Q&A: Stroke Awareness with Ali Krisht, MD


‘Time is Brain’ when it comes to treatment and brain health after a stroke. Dr. Ali Krisht, a neurosurgeon at the Arkansas Neuroscience Institute at CHI St. Vincent, is an advocate of providing fast treatment after a stroke occurs.

Why is quick treatment so important when you’re having a stroke?

Think of a stroke as a brain attack. The patient either has a clot or a bleeding blood vessel in the brain. And the brain doesn’t get enough oxygen. Without oxygen brain cells start to die within minutes. And once they’re dead they can’t be replaced.

And since the brain controls the rest of the body the result, if left untreated, could be death, permanent brain damage and disability. Fast treatment can minimize the damage.

What treatment is available?

For a stroke caused by a blood clot we use a drug called tPA. That stands for tissue plasminogen activator. It dissolves the blood clots that cause stroke. That dramatically reduces the amount of damage caused by stroke when not treated or when treatment is delayed. The sooner these drugs are given the less damage to the brain and the body and less disability to the patient.

How are these drugs given?

tPA only works if it is given directly into the bloodstream either through a vein or an artery. It is more than just putting an IV into the arm of the patient. It has to be done by a team of medical professionals and involves a test called cerebral angiography to find the location of the clot. And all of this has to be done within a few hours of the stroke to stop permanent brain damage.

Is there a specific time limit that these drugs work best?

Yes. The window of time for the best results is within three hours of the first signs of stroke. After three hours the drugs are less effective because brain cells die by the minute. But that’s not to say that the drugs shouldn’t be used after three hours.

Are there risks with using tPA?

 tPA works by traveling through the blood to the clot and dissolving it, which allows normal blood flow again. But tPA can cause increased bleeding. That is why it should never be used for strokes caused by a burst blood vessel.

Well let’s talk about that type of stroke. How important is it to get quick treatment for a burst blood vessel?

This type of stroke is call hemorrhagic stroke. The immediate concern is controlling the bleeding and reducing pressure in the brain. If you take blood thinners like warfarin or Plavix you might be given drugs to counteract those blood thinners. You may also be given medicine to lower pressure in your brain as well as your blood pressure and to prevent seizures.

When the bleeding stops the blood will eventually absorb into your body in the same way that a bad bruise heals. But if there is a large amount of blood you might have surgery to relieve the pressure on your brain. There are several types of surgeries. They are aimed at correcting any problems, like a malformed vein or an aneurysm that might have caused the blood vessel to break.

Tiny clamps are used to stop blood flow and to keep an aneurysm from bursting. Also small coils are used to block blood flow to an aneurysm and cause the blood to clot. In a few cases we can perform bypass surgery on a blood vessel in the brain to direct blood to a region of the brain. It’s the same type of surgery that is used in heart bypass surgery – just on the brain.

Earlier you mentioned the first signs of stroke. What are they?

Stroke symptoms often occur suddenly including numbness or weakness of face, arm or leg, especially on one side of the body. Confusion, trouble speaking or understanding. A person might have trouble seeing in one or both eyes. They might have trouble walking, become dizzy or lose their balance. And some patients say they have a severe headache that hits like a clap of thunder – the worst headache they’ve had in their life.

If you suspect you or someone you love is experiencing stroke-like symptoms, call 9-1-1 or visit one of our emergency rooms immediately.

Learn more about Dr. Ali Krisht or the Arkansas Neuroscience Institute.