Uncle's experience illustrates need for rapid response to ischemic stroke

I have a personal interest in finding better ways of treating stroke. My favorite uncle was struck down by one in 1994, just as I was reporting on how the combination of tPA and head CT could produce miracles.

That news came too late for Uncle Louie. He had the bad luck to have his stroke at midnight in a small Midwestern town served by an average community hospital. I've since been frustrated by the vision of him lying for hours in the ICU, waiting for a CT tech and physician to arrive for his evaluation. Today, Uncle Louie still can't speak. His right side is paralyzed. His life is ruined.

It is even more frustrating to learn that many communities are no better served now than 12 years ago. Fewer than 5% of stroke patients who should qualify for intravenous tPA thrombolysis actually receive it.

Help may be on the way, however. The Brain Attack Coalition has set guidelines for fast, efficient around-the-clock execution of the tPA protocol at most community hospitals. These criteria have guided the Joint Commission on the Accreditation of Healthcare Organizations' standards for designated primary stroke centers. More than 230 hospitals have earned that designation since 2004. New imaging techniques and better therapies are leading to better outcomes for more patients.

More work needs to be done. Every hospital licensed to operate an emergency room and staffed with a radiologist and neurologist should seek JCAHO primary stroke center designation. Transportation, ER, and imaging protocols should be streamlined.

Too many people suffer catastrophic strokes unnecessarily. The Uncle Louies of the world deserve better.

-James Brice is senior editor of Diagnostic Imaging.