Importance: The effectiveness of intravenous thrombolysis in acute ischemic stroke is time dependent. The effects are likely to be highest if the time from symptom onset to treatment is within 60 minutes, termed the golden hour.
After getting proper treatment during stroke attacks, golden period for post stroke rehab is within 3-6 months. This period of time is very crucial and important because most of the neurological recovery happens in this time. This is the reason that golden period plays significant role in recovery of the patient.
For this reason, the 60 minutes after the onset of stroke symptoms are known as “the golden hour.” If treatment can be initiated within this brief window, the patient's outcome is likely to be better.
Thrombolysis – "clot buster" medicine
Alteplase is most effective if started as soon as possible after the stroke occurs – and certainly within 4.5 hours. It's not generally recommended if more than 4.5 hours have passed, as it's not clear how beneficial it is when used after this time.
Moreover, initiating tPA treatment beyond 4.5 hours (i.e., delayed tPA treatment) has been associated with deleterious side effects, notably, hemorrhagic transformation (HT) which could lead to high mortality in stroke patients [4].
Mechanical thrombectomy is indicated for patients with acute ischemic stroke due to a large artery occlusion in the anterior circulation who can be treated within 24 hours of the time last known to be well (ie, at neurologic baseline), regardless of whether they receive intravenous thrombolytic therapy for the same ...
4.5 Hours – The Golden Period to save a life.
Fugl-Meyer Assessment
It is widely used in stroke research and has been used as a gold standard to compare the reliability and validity of other outcome measures. Scoring ranges from 0 to a maximum of 66 for upper limb movement.
“The first three months after a stroke are the most important for recovery and when patients will see the most improvement,” says Raghavan. During this time, most patients will enter and complete an inpatient rehabilitation program, or make progress in their outpatient therapy sessions.
: a period of great happiness, prosperity, and achievement.
If you get to the hospital within 3 hours of the first symptoms of an ischemic stroke, you may get a type of medicine called a thrombolytic (a “clot-busting” drug) to break up blood clots. Tissue plasminogen activator (tPA) is a thrombolytic. tPA improves the chances of recovering from a stroke.
Mortality within 72 hours after stroke onset was 5.0% (32 patients) and a further 4.2% (27 patients) died within ten days. At discharge from the stroke unit, 63.9% of the 571 patients who survived went directly to their home with or without homecare and the other patients required further hospital based rehabilitation.
During the first few days after your stroke, you might be very tired and need to recover from the initial event. Meanwhile, your team will identify the type of stroke, where it occurred, the type and amount of damage, and the effects. They may perform more tests and blood work.
Because the cause of a stroke and the amount of damage it causes in the brain vary widely, there's no “typical” duration of a stroke. Some strokes last for a few minutes while others continue for hours or even days.
The term gold standard refers to a benchmark that is the available under reasonable conditions. Indeed, is not the perfect test, but merely the best available one that has a standard with known results. This is especially important when faced with the impossibility of direct measurements.
The Cincinnati Prehospital Stroke Scale (CPSS)
This scale tests for three possible signs of stroke, including facial droop, arm drift and speech abnormality.
MRI has the capacity to show hemorrhages in different stages, enabling the assessment of bleeding onset, whereas CT is positive only for acute and subacute hemorrhages.
The “1-3-6-12-day rule” is a known consensus opinion with graded increase in delay of anticoagulation between 1 and 12 days after onset of IS/TIA according to neurological severity and reasonable from the perspective that the timing should vary according to the severity.
Currently, the stroke chain of survival for the management of acute stroke comprises the following 8 steps (the "8Ds"): detection (D1), dispatch (D2), delivery (D3), door (D4), data (D5), decision (D6), drug/device (D7), and disposition (D8).
The risk of stroke after transient ischemic attack is somewhere between 2% and 17% within the first 90 days. Among patients with transient ischemic attack, one in five will have a subsequent stroke (the most common outcome), a heart attack or die within one year.
Achieve door-to-device times (arrival to first pass of thrombectomy device) in 50% or more of eligible acute ischemic stroke patients within 90 minutes (for direct arriving patients) and within 60 minutes (for transfer patients) treated with endovascular therapy (EVT).
Thrombectomy has demonstrated clinical efficacy against acute ischemic stroke caused by intracranial occlusion of the internal carotid artery (ICA), even if performed 6–24 h after onset. This study investigated the outcomes of thrombectomy performed 6–24 h after stroke onset caused by extracranial ICA occlusion.
In the vast majority of cases, thrombectomy is only effective up to five hours after a stroke. Although new research has shown that in some very specific cases thrombectomy can be performed up to 24 hours after a stroke.