Prof. Dimitrov: Medical care in the first 4 hours and 30 minutes from the onset of an ischemic stroke is crucial for the patient’s recovery

On the occasion of World Stroke Day – 29 October, the specialist gave detailed information and advice on proper treatment

Prof. Ivan Dimitrov is qualified in neuropsychology, electroencephalography, evoked potentials, Doppler sonography. His professional and scientific interests are in the field of cognitive disorders and dementias, multiple sclerosis, epilepsy, etc. He organized the first study on the prevalence of dementias in Bulgaria.

– Professor Dimitrov, what is stroke and how is this disease diagnosed?

– Cerebrovascular diseases are widespread in our country and are unfortunately among the causes of severe disability and significantly increased mortality. More prevalent are ischemic strokes, which are associated with blockage of blood vessels supplying the brain, and the result is death of brain tissue. This leads to paralysis, speech impairment and other neurological symptoms and, unfortunately, often to death.

– What are the first symptoms of the disease and can they mislead the patient and treating physicians in making the diagnosis?

– Common first symptoms include weakness of the limbs (often left arm and left leg or right arm and right leg), drooping of the lip, speech disorders, balance disorders, etc. It is important that these are recognised by people so that action can be taken quickly. Similar symptoms can occur in other neurological disorders, but timely examination by a specialist and appropriate investigations will determine the correct diagnosis.

– How can patients and their loved ones help doctors to better manage the disease?

– Prevention of risk factors is important. They are known to everyone – high blood pressure, poorly controlled diabetes mellitus, elevated cholesterol, smoking, etc. Very often, however, not enough attention is paid to them. It is also of paramount importance for physicians seeing a stroke patient in an emergency setting to quickly obtain adequate information about the exact time of onset of complaints, comorbidities, medications taken, including whether any are being taken to “thin” the blood.

– What opportunity does early diagnosis provide to counteract the disease? How is the treatment of patients with ischaemic stroke?

– In recent years, the motto “time is brain” has become popular in neurological circles. This is indeed a true statement because there is a greater chance of successful treatment of ischemic stroke in the first few hours after the onset of symptoms. If the patient is promptly transported to a specialized hospital facility within a time window of up to 4 hours and 30 minutes from the onset of the stroke, thrombolytic treatment can be administered to try to restore circulation to the affected area. Unfortunately, if this time is exceeded, thrombolysis cannot be performed, and the treatment is not as effective.

– What tests do you do at Heart and Brain to confirm such a diagnosis? Do you perform the thrombolysis already mentioned?

– At Heart and Brain, all the necessary tests are carried out. In addition to a general and specialized neurological examination, laboratory tests, computed tomography, if necessary – with imaging of cerebral vessels, radiographs are carried out in an urgent order. Doppler sonography, magnetic resonance imaging, etc. are also applied. Teamwork of neurologists with fellow cardiologists, vascular surgeons and doctors from other specialties is important. On admission of a patient with ischaemic stroke, we always assess and if appropriate – perform thrombolytic treatment.