Neurologists evaluate strokes remotely: providence Alaska hub for new REACH technology.

• Author: Stomierowski, Peg
• Position: HEALTH & MEDICINE

Nonsurgical stroke care in sprawling Alaska began a new chapter this year with adoption of the REACH program by Providence Alaska Medical Center.

REACH (Remote Evaluation of Acute isCHemic stroke) allows a neurologist, using an Internet connection, to remotely view, evaluate, diagnose and treat potential stroke patients through the use of a computer equipped with a high-resolution web camera. The camera is placed at the foot of a patient's bed. This technology allows rapid evaluation of patients who seek care in places where neurological expertise may not be readily available.

Strokes happen when the brain is deprived of the constant supply of oxygen and nutrients it needs because of blockage or damage to the blood vessels. Brain cells may quickly die, and related areas of the body may become disabled. Surgery could be needed to control vessel damage, but less invasive care is possible if the signs and symptoms associated with strokes are recognized fast.

TREATMENT URGENCY

In diagnosis, every minute counts, and the hour after onset of symptoms is often referred to as "the golden hour." An educational campaign is underway in Alaska to raise awareness of these symptoms and drive home the importance of getting expert help quickly, rather than trying to try "ride out" the signs of distress.

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For in order to safely receive the clot-busting drug tPA, patients must be treated within three hours of the onset of symptoms. Early treatment with tPA can decrease or eliminate disabilities associated with strokes, with up to 13 percent of people recovering fully.

But strokes aren't always a snap to identify. Harvard-trained neuroanatomist Jill Bolte Taylor, Ph.D., recounted for a National Public Radio interviewer how it took 45 minutes or more for her to realize she was having a stroke a dozen years ago, when she was 37. Taylor suffered a brain bleed that greatly impaired her thought processes.

Waking up with a piercing pain behind her left eye, she rolled out of her waterbed and began working out on her cardio-glider. Bolte, who recovered over eight years, went on to write a book called "My Stroke of Insight," and to be chosen one of Time Magazine's 100 Most Influential People in the World for 2008.

She tells of how, despite her knowledge, awareness of her own stroke dawned slowly. She looked down at her hands at one point and saw something akin to primitive claws.

Christie Artuso, RN, MA, director of neuroscience services for Providence Health Services, said in a classic stroke a person usually loses control of movement on one side...