UKMMC'S "KRISIS" TEAM BEGINS TO REVERSE STROKE ATTACKS

KUALA LUMPUR, Sept 13 (Bernama) -- The Universiti Kebangsaan Malaysia
Medical Centre (UKMMC) can now reverse a stroke attack and patients can get back
to their normal life instead of spending years trying to recover from partial
paralysis.

National University of Malaysia (Malay: Universiti Kebangsaan Malaysia) is a
public university located in Bangi, Selangor which is about 35 km south of Kuala
Lumpur.

According to UKM News Portal, a web publication by the university's
corporate communications centre, a drug known as Recombinant Tissue Plasminogen
Activator (r-tPA) can reverse a stroke provided that it is given within four and
a half hours of the stroke onset and under strict and controlled conditions.

This is to ensure that in trying to reverse the stroke, physicians do not
end up killing the patient, said Prof Dr Raymond Azman Ali, Senior
Consultant Neurologist at UKMMC, who also heads UKMMC's stroke-ready team called
the Kuala Lumpur Regionalised Integrated Stroke Intervention System or KRISIS.

Stroke starves the brain cells of oxygen, which is vital for it to function.
How this happens is through the formation of a blood clot in a blood vessel,
thus blocking the blood from flowing to an area of the brain.

After four and half hours of oxygen deprivation the affected brain cells
will start to die.

During this crucial time, an emergency back-up system kicks in in the brain,
opening dormant bridges between blocked blood vessel and healthy ones that
normally supply blood to different areas of the brain. This enables blood to
flow around the blockage, resupplying starved brain tissue with oxygen. The
back-up system, known as collateral circulation, forms by opening blood vessels,
which makes them vulnerable to bleeding.

The r-tPA, which is only intended to dissolve the blood clot (or thrombus)
within the affected blood vessel, is highly likely to transform the stroke into
a cerebral bleed (haemorrhage) and worsen the patient’s neurological deficit and
even kill the patient.

Until recently, the treatment for stroke is thought to be rehabilitation or
prevention at best but not many know that there is such a thing as stroke
reversal.

“Yes, you can actually reverse a stroke and live a normal live again,” said
Prof Raymond.

Stroke reversal is about keeping the cells that are being deprived of oxygen
alive. The only way to do this is to resume the blood flow as soon as possible
(reperfusion). This can be done by giving the patient the medication r-tPA which
will dissolve the blood clot that is blocking the blood from flowing to an area
of the brain.

Prof Raymond said UKMMC's KRISIS team was also currently the only
programme
of its kind in Malaysia.

An acute stroke intervention programme such as this often involves a
dedicated team comprising the full complement of specialised neurologists,
emergency physicians, neurosurgeons, neuroradiologists, family physicians,
nurses, medical assistants, rehabilitation staff and pharmacists.

Prof Raymond said such a programme also required a CT perfusion scan and
this was not usually available in many centres. A neuroradiologist is also
needed to interpret the plain brain CT and CT perfusion scans in order to
confidently predict the outcome from reperfusion procedures.

At present, KRISIS conducts regular workshops to train doctors, nurses and
assistant medical officers to be competent in stroke management. It is basically
aimed at teaching them to recognise the early symptoms and signs of stroke and
who to give and not to give the r-tPA.

KRISIS is a comprehensive management system from pre-hospital to
post-hospital care, right from when one dials 999, as it also alerts the
ambulance team members who would already know what to do in the ambulance.

Once the patient gets to the emergency department, the KRISIS team will
know
exactly what to do and who else to channel the patient to.

One of the main reasons why stroke patients do not recover is when they take
their own sweet time to get medical treatment. Once the symptom is apparent,
many of the patients often prefer to seek alternative traditional treatment.

In reality, if they come to hospital immediately and the blood flow to the
brain can be restored the patient is highly likely to recover fully.

-- BERNAMA