Many hospitals say they cannot afford to have neurologists on call to diagnose strokes, and cannot afford to
have M.R.I. scanners, the most accurate way to diagnose strokes, for the emergency room.
Although tPA was shown in 1996 to save lives and prevent brain damage, and although the drug could help
half of all stroke patients, only 3 percent to 4 percent receive it. Most patients, denying or failing to
appreciate their symptoms, wait too long to seek help — tPA must be given within three hours. And even
when patients call 911 promptly, most hospitals, often uncertain about stroke diagnoses, do not provide the
“I label this a national tragedy or a national embarrassment,” said Dr. Mark J. Alberts, a neurology professor
at the Feinberg School of Medicine at Northwestern University. “I know of no disease that is as common or as
serious as stroke and where you basically have one therapy and it’s only used in 3 to 4 percent of patients.
That’s like saying you only treat 3 to 4 percent of patients with bacterial pneumonia with antibiotics.”
And the strokes in the statistics are only the beginning. For every stroke that doctors know about, there are 5
to 10 tiny, silent strokes, said Dr. Vladimir Hachinski, the editor of the journal Stroke and a neurologist at the
London Health Sciences Centre in Ontario.
“They are only silent because we don’t ask questions,” Dr. Hachinski said. “They do not involve memory, but
they involve judgment, planning ahead, shifting your attention from one thing to another. And they also may
involve late-life depression.”
They are also warning signs that a much larger stroke may be on the way.
Most strokes would never happen if people took simple measures like controlling their blood pressure. Few
do. Many say they forget to take medication; others, like Dr. Fite, decide not to. Some have no idea they need
Still, there is much more hope now, said Dr. Ralph L. Sacco, professor and chairman of neurology at the
Miller School of Medicine at the University of Miami. Like most stroke neurologists, Dr. Sacco entered the
field more than a decade ago, when little could be done for such patients.
Now, Dr. Sacco said, there is a device, an M.R.I. scanner, that greatly improves diagnosis, there is a treatment
that works and there are others being tested. “Medical systems have to catch up to the research,” he said.
In medicine, Dr. Sacco said, “stroke is a new frontier.”
One Tuesday morning in March, Dr. Steven Warach, chief of the stroke program at the National Institute of
Neurological Disorders and Stroke, met with a team from Washington Hospital Center, the largest private
hospital in Washington, to review M.R.I. scans of recently admitted patients. They were joined in a
teleconference by neurologists at Suburban Hospital in Bethesda, Md., the only other stroke center in the
Washington and suburban Maryland area.
The images were mementos of suffering.