Sunday, September 12, 2010

fyi

UKMMC says it can reverse stroke attacks...


KUALA LUMPUR: The Universiti Kebangsaan Malaysia Medical Centre (UKMMC) can now reverse a stroke attack and patients can get back to their normal life instead of spending years trying to recover from partial paralysis.

According to UKM News Portal, a web publication by the university's corporate communications centre, a drug known as Recombinant Tissue Plasminogen Activator (r-tPA) can reverse a stroke provided that it is given within four and a half hours of the stroke onset and under strict and controlled conditions.

This is to ensure that in trying to reverse the stroke, physicians do not end up killing the patient, said Prof Datuk Dr Raymond Azman Ali, Senior Consultant Neurologist at UKMMC, who also heads UKMMC's stroke-ready team called the Kuala Lumpur Regionalised Integrated Stroke Intervention System or KRISIS.

Stroke starves the brain cells of oxygen, which is vital for it to function. How this happens is through the formation of a blood clot in a blood vessel, thus blocking the blood from flowing to an area of the brain.

After four and half hours of oxygen deprivation the affected brain cells will start to die.

During this crucial time, an emergency back-up system kicks in the brain, opening dormant bridges between blocked blood vessel and healthy ones that normally supply blood to different areas of the brain.

This enables blood to flow around the blockage, resupplying starved brain tissue with oxygen. The back-up system, known as collateral circulation, forms by opening blood vessels, which makes them vulnerable to bleeding.

The r-tPA, which is only intended to dissolve the blood clot (or thrombus) within the affected blood vessel, is highly likely to transform the stroke into a cerebral bleed (haemorrhage) and worsen the patient's neurological deficit and even kill the patient.

Until recently, the treatment for stroke is thought to be rehabilitation or prevention at best but not many know that there is such a thing as stroke reversal.

"Yes, you can actually reverse a stroke and live a normal live again," said Prof Raymond.

Stroke reversal is about keeping the cells that are being deprived of oxygen alive. The only way to do this is to resume the blood flow as soon as possible (reperfusion).

This can be done by giving the patient the medication r-tPA which will dissolve the blood clot that is blocking the blood from flowing to an area of the brain.

Prof Raymond said UKMMC's KRISIS team was also currently the only programme of its kind in Malaysia.

An acute stroke intervention programme such as this often involves a dedicated team comprising the full complement of specialised neurologists, emergency physicians, neurosurgeons, neuroradiologists, family physicians, nurses, medical assistants, rehabilitation staff and pharmacists.

Prof Raymond said such a programme also required a CT perfusion scan and this was not usually available in many centres.

A neuroradiologist is also needed to interpret the plain brain CT and CT perfusion scans in order to confidently predict the outcome from reperfusion procedures.

At present, KRISIS conducts regular workshops to train doctors, nurses and assistant medical officers to be competent in stroke management.

It is basically aimed at teaching them to recognise the early symptoms and signs of stroke and who to give and not to give the r-tPA.

KRISIS is a comprehensive management system from pre-hospital to post-hospital care, right from when one dials 999, as it also alerts the ambulance team members who would already know what to do in the ambulance. Once the patient gets to the emergency department, the KRISIS team will know exactly what to do and who else to channel the patient to.

One of the main reasons why stroke patients do not recover is when they take their own sweet time to get medical treatment.

Once the symptom is apparent, many of the patients often prefer to seek alternative traditional treatment.

In reality, if they come to hospital immediately and the blood flow to the brain can be restored the patient is highly likely to recover fully. - Bernama