportunity: Emerging responses

The traditional view of who has strokes and how they can be treated is changing.

By Kathleen Phalen Tomaselli, AMNews correspondent. June 18, 2007.

John Murphy was no weekend warrior. The 47-year-old had been running four-minute miles for years. So when he had difficulty seeing out of one eye at mile 23 of his second Chicago Marathon, he thought, "That's weird." He stopped at a water stop, convinced it was "a dehydration thing," and went on to finish in his usual "Johnny Go-Go" style.

The Austin, Texas, resident says his hamstring had been bugging him for weeks. That's why he got on the floor to stretch later that evening, but then he couldn't get up. "I was horribly embarrassed when someone said to call an ambulance."

Murphy was diagnosed with an ischemic stroke from a dissection in his carotid artery -- a finding physicians did not discover until the wee hours of the next morning. "Initially I was admitted to general medical versus neurological," he says.

Stroke has long been associated with the 65-and-older population, and symptoms in younger patients often go undetected for hours or days as valuable intervention minutes vanish.

For Murphy, the window for the clot-dissolving drug, tissue plasminogen activator, or tPA, had closed, leaving few options to treat this runner who suddenly was partially paralyzed.

"When a clot blocks a blood vessel and stroke occurs, blood is cut off completely to a small group of cells, and they die almost immediately," says Jeffrey L. Saver, MD, professor of neurology at the University of California, Los Angeles, who quantified and timed the brain damage that occurs during a stroke. "Surrounding that is a larger region of cells that suffers moderately reduced blood flow, a situation [the brain] can tolerate for a short period. This gives us a brief window of opportunity to intervene and save the threatened brain."