hospital - Moran Mayan - December 6 2010
Patients in the hallways at Haifa’s Rambam Medical Center. Photo by Moran Mayan
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Every year, some 15,000 Israelis experience a stroke or other serious brain event, according to a new report by the Israeli Neurological Association.

The report is the latest update of the National Acute Stroke Israeli Survey, which is conducted every three years over a two-month period and consists of data from the neurology wards of Israel's 28 general hospitals. The first NASIS was carried out in 2004.

According to the most recent survey, which took place in April-May of this year, the most common form of stroke in Israel is an ischemic cerebrovascular event involving the blockage of all blood vessels in the brain (92 percent ). The remaining 8 percent of strokes involve cerebral hemorrhaging, or bleeding in the brain. Cerebral hemorrhage is considered the most lethal type of stroke, leading to death or severe disability in 81 percent of cases.

While the average age of stroke patients in Israel is 72 for men and 68 for women, younger people are also affected: 8 percent of patients are under the age of 50 and 25 percent are below age 60.

The report points to a continuing lack of adequate infrastructure for treating stroke victims. Only 5.9% of patients included in the 2010 survey received treatment to break up blood clots - generally using Tissue Plasminogen Activator (tPA ), a drug that must be administered within four and a half hours after the onset of stroke symptoms. But even that represents an improvement: In 2004, only 0.5% of stroke patients received anticoagulant treatments.

The use of tPA was approved in Israel in August 2004, and it is currently administered in 17 Israeli hospitals - up from just three in 2004. The earlier a person who is having a stroke receives tPA, the more likely the treatment is to reduce brain damage.

In certain circumstances, catheterization can be used to remove a blood clot within six to eight hours after the stroke. This procedure is carried out in five Israeli hospitals: Haifa's Rambam Medical Center; Beilinson Hospital in Petah Tikva; Sheba Medical Center, Tel Hashomer; Ichilov Hospital, Tel Aviv; and Hadassah University Hospital, Ein Karem in Jerusalem. But in 2010, only 1 percent of stroke victims underwent catheterization for stroke.

According to Prof. David Tanne, director of Sheba hospital's stroke center and secretary of the Israeli Neurological Association, the organization's goals are "to double, within three years, the proportion of patients who are treated pharmacologically, [and] to reduce the damage from cerebral strokes by improving infrastructure and reducing the time it takes stroke victims to get to the hospital."

The INA yesterday presented a nationwide plan to ensure optimal and accessible treatment of strokes. It includes creating stroke units in all hospitals and also creating "super-centers," facilities with advanced brain imaging capabilities, for post-stroke treatment in all parts of the country.

"Action must be taken on a national level," said Dr. Natan M. Bornstein, director of Ichilov's stroke unit and vice president of the World Stroke Organization. "So far, no hospitals have received a budget for stroke treatment units." Yet the Health Ministry has been deliberating over the creation of cerebral stroke treatment units for five years now.

Over the years, the number of stroke patients in Israel has remained stable, but mortality rates have plunged by 30 percent since 2004.

The greatest risk factors for stroke are high blood pressure (in 80 percent of cases ) high cholesterol (73 percent ), diabetes (42 percent ), a past history of strokes (42 percent ) and smoking (23 percent ).