Stroke patients in the Mass General emergency room receive advanced treatments designed to stop brain damage and start recovery.

Victory is survival for the vast majority of the 800,000 people who have a stroke each year. But it’s only a partial success for the up to 30 percent left with a disability in speech, movement, or thinking. “The main focus of our advanced stroke care is to lessen the amount of disability that stroke causes,” says W. Taylor Kimberly, MD, PhD, associate director of Mass General’s Neuro ICU.

W. Taylor Kimberly, MD, PhD on disability that stroke
W. Taylor Kimberly, MD, PhD

Rapid diagnosis and initiation of therapy to stop brain damage and start recovery are critical. Those who arrive at Mass General’s emergency room with a stroke are typically diagnosed and treated with special medications within an hour of arrival, says Lee Schwamm, MD, director of Mass General TeleStroke and Stroke Services and executive vice chair of Neurology. A quick response is also available via telemedicine at more than 30 New England hospitals that are part of Mass General’s TeleStroke network.

A clot-busting drug called tPA can significantly improve the chances of resuming an independent life if given within 4.5 hours of the stroke’s start. But tPA only helps those having an ischemic stroke, caused by a clot blocking the brain’s blood supply. It will worsen brain damage in the 20 percent who have a hemorrhagic stroke due to bleeding in the brain. At Mass General, 100 percent of those eligible for tPA receive it in time.

Reducing Brain Pressure from Stroke

Although there is no comparable “magic” drug like tPA for hemorrhagic strokes, Mass General’s scientists are discovering new ways to control bleeding and reduce brain pressure. One study, for example, is assessing blood pressure-lowering drugs.

“We are optimistic that our novel approaches to therapy will help stem the tide of death and disability that stroke could otherwise bring to our aging population.”

Dr. Kimberly is co-leading another multisite clinical trial to see if a drug called glyburide prevents brain swelling. “Just like if you twist an ankle and it swells, the brain after stroke can also swell, which contributes to disability,” he says.

Because Mass General is a research hub, patients can participate in clinical trials with potential to prevent stroke or improve recovery. Mass General’s Stroke Service will now lead a regional consortium of hospitals for a new National Institutes of Health Stroke Clinical Trials Network, an ambitious effort to create a single national research infrastructure to develop and test new methods of stroke diagnosis, prevention and treatment.

“We are optimistic that our novel approaches to therapy will help stem the tide of death and disability that stroke could otherwise bring to our aging population,” Dr. Schwamm says.