Health and Stroke

Time is Brain

Learn why time in strokes is important

Nov 27, 2023

Zeit Medical

There is a saying in the medical field that “time is brain” when it comes to strokes. This is because the sooner a person receives medical attention following a stroke, the better their chances are of recovering otherwise lost neural function. This emphasis on timing has become the cornerstone for evaluation and treatment of stroke.

Key Points: The quicker someone gets medical treatment after a stroke, the more likely they are to recover lost function. Every minute counts!

Time is Brain: What Does It Stand For?

The phrase "time is brain" underscores the critical window during which medical intervention can make a significant difference in a stroke patient's outcome. When blood flow to the brain is compromised, brain cells begin to die within minutes. In fact, a study published by the American Heart Association estimates that an average of 1.9 million neurons are lost each minute during an ischemic stroke (for reference, the brain has approximately 86 billion neurons!). As more neurons are lost, this can lead to a vicious cycle with a devastating  effect on the function of the brain.

So what’s the bottom line? Getting stroke treatment as soon as possible to re-perfuse affected tissues with oxygen and nutrients is absolutely essential. Stoke care is an emergency, making it important to recognize the signs of a stroke and seek help immediately. The difference between a full recovery or permanent disability is sometimes the difference of minutes or hours from the onset of stroke to the time the patient is able to receive medical care.

Is Time the Most Important Factor for Stroke Care?

Because treatments are based on the duration of symptoms, timing is everything when it comes to evaluation and treatment of strokes. Medical professionals often refer to the "golden hour" in stroke management. This refers to the precious 60-minute period following the onset of stroke symptoms when timely treatment can greatly impact the patient's prognosis. Rapid intervention during this period can minimize cell death and improve the chances of recovery. Frequently patients who do arrive with stroke-like symptoms are ineligible for treatment because they did not arrive on time. Although certain strokes can be treated after this golden hour, it is now a well established fact that any stroke, even the ones that get treated would have fared better if they had been treated earlier.

A clot busting medicine called tPA is currently one of the mainstays of stroke treatment. Hospitals strive for a “door to needle time” (needle time refers to giving tPA through an IV) of less than sixty minutes from when the patient arrives at the hospital. This “door to needle time” includes immediate evaluation, CT imaging, and tPA started within sixty minutes. Per guidelines, tPA has to be administered within a 4.5-hour time-window after symptom onset. Patients who present after this crucial time are considered to be “outside the tPA window” and have to look towards other treatments. Thrombectomy has recently become a treatment that is very successful at treating patients with stroke. While it can still help some patients well beyond the time of tPA (some patients can benefit up to 24 hours), data still shows that the level of disability improves the earlier the patient gets the treatment.

Other Factors That Determine Stroke Outcomes:

While time is critical for stroke care, changes in the use of imaging technology have led to a shift in the way that medical diagnosis and care following a stroke is conducted. With increased access and utilization of imaging technologies like MRI and CT perfusion scans, doctors are able to quickly get a more detailed picture of what is happening in the brain during and after a stroke. This is allowing them to focus on treating patients based on their individual anatomy, rather than by the clock. These special modalities show which areas of the brain can still be salvaged. Imaging can give a more detailed outlook into an individual's outcomes, based on factors like stroke volume and the degree and location of blockage in the brain. Using the information from the imaging lets physicians determine areas of the brain that have been lost to ischemia (known as the infarct core) and areas that are at risk but can still be recuperated with proper management (known as an infarct penumbra). They can also get an idea of overall vascular health of the area affected and to what degree local vessels can help sustain tissue health (collaterals). Neurologists specially trained in strokes can assist in helping decide the best treatments.

Time and the Window of Opportunity

In the world of stroke management, "time is brain" isn't just a catchphrase; it's a profound truth that underscores the urgency of early intervention. Swift action within the golden hour can mean the difference between full recovery and permanent disability. Public education, healthcare infrastructure, and efficient emergency response systems all play a pivotal role in ensuring that stroke patients receive the timely care they need. As we continue to advance in medical science, it is our responsibility to spread awareness about stroke symptoms, the importance of acting promptly, and the life-saving potential of the "time is brain" principle.

If you think you or a loved one is experiencing a stroke, it's best to get to a hospital as quickly as possible. It could save millions of neurons in the brain and significantly boost the recovery process following a stroke. With strokes, every minute counts!

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