Rethinking the “stroke rule”

In 1993 neurologist Camilo Gomez, M.D., coined a phrase that for the last 25 years has been a fundamental rule of stroke care: Time is brain! That rule means the longer post-stroke treatment is delayed the less effective it will be.

Now a new study by Dr. Gomez is rethinking that rule and the idea that “Time is brain” may b more complicated than believed.

In an editorial 25 years ago Dr. Gomez wrote: “Unquestionably the longer therapy is delayed, the lesser the chance that it will be successful. Simply stated: time is brain!” In the August, 2018 Journal of Stroke & Cerebrovascular Diseases he writes that it is still true that it is imperative to call 911 immediately the longer the wait, the less effective the treatment, but the effect of time can vary from patient to patient.

Gomez writes that “depending on the blood circulation pattern in the brain, emergency treatment could greatly help one patient, but be too late for another patient treated at the same time.It’s clearly evident that the effect of time on the ischemic process is relative.”

About 85 percent of strokes are ischemic, meaning the stroke is caused by a blood clot that blocks blood flow to an area of the brain. Starved of blood and oxygen, brain cells begin dying.

Traditionally, there was little physicians could do to halt this process, so there was no rush to treat stroke patients. But in his groundbreaking editorial, Dr. Gomez wrote that rapid improvements in imaging technologies and treatments might enable physicians to minimize stroke damage during the critical first hours.