As the lights came on during the intermission of a Spoleto Festival USA performance in 1996, Naeemah Chandler noticed her mother didn’t look well. Her head was cocked to one side and her eyes were rolled back. “But I couldn’t say anything,” Saadeka Joyner remembers. She was having a stroke, or “brain attack.”

Luckily, two nurses sitting behind Joyner in the theater and two doctors elsewhere in the audience were able to help. Most fortunate for Joyner was the fact that she was able to get to MUSC Emergency Services in time to benefit from a new treatment that helps limit the damage stroke can cause.

Stroke occurs when blood flow to the brain is interrupted by a clogged or burst artery. Deprived of blood and oxygen, cells in the brain begin to die. In the past, there was little doctors could do for stroke, but the development of new drugs and procedures is changing that.

“If you experience stroke symptoms, it’s important to get to the hospital quickly,” said Timothy Carter, M.D., assistant professor of neurology. In fact, it may be the only way to get the newest, best treatment for strokes.

Approved in June 1996—the same month Joyner experienced her stroke —tissue plasminogen activator, or t-PA, is a thrombolytic drug, which means it can break up blood clots and restore blood flow. T-PA can only be used in the case of ischemic stroke, in which a blood clot has blocked the flow of blood to the brain. In hemorrhagic stroke, where bleeding into the brain causes the brain attack, use of t-PA could be harmful because it could cause increased bleeding. T-PA must also be administered within three hours of the onset of stroke symptoms. “The biggest reason that t-PA is not used is that the patients don’t get to us in time,” Carter said.

Once at MUSC, Joyner underwent tests to determine the type of stroke she had suffered. The team assembled at MUSC to help treat stroke patients includes on-call neurologists, neuro-surgeons, neuroradiologists and CT technicians, as well as emergency medicine doctors and nurses. “Not only do we need to determine what type of stroke the patient had,” Carter said, “but someone showing the symptoms of stroke may also have other medical problems that are revealed only through blood tests or a CT scan.”

Although prompt treatment limited damage from the stroke, Joyner still suffered paralysis on her right side and was unable to speak for several days. After a week in the hospital and another week spent in the rehabilitation unit, Joyner went home to face many months of rebuilding skills usually taken for granted. With the help and support of many friends and relatives, Joyner taught herself such things as how to read again. Today she is back selling real estate at Agent-Owned Realty Co. where she is an agent-owner.

Carter said new research may be buying time for doctors who treat stroke. “Cells in the brain can be denied blood flow and oxygen for a period of time without resulting in irreversible injury. But a lot of the time, deprivation of blood flow sets off a chain of chemical events that ultimately—maybe hours or days later—leads to the death of those cells.” Studies are now under way to develop neuroprotective agents that will interfere with this chain of events so the cells can survive. Carter said the technology may develop to the point where EMS staff will be able to administer one of the new agents to a stroke victim without fear of triggering side effects. This treatment may be valuable in treating head or spinal cord injuries as well.

Limit your risk factors. Men and women of all ages and races have strokes, but some risk factors for stroke are treatable, such as high blood pressure, heart disease, diabetes, smoking, high cholesterol, obesity, excessive alcohol consumption, lack of exercise and transient ischemic attacks (brief episodes of stroke’s warning signs that can be treated). You are also at higher risk if you have a family history of stroke or if you are African-American.

Editor's note: The article is reprinted from Checkup newsletter, produced by MUSC Creative Services.

LEARN THE SIGNS OF STROKE

Stroke is a medical emergency, and every minute counts. When brain cells die, paralysis, speech problems, memory and reasoning deficits, coma and possibly death can result.

• One-sided weakness, numbness, or paralysis of face, arm or leg.
• Sudden blurred or decreased vision in one or both eyes.
• Difficulty speaking or understanding simple statements.
• Dizziness, loss of balance or loss of coordination, especially when combined with another symptom.
• Sudden severe, unexplainable headache—often described as “the worst headache of my life.” Source: National Stroke Association