PHOTO BY DANIEL LIPPITT .00X2.r...,WARVAreikWarrfelarMaiMe&M.V1424.3gratrAMANWArefeWOMXMI 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 answers. 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 care. "How do you enjoy your retirement from a rehab facility?" Dr. Levine wants to know. The issue underscores a frustration that has plagued him for decades. 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. she said. 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- quences. 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 their problem. 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- ing tested. 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 When Get screened atheroscler9sis. ach year, there are 500,000 re- America can be predicted from 20 coritrol Quit smoking, 'ex ported strokes in the United percent, of the population. A host of symptoms might flag the high blood pressure; w"l is is the No. 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.