World Stroke Day | "Time is brain", every second counts

October 29 is World Stroke Day. This year's theme is "Early identification of stroke leads to better treatment results."

Stroke, also known as stroke , includes ischemic stroke and hemorrhagic stroke. It refers to a group of organic cerebrovascular diseases caused by stenosis or occlusion of blood vessels and rupture of blood vessels in the brain. Its main clinical features are sudden onset and rapid onset of neurological dysfunction .

In recent years, with the aging of the population and the acceleration of urbanization, the living structure of residents has changed. The global stroke disease has 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 seriously threatening the physical and mental health of residents 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 various cerebrovascular diseases such as cerebral thrombosis and cerebral embolism, local blood supply disorders in brain tissue, ischemia and necrosis, and then sudden neurological dysfunction such as weakness or numbness of one side of the limbs and slurred speech. This disease is the main reason for the increase in the burden of stroke in my country.

Early recognition of stroke symptoms

"Time is brain" is the "golden rule" for improving the long-term prognosis of patients with cerebral infarction. Early detection, early diagnosis and treatment can minimize the degree of damage to the patient's brain tissue, saving most patients from death and lifelong disability.

In clinical practice, we often use the "last normal time" to calculate the patient's treatment window, that is, the time when the patient has not yet shown relevant neurological dysfunction. Unfortunately, research data show that only about 12% of patients go to the hospital for treatment within 3 hours after onset, and only 50% of patients go to the hospital for treatment within 24 hours after onset. Therefore, we need to re-emphasize the importance of early identification and early treatment.

There are several commonly used formulas (scales) in clinical practice that can help people identify stroke symptoms early . This is especially important for residents with stroke risk factors such as advanced age, and underlying diseases such as hypertension, diabetes, and atrial fibrillation.

Taking "BE-FAST" as an example, the formula mentions five symptoms, namely difficulty in balance (B), unclear vision (E), crooked face (F), uneven arms (A), incoherent speech (S), and emphasis on the importance of time (T).

Among them, difficulty with balance refers to the sudden difficulty walking due to loss of balance or coordination; blurred vision refers to sudden changes in vision and difficulty seeing things; face misalignment refers to sudden facial asymmetry and crooked corners of the mouth; arm unevenness refers to sudden weakness or numbness of the arm, mostly on one side of the body; speech impairment refers to sudden 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 treatment are the primary prerequisites for active treatment and improved prognosis. Once a stroke occurs, do not wait for the symptoms to disappear on their own, but go to the hospital immediately or call "120" for medical assistance.

The golden window of time for stroke treatment

"Time is brain" is not only reflected in early pre-hospital identification, but also has important guiding significance for in-hospital diagnosis and treatment.

Given that cerebral infarction is mostly caused by cerebral vascular occlusion, timely opening of blood vessels and reperfusion therapy to restore brain tissue blood perfusion is still the best treatment for cerebral infarction. If patients with highly suspected cerebral infarction can be evaluated by a professional doctor within 4.5 hours after onset and contraindications are eliminated, they can receive intravenous thrombolytic therapy.

Thrombolytic drugs can dissolve the thrombi that block blood vessels, restore blood flow, save brain tissue, and increase the probability of a good prognosis by 30%. With advanced imaging guidance (including head and neck CTA, CT perfusion imaging, and magnetic resonance imaging), the time window can be further extended to 9 hours after onset.

Patients with cerebral infarction within 6 hours of onset can receive endovascular treatment if they do have large vessel occlusion after receiving relevant imaging assessment. Endovascular treatment can remove the embolus through a thrombectomy device, restore blood vessel recanalization, increase the probability of a good prognosis by 50%, and allow patients to completely or basically return to their daily state before the onset of the disease. If advanced imaging is further improved, the time window can be extended to 24 hours after onset.

Whether it is intravenous thrombolytic therapy or endovascular therapy, the earlier the treatment is received, the greater the room for recovery.

Related studies suggest that for every 1 minute saved from onset to thrombolysis, the patient's ability to live independently can be increased by an average of 4.4 days; for every 1 minute saved from onset to endovascular treatment, an average of 4.2 days of additional healthy life expectancy can be obtained; and for every 15 minutes saved, the patient's likelihood of regaining functional independence will increase by 0.91%.

On the contrary, for every hour of delay between the patient's arrival at the hospital and endovascular treatment, the patient's probability of successfully restoring cerebral blood perfusion will decrease by 22%, which is not conducive to the patient's outcome; for patients receiving bridging treatment (intravenous thrombolysis followed by endovascular treatment), for every 15 minutes of delay in receiving intravenous thrombolysis, the probability of the patient being unable to walk home independently will increase by 1.12 times.

In short, “time is brain” and the less delay there is throughout the entire process from when a patient discovers symptoms, goes to the hospital for treatment, and receives treatment, the more likely the patient will get a good outcome.

Author: Wang Xinru and Cheng Xin, Department of Neurology, Huashan Hospital, Fudan University

Reviewer: Dong Qiang, professor and chief physician of the Department of Neurology, Huashan Hospital, Fudan University, expert in the National Health Science Popularization Expert Database