Cerebro Vascular Accident (Stroke)

Stroke is a term given to a medical condition caused by a lack of oxygen to brain cells. This can be caused by a blocked or ruptured artery. As a result, of this condition oxygen starved brain cells die and depending on the location of the stroke can cause a variety of symptoms such as:

• One-sided weakness, numbness, or paralysis in the extremities, and facial drooping

• Sudden intense headache

• Dizziness, loss of balance, or loss of consciousness

• Aphasia (difficulty in speaking or understanding), or slurred speech

• Blurred or loss of vision in one or both eyes

If you encounter anyone with the above symptoms, the best action to take would be to Activate the EMS (Emergency Medical Services) by calling 911. Currently, we are conducting a number of stroke studies in the San Diego area (Mercy Hospital, Sharp Hospital). The medications studied generally target patients with an acute on-set of symptoms. In order to improve the chances of survival and prevent long-term disability, it is important that patients arrive early at a Medical Center where treatments such as t-PA (tissue plasminogen activator) and experimental treatments are available.

More than half of strokes can be prevented by reducing risks. You can prevent strokes by controlling certain risk factors such as:

• Hypertension or High Blood Pressure (Can be controlled through diet and medication)

• Heart Disease: Especially Atrial Fibrillation and High Cholesterol which can be controlled through diet and medication

• Smoking (Don't do it!)

• Diabetes (Keep your diabetes under control through diet, medication, and regular monitoring of glucose levels)

• Obesity (Consult your physician regarding a weight loss program, diet, and exercise)

• Alcohol (Limit alcohol intake to one glass of wine per day)

Certain other risk factors such as the following are not preventable. But if you do have these risks, by controlling the risks described above you may be able to reduce your risk of suffering from a stroke.

• Family history of Stroke or Heart Disease

• Previous stroke or TIA (Transient Ischemic Attack)

• Age (generally >55)

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Current Clinical Trials in Acute Stroke

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I. Scripps Mercy Hospital

    GAIN (Glycine Antagonist in Neuro-protection):   This is a multi-center, double-blind, placebo-controlled study.  The study medication is a neuro-protective agent that combats the neuro-toxication caused by the over abundance of the neuro-transmitter Glutamate after an ischemic event.  The study medication is administered intravenously as a loading dose and five maintenance doses every 12 hours.  The following patients presenting to Mercy Emergency Department may qualify:

• Ischemic & Hemorrhagic Stroke patients presenting with symptoms to the E.R. within 6 hours of on-set
• Functionally Independent prior to the current stroke
• Stroke that includes measurable motor (limb)weakness

    Clomethiazole Stroke Study:   This is also a multicenter, double-blind, placebo controlled study.  Clomethiazole has long been used in Europe as a sedative and anti-convulsant agent.  It is thought that it by stimulating GABA receptors it may be effective in reducing damage to cells resulting from over activation caused by Glutamate.  The medication is administered as a continuous infusion intravenously for 24 hours starting no longer than 12 hours after the on-set of symptoms.  The following patients may qualify for this study:

• Ages 18 to 90
• Presentations consistent with ischemic stroke within 12 hours of on-set
• Functional Independence prior to the current stroke
• Measurable motor (limb) weakness
• Visual field deficit
• Higher cortical dysfunction (i.e.  aphasia, apraxia, alexia, agraphia, neglect, extinction, agnosia)

These studies are conducted in collaboration with and through the Mercy Hospital Emergency Department.  A Stroke Team composed of Neurologists and Study Coordinators is on a rotating call-schedule 24 hours/day, 7 days/week to respond to Stroke Codes activated by the Emergency Department Staff.  Participation in these studies are completely voluntary.  Patients and families are informed of the nature of the study and risks and benefits and are asked to provide informed consent.  All Patients who are enrolled in these studies receive study medication, laboratory tests, neurological assessments, and three months of follow-up care at no charge. 

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II. Sharp Memorial Hospital

The Citicoline Stroke Study is currently underway at Sharp Memorial Hospital.   This is a large multi-center, double-blind, placebo-controlled study.  The medication is an oral agent administered for 6 weeks after an acute CVA.  The study medication is a neuro-protective agent which stabilizes membranes in the cells surrounding the ischemic region.  The following patients may qualify to participate in this trial:

• Patients arriving in the Emergency Department within 24 hours of Stroke Symptoms persisting at least 60 minutes
• Diagnosis of Ischemic Stroke (CT scan should be negative for hemorrhage)
• Patients between the ages of 18 and 85 years old
• Must have been functionally independent prior to the stroke
• Must not have any contra-indications for MRI to be performed in 12 weeks (no metallic implants)

The study is performed in collaboration with the Sharp Memorial Hospital Emergency Department. 

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III. Pomerado Hospital

We welcome the addition of Pomerado Hospital to our stroke studies.  Currently on-going is a large multi-center, double-blind, placebo-controlled study to test the safety and efficacy of an intravenous agent for acute stroke.  The following patients may qualify for this study:

• Diagnosis consistent with acute stroke
• Present with symptoms to the E.R. within 6 hours of on-set
• NIH Stroke scale of 6-23
• Prior functional independence

This study is conducted in collaboration with and through the Pomerado Hospital Emergency Department.  A Stroke Team composed of Neurologists and Study Coordinators is on a rotating call-schedule 24 hours/day, 7 days/week to respond to Stroke Codes activated by the Emergency Department Staff.  Participation in these studies are completely voluntary.  Patients and families are informed of the nature of the study and risks and benefits and are asked to provide informed consent.  All Patients who are enrolled in these studies receive study medication, laboratory tests, neurological assessments, and three months of follow-up care at no charge.

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If you are interested in more information regarding these stroke studies and for the sites nearest you participating in these trials, please contact:

The Center for Neurologic Study

(858) 455-5463

email at: cns@cts.com

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For more information regarding stroke please visit the following site:

• The National Stroke Association

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Last updated: 3/4/99