Drug May Reverse Brain Damage Caused by Strokes, Researchers Say : Medicine: Treatment that dissolves clots can produce dramatic results if given within a few hours of onset of stroke, UCI team says.

Rapid treatment with a clot-dissolving drug may stop or even reverse brain damage caused by strokes, according to a team of physician researchers at the UCI Medical Center.

Dr. Larry-Stuart Deutsch, the medical center’s chief of cardiovascular and interventional radiology, said one stroke victim, an 18-year-old woman, so far has been treated by the researchers with the clot-dissolving drug urokinaseM, an enzyme.

But he said the outcome was “very dramatic” in the patient who had suffered a stroke last spring at the hospital. The stroke paralyzed her right arm and leg and made it impossible for her to speak.

The drug was injected into a large blood clot in the carotid artery that goes along the throat to the brain and in four hours the clot dissolved, he said.

“By the end of the day, she had normal strength and control of her right arm and leg and by the following morning, she was speaking fine. She was back to work about a week later,” Deutsch said.

Preliminary results of this new treatment for so-called “ischemic” strokes, which are caused by blood clots rather than brain hemorrhage, were presented in December by Deutsch at the annual meeting of the Radiological Society of North America.

Similarly, a group of French physicians at the major meeting of radiologists in Chicago said 40% of the 11 stroke victims they had treated with other clot-dissolving drugs had shown good recovery. This was considered impressive because the French team treated patients who were expected to die.

Despite the small number of patients studied, “the rapid and dramatic recovery of critically ill stroke patients has prompted researchers to predict that the care of ischemic stroke might be revolutionized by adopting an approach that is similar to the way heart attacks are now treated,” said an article in the Jan. 13 issue of the Journal of the American Medical Assn. in its coverage of the meeting.

Clot-dissolving drugs are now commonly used after heart attacks to open clogged blood vessels to resupply oxygen to the heart with the objective of preventing further damage to the heart muscle.

By contrast, Deutsch said, “for a long time people believed if you took the blood supply from the brain, the brain would die in a few minutes.” Under this “spilled milk” theory, he said the medical community believed that there was nothing that could be done after a stroke to restore brain tissue that had been injured.

But he said within the last decade animal studies and a few experiments with patients such as the one at UCI have shown that brain functions can be restored if the clot-dissolving treatment is done within the first four to six hours of the beginning of a stroke.

“Time is of the essence,” said Deutsch, adding that animal studies also indicate that if the treatment is delayed for 10 hours or longer, it can pose a danger of serious bleeding. There are about 500,000 strokes a year in the United States, about a third of which are fatal while another third result in permanent major disabilities, he said.

Deutsch said UCI’s stroke team--which also includes vascular surgeon Ian Gordon, neurosurgeon Michael Pritz and emergency medicine physician Mark Langdorf--has been frustrated by a shortage of stroke patients referred to its program, which has been operating for six months.

Six of seven referrals were poor candidates for the clot-dissolving treatment either because they were hemorrhaging or because they had waited too long before seeking help.

Surprisingly often, Deutsch said, people who have strokes are panic-stricken and wait at home in the irrational hope that their condition will improve. “They should come as soon as they notice a problem,” he said.

The warning signs of a stroke are loss of movement or severe weakness on one side of the body, sudden disruption of speech or vision, sudden headaches, unsteadiness or unexplained falls.

Deutsch said the team is launching an educational campaign to let the public and physicians know about the new stroke treatment. Last week, he said, letters were sent to all of the medical center’s nurses, physicians and residents who might encounter stroke victims in the hospital’s emergency room.