hat is a brain attack? Very few people can answer that question. However, if you were to ask 'what is a heart attack?' most people are able to give you an answer that is relatively accurate, and most everyone will agree that a heart attack is a medical emergency requiring immediate attention.
Why is it then that very few people, including many in the medical field, are not familiar with a 'brain attack'? Perhaps it is because this is a relatively new term which implies a completely different way of approaching a group of illnesses that affect the brain.
To better understand this new term it would be helpful to review the much more familiar one, 'stroke.'
A stroke is caused by a clot that prevents a sufficient supply of blood from reaching the brain.
An embolic stroke is caused by a clot which forms in one of the arteries outside of the brain or in the heart but travels through the blood stream until it blocks one of the arteries in the brain. A clot formed in an artery of the brain itself causes a thrombotic stroke. A stroke can also occur during a heart attack if the heart is not strong enough to supply the brain with enough blood.
A brain tumor can also indirectly be the cause of a stroke. In this case a tumor grows to the point where the pressure that it exerts on the adjacent brain tissue is greater than the pressure of the arteries supplying that part of the brain; blood and its nutrients are no longer able to reach those areas of the brain resulting in a stroke.
The ultimate effects of a stroke are determined primarily by which specific artery in the brain is affected, how severe the drop in blood supply was, and how long it lasted. Unfortunately when a full blown stroke has occurred, the cells in that part of the brain suffer irreversible damage.
For people who deal with a stroke, whether it be the patient, the family, or medical and paramedical personnel involved in treatment and rehabilitation, this can be one of the most frustrating diseases to deal with. One of the reasons is that in the functionally mature brain of an adult, once part of the brain has suffered permanent damage, body functions that were controlled by that part of the brain are lost forever.
Until now the evaluation and treatment of a patient with a severe stroke has consisted essentially of three basic principles (with a few variations according to each individual case):
- Determine the primary cause of the stroke;
- Treat the primary cause in an attempt to prevent an even more devastating stroke; and
- stabilize the patient to prevent complications in other parts of the body.
The patients who benefit the most from principles 1 and 2 are those who are examined by a health care professional when they exhibit the early stages of a stroke. An example is the patient who briefly loses vision in one eye. This often heralds the occlusion (blockage) of one of the arteries in the neck which is a major source of blood for the brain. Treating this narrowing of the artery in the neck, medically or surgically, will help prevent a full blown stroke.
Until recently, however, there was little that could be done to reverse the effects of a developing stroke. As a result, a patient with a stroke was not considered to have a medical or surgical emergency unless the stroke had produced a complication that was life threatening, massive brain swelling, for instance. Otherwise, if the patient was stable treatment was performed on a less urgent basis.
For the patient who survives a stroke, then rehabilitation becomes a process to help the patient with any resulting physical limitations to function as independently as possible.
But over the last 10 to 15 years a tremendous effort has been carried out by the neuroscience researchers looking for ways to prevent the irreversible damage to brain cells caused by a stroke. One result of these efforts has been the use of tPA, a drug that also has been used successfully for some time in treatment of heart attacks to dissolve a clot blocking an artery.
If given at the appropriate time, tPA can restore the flow of blood to the brain before brain cells suffer irreparable damage. Over the past three years protocols for the use of tPA in stroke patients have been established, redesigned, and improved.
Even though tPA is the only drug approved for stroke treatment at this time, at least three dozen other drugs are being tested.
The key to using tPA is time. To be effective it must be administered within three hours after the onset of stroke symptoms, so it is important that medical and non-medical personnel recognize that a stroke may be in progress and take the appropriate steps quickly.
This brings us back to the definition and concept of a brain attack. This term implies and demands that there be a dramatic change in the attitude and in the management of a patient with a potential for a developing a stroke. A stroke is a medical emergency that requires immediate attention if it's potential deleterious effects are kept to a minimum or avoided altogether.
This change in attitude and management of the stroke patient must involve everyone, lay people as well as medical and paramedical personnel. It is an educational process which involves all of us.
The Brain Attack Coalition has been formed to help with this task, it is the largest coordinated effort of its kind and the first-ever multi-specialty, multi-society collaboration in stroke.
It is a partnership among the American Academy of Neurology, American Association of Neurological Surgeons, American Society of Neuroradiology, American College of Emergency Physicians, National Institute of Neurological Disorders and Stroke, and the National Stroke Association.
Hopefully, as a result of the Brain Attack Coalition and its efforts we will all recognize and understand that a stroke is a medical emergency - it is a brain attack.
Covenant Health and its Stroke Network are also working hard to provide the people of East Tennessee with the advances in the evaluation, treatment and rehabilitation of stroke. The Covenant Health Stroke Network consists of emergency room physicians, internists, neurologists, neurosurgeons, radiologists, phvsiatrists, nurses, EMTs, physical and rehabilitation therapists, as well as administrators of the five hospitals that form part of Covenant Health.
Since its inception in 1997, the Stroke Network has sponsored community screenings for stroke risk factors in the Knoxville area and surrounding counties; provided community education through health talks, newspaper articles, and TV spots; provided education and direction for EMS agencies in three counties; changed the on site approach to stroke assessment and triage; redesigned the assessment and treatment protocols for stroke patients in emergency rooms; incorporated the team model; developed a collaborative model between the different hospitals that allow for appropriate, smooth transfer and triage of stroke patients from a community hospital to the referral hospitals; and expanded and improved a comprehensive outpatient service for stroke rehabilitation.
The Covenant Stroke Network is one of the participants in the 12-state Stroke Consortium, an organization committed to the prevention and treatment of stroke. It is also a member of the National Stroke Association and of the Stroke Center Network, organizations committed to the prevention, treatment, and research of stroke.
The Covenant Health Stroke Network and all its participants have been instrumental in making tPA available to those stroke patients that meet the criteria for this type of treatment. However, as mentioned above, its current and future achievements and goals involve all aspects of stroke prevention, evaluation, treatment, rehabilitation and research.
