PHOTO BY DANIEL LIPPITT
loot! l o ts
Striking back at strokes, local doctor
helped lead a landmark study.
RUTH LITTMANN STAFF WRITER
eurologist Steve Levine talks like a
plumber. Strokes, he says, are sim-
ply a matter of leaks and plugs.
The hemorrhagic type are caused
by leaks, or bleeding in the brain.
More common are ischemic strokes,
resulting from plugs or blood clots.
Of nearly 500,000 Americans who
suffer a stroke each year, about 80
percent have a plug. Trouble is, un-
like backed-up sinks, a stroke can't
be fixed with a plunger, wrench and
toolbox. So, physicians like Dr. Levine
have looked toward video games for
What they've come up with is a
"pac man" for blood clots, a drug
called t-PA (tissue plasminogen acti-
vator) that dissolves blockage in the
bloodstream and boosts a patient's
chance of recovery.
"Up to now, there has been no ef-
fective treatment for patients in the
midst of an acute stroke, one of the
worst health problems in the coun-
try," Dr. Levine says.
Strokes kill 150,000 Americans
each year. For those who survive, life
often changes forever. Brain damage
can result in physical and mental dis-
abilities. Stroke victims, whose av-
erage age is 65, must undergo
extensive, expensive programs of re-
habilitation. Many wind up in nurs-
ing homes providing around-the-clock
"How do you enjoy your retirement
from a rehab facility?" Dr. Levine
wants to know. The issue underscores
a frustration that has plagued him
During his childhood on Long Is-
land, young Steve always listened to
his grandmother, who warned that
strokes are caused by shmutz in our
blood vessels — in our pipes, that is.
Mildred Levine, a step ahead of her
time, never let her grandchildren eat
chicken with the
fatty, greasy skin.
Dr. Steve Levine:
That was shmutz, A plumber at heart.
Taking the basic
medical lesson to heart, Dr. Levine
grew up to become a neurologist and
senior staff physician at Henry Ford
Hospital in Detroit, where he led part
of the widely publicized attack on
"shmutz" and its devastating conse-
The groundbreaking results from
the national t-PA study graced front
pages of the New York Times and
both metro dailies last December. Sci-
ence, the headlines read, had found
a new way to help ischemic stroke vic-
tims escape the hellish aftermath of
The drug, t-PA, works by dissolv-
ing blood clots that block arteries in
the brain. For safety's sake, it must
be administered within three hours
of the onset of stroke symptoms,
which include blurred vision, slurred
speech, weakness or numbness on
one side of the face, arm or leg, as well
as an unsteady gait.
If stroke patients receive t-PA af-
ter three hours of first experiencing
these symptoms, they likely run a
greater risk of brain hemorrhage, and
the efficacy of the drug, if adminis-
tered beyond three hours, is still be-
As part oft-PA's five-year clinical
trial, funded by the National Insti-
tutes of Health, thousands of patients
were brought to hospitals, where each
underwent an emergency CAT scan
to determine the type of stroke. Was
it a plug or a leak?
Doctors also administered a vari-
ety of blood tests and obtained the ex-
act time the stroke began.
Six hundred twenty-four patients
with plugs (ischemic disorders) re-
ceived t-PA or a placebo intravenously
within three hours of their episode.
The results: Patients who received
t-PA showed a drastic improvement.
BLOOD CLOTS page 63
Get screened atheroscler9sis.
ach year, there are 500,000 re- America can be predicted from 20
Quit smoking, 'ex
ported strokes in the United percent, of the population.
States. A stroke strikes one
Michigan resident every 30 to onset of a stroke. Dr. Steve Levine 1 risk factor for both leaks and plugs
40 minutes. Country-wide, statis- of Henry Ford Hospital advises peo- (see main story).
Initial symptoms of a stroke in-
tics show the average age of stroke ple to get their blood pressure test-
ed at least, once a year. Regular clude blurred vision or loss of it
victims is 65.
Risk factors for strokes include blood tests for diabetes and high cho- slurred speech or an inability to find
high blood pressure, smoking, dia- lesterol also are recommended. the right words, acute confusion,
Dr. Levine says to listen for bruits falling down to one side, weakness
betes, heart disease, high choles-
terol, drug usage and a family (pronounced: bru-ees). He describes or numbness on one side of the face,
them as a sound like "pshh, pshh," arm or leg, as well as an unsteady
history of strokes.
Based on these risk factors, doc- indicating possible narrowing of the gait. ❑
tors say, 80 percent of the strokes in carotid arteries.