Nurologists from Unicamp's Faculty of Medical Sciences (FCM) are obtaining promising results with the use of thrombolytic medication in the treatment of victims of cerebrovascular accident (CVA), popularly known as stroke. In two cases treated by the Neurology Department team, the patients, who had an ischemic stroke [caused by vessel obstruction], made a complete recovery. This was only possible, according to the doctors, because both had the problem identified immediately by relatives and friends and were helped within a period of less than three hours. “If people learn to recognize the symptoms of stroke and know that it can be treated, many lives could be saved”, says Professor Li Li Min, coordinator of the group.

Leak of symptoms and Service immediate are fundamentals

In addition to the technical and material resources allocated by medicine, information also constitutes an important factor in the success of treatment, according to professor Li Li Min. According to him, when properly guided, the population is able to correctly identify certain diseases and, consequently, provide immediate and effective assistance to the patient. When it comes to stroke, this premise is especially important. The longer the treatment takes, the greater the chances of the victim suffering irreversible sequelae or even dying. To exemplify the degree of people's lack of knowledge regarding stroke, the researcher uses a comparison.

According to him, when someone suffers a sudden illness and experiences severe chest pain, the association with myocardial infarction is almost immediate, which usually provides quick care for the victim. However, when a person is also unwell, but has a condition consisting of difficulty speaking, loss of movement of the limbs on one side of the body and changes in vision, the relationship with the stroke is not so automatic. There are those who even think that these are symptoms related to depression. “This causes help to be delayed, which reduces the success of treatment”, warns Professor Li Li Min. Furthermore, continues the neurologist, the literature indicates that an important portion of the population (90%) and even the The medical profession (50%) is unaware of the existence of therapy for the problem.

It is still common among people to imagine that there is nothing to do when someone is a victim of a stroke and that the only possible approaches are those provided by physiotherapy and speech therapy, specialties that take care of the rehabilitation of patients who maintain motor or speech difficulties after a stroke. cerebral. “Yes, stroke can be treated. In the case of ischemic accidents, which correspond to 80% of episodes, the use of thrombolytic medication has provided good results in several countries, which have achieved success rates of around 30%. Here, at Hospital das Clínicas (HC) at Unicamp, we used the medicine on two patients, both of whom were discharged within a week and did not present any sequelae”, reports neurologist Leonardo de Deus Silva, member of the team coordinated by Professor Li Li Min.

Medication – The thrombolytic drug, explains the specialist, can be applied intravenously (injection into the vein) or directly to the site where the blood vessel is blocked, using a catheter. The function of the medicine is to dissolve the clot (thrombus) and cause the affected region to be irrigated again. Silva warns, however, that the treatment should preferably be applied within the first three hours and only in cases of ischemic stroke. “This period can be extended to up to six hours, but it is important to make it clear that the possibility of successful treatment is directly related to the speed of care.”

According to another member of the team, neurologist Wagner Mauad Avelar, help must be quick precisely to prevent the area of ​​the brain affected by the stroke from remaining for a long time without being irrigated. When this happens, the tissue becomes necrotic, which prevents its recovery. “In other words, time is brain,” he says. The doctor points out that the use of thrombolytic medication can eventually cause adverse effects. The biggest concern is the occurrence of hemorrhage. Exactly for this reason, neurologists follow a strict care protocol. Before undergoing therapy, the patient undergoes a series of assessments and exams, including a computed tomography. “An international study indicated that of 312 patients undergoing this type of treatment, only 5,6% presented symptomatic hemorrhage. In these cases, there is a need for surgical intervention to treat these complications”, he explains.

Success - The success rate of stroke treatment based on thrombolytic medication, experts say, is very significant, especially considering the advantages that the approach brings to patients and the public health system. According to neurologist Wagner Avelar, studies in the United States indicate that each stroke victim incurs a monthly cost to the country ranging from US$18 to US$31. “Not to mention the social cost, since many stroke victims end up retiring due to disability during a period of their lives that is still active, which puts a burden on social security”, he ponders.

A study developed based on the analysis of death certificates by physiotherapist Priscila Porto, who is also part of the FCM team, shows that in Campinas, every four-year period, there is one death caused by stroke per 100 households. According to data from the Brazilian Institute of Geography and Statistics (IBGE), the city has 290 thousand residences. It is estimated that in Brazil the mortality rate caused by brain strokes is in the order of 56 people for every group of 100 thousand inhabitants. It is also estimated that stroke is responsible for around 8% of hospitalizations and for around 19% of the costs of Brazilian public hospitals.

Victims are over 45 years old

Stroke is more common among men and women over the age of 45, although it can also affect younger people. The popular stroke is characterized by the interruption of blood flow in a certain area of ​​the brain, caused by the clogging (ischemic type) or rupture (hemorrhagic type) of a vessel. Some diseases can contribute to the emergence of the problem, such as high blood pressure, diabetes and heart disease. According to neurologist Li Li Min, professor at the Faculty of Medical Sciences (FCM) at Unicamp, the most common symptoms of stroke are: difficulty speaking, loss of strength in the limbs, crooked mouth and changes in vision. These can manifest themselves in isolation or in combination.

The specialist states that quickly identifying the problem facilitates treatment and can mean the patient's full recovery. Ideally, the person should be rescued immediately and taken to a tertiary hospital, that is, one prepared for highly complex procedures. If care is provided preferably within three hours, the chances of administering thrombolytic medication increase. According to data from the study developed by researcher Priscila Porto, diseases of the circulatory system are the main cause of death in Campinas. Among them, stroke accounts for a third of deaths in this group. In Brazil, stroke occupies the top ranking of diseases that kill the most, in addition to being the first factor that causes motor disability.

In addition to the population, the medical profession also needs to be better informed about the risks and treatment possibilities of stroke, in the opinion of Professor Li Li Min. According to him, some institutions, notably Unicamp, are making efforts in this direction. An example is the “I Unicamp Neurovascular Symposium”, which will be held on May 25th, starting at 8:30 am, in the FCM auditorium. On this occasion, several points related to the topic will be discussed. Information about the event can be obtained via the website www.fcm.unicamp.br or via e-mail.