What is the “Golden Hour” for a Stroke Patient?
There is a saying among doctors who treat stroke patients: “time = brain.” In the case of a stroke, the sooner treatment is received, the more brain function can be preserved, and the less likely there is to be permanent brain damage. The longer treatment is delayed, the more chance of significant deficits, and the greater the likelihood that those deficits will be permanent. For this reason, the 60 minutes after the onset of stroke symptoms are known as “the golden hour.” If treatment can be initiated within this brief window, the patient’s outcome is likely to be better.
Unfortunately, many people don’t want to believe that they could be having a stroke, and may resist treatment, hoping that a troublesome symptom (like a severe headache or sudden loss of balance) will go away if they just take some time to rest. But as we will discuss, time is a luxury stroke victims just don’t have.
What is a Stroke?
Simply put, a stroke is what happens when blood flow to a part of the brain is cut off. Deprived of the oxygen that blood flow would ordinarily carry, brain cells in the affected region can die. There are two types of strokes. Ischemic or thrombotic strokes are most common, making up about 85 percent of strokes.
In an ischemic stroke, a blood clot blocks the flow of blood to one region of the brain, much like a foot on a garden hose blocks the flow of water. The rarer hemorrhagic stroke occurs when a blood vessel in the brain ruptures.
Why the Golden Hour Matters
The reason the golden hour is so important is that there is a medication which, if administered shortly after the onset of symptoms, can dissolve a blood clot which is interrupting the flow of blood to the brain in an ischemic stroke. This medication is called tissue plasminogen activator, or tPA. It is the only FDA-approved “clot busting” medication available for this purpose.
TPA is a protein that occurs naturally in the body, in the cells that line blood vessels, called endothelial cells. This protein activates the conversion of plasminogen, a glycoprotein, into plasminogen, an enzyme which breaks down blood clots. TPA is a very powerful medicine when used promptly and properly. While it can be administered up to three hours after the onset of a stroke, the sooner it is given the better.
Hemorrhagic strokes, like ischemic strokes, need immediate treatment. Unlike ischemic strokes, however, hemorrhagic strokes must not be treated with tPA. TPA is a blood thinner which would worsen a hemorrhagic stroke, rather than help it. A hospital that misdiagnoses what type of stroke a patient is experiencing may be liable for medical malpractice.
The American Heart Association estimates that every minute treatment of a stroke victim is delayed translates to the loss of 1.9 million neurons (nerve cells). In an hour, that patient’s brain will lose as many neurons as it ordinarily would in over three and a half years of the normal aging process. Stroke is a big deal, and even seemingly minor symptoms should be checked out promptly. If a loved one is exhibiting symptoms of a stroke, don’t drive them to the ER; call 911 for an ambulance. Not only will they get to the hospital faster, they are likely to be seen more quickly when they arrive—and now you know exactly how much every one of those minutes matters.
Symptoms of a Stroke
Knowing the signs of a stroke means that you can identify when someone is in trouble, and help them get the treatment they need within that crucial golden hour. The words BE FAST are a mnemonic to help you remember stroke symptoms:
- BALANCE refers to sudden onset of balance problems, or the inability to stand up or to walk.
- EYES refers to sudden vision changes like blurred vision or a loss of vision.
- FACE refers to one side of the face drooping due to nerve damage. Ask the person to smile; if their smile is crooked, it could indicate a stroke.
- ARMS refers to difficulty raising both arms equally or keeping one raised. Ask the person to stretch out their arms at shoulder height with palms facing upward. One arm that cannot be lifted, or kept up, is a sign of trouble.
- SPEECH refers to the fact that garbled or slurred speech is a common sign of stroke.
- TERRIBLE HEADACHE refers to the fact that stroke victims may experience sudden, severe headaches—often described as “thunderclap headaches.” Thunderclap headaches are a frequent sign of hemorrhagic stroke as well as other serious conditions.
Again, if you suspect someone is having a stroke, don’t hesitate to call 911. Do not administer aspirin or other blood thinners; if the person is having a hemorrhagic stroke, it could make things worse. Even if the person is having an ischemic stroke, their ability to swallow may be compromised, and they could choke on an aspirin or the water given with it.
If you have more questions about stroke, the “golden hour,” or tPA, we invite you to contact Huegli Fraser to schedule a consultation.
The information in this blog post is provided for informational purposes only and is not intended to be legal advice. You should not make a decision whether or not to contact a qualified medical malpractice attorney based upon the information in this blog post. No attorney-client relationship is formed nor should any such relationship be implied. If you require legal advice, please consult with a competent medical malpractice attorney licensed to practice in your jurisdiction.