New Treatment Protocol at Shaare Zedek Saves Stroke-in-Sleep Woman


The new protocol says that even in cases when a stroke occurs during sleep


The new protocol says that even in cases when a stroke occurs during sleep, an MRI scan is performed immediately to assess the option of injecting TPA (Tissue Plasminogen Activator).

Dr. Roni Eichel, Director of Shaare Zedek's Neurology Department: "About 20% of stroke sufferers get it in their sleep. Since we cannot define exactly when such a stroke begins, the customary protocol was a CT and immediate catheterization if possible. But patients not suited to catheterization for whatever reason are left without a solution and many suffer from severe disabilities. The new protocol allows us to save many more people from these disabilities or – Heaven forbid – death." 

Two weeks ago, Shulamit, a 70-year-old woman, had a severe stroke in her sleep, which led to the loss of sensation in her legs and her right hand. She was rushed to Shaare Zedek Medical Center, and after a quick diagnosis it was decided to act according to the new protocol and perform an urgent MRI scan. The examinations showed a sharp stroke that could still be treated with a TPA injection, administered up to four and a half hours from the appearance of the first signs of a stroke. Thanks to the speedy treatment response Shulamit was able to return to normal functioning.

Until recently, TPA treatment was only possible in situations in which one could know – more or less – when the neurological symptoms of a stroke had first appeared, and it was not administered to patients who'd had a stroke in their sleep.

The new MRI protocol allows doctors to determine whether the patient should be treated with TPA even if he or she awoke with stroke symptoms, on condition that not more than four and a half hours have passed since their awakening.

The new protocol is based on many studies recently published, which show that most stroke-during-sleep cases occur close to the time of awakening, so in many cases there is still a critical window of time in which one can treat the patient. Using MRI, which enables an accurate diagnosis, doctors can determine whether there is still time for treatment.

Shulamit recounts: "I woke up in the morning and saw that I couldn't move my legs or my hand. I immediately realized I'd had a stroke and told my husband to call an ambulance, which rushed us to Shaare Zedek. At the hospital they took me straight into the MRI and gave me the injection. After a few hours the sensations in my hand and legs began to return. Today I'm fully functional again and that's only thanks to the fast and excellent treatment I received at Shaare Zedek."

Dr. Eichel: "Shulamit arrived here after a stroke, was treated according to the new regulations and was saved from significant disability. After a short rehabilitation, she will be able to return to her routine activities." 

"In treating a stroke, time equals brain, so it's vital to know the signs of a stroke – such as a sudden appearance of facial asymmetry, weakness in one side of the body, hands or legs, difficulty in speaking or communicating or understanding surroundings. If you observe one or more of these symptoms, call an ambulance immediately and get to the hospital as soon as possible."