The most important factor in successful stroke treatment is time. When a stroke patient is encountered by EMS, or when they present to an emergency department, it is absolutely vital to determine the time “last known well” to make decisions about what treatments may be available and appropriate.
A 97-year-old woman arrived in our emergency department after suddenly becoming unable to speak, and rapidly developing right sided weakness, progressing to complete paralysis. She was brought in by EMS accompanied by her husband, also in his 90s. A CT scan was immediately performed, and did not demonstrate any bleeding in the brain. That meant that she had the type of stroke caused by a blood clot, cutting off circulation to the brain. In order to be able to treat her stroke, it was absolutely necessary to find out when her symptoms started. She was potentially eligible to receive the clot dissolving drug tPA, in this case it could only be administered within 3 hours of the time of onset of the stroke. And the treatment works better the sooner it is administered.
We tried to find out from the husband exactly when her symptoms started. At first it seemed that we would not be able to get this information from him. He told us he was not wearing a watch, and was not looking at the clock. It was time for some detective work. We asked him what he was doing at the time, and he told us he was watching a Yankees game. Then he looked at us and said “she fell off the sofa in the seventh inning.”
Now we needed to very rapidly find out when the game was in the seventh inning. Various ideas were offered, such as checking the online box score on sports websites. I thought someone must have been tweeting during the game. Fortunately, our hospital did not block search.twitter.com. We searched on “Yankees” and found a series of tweets that occurred throughout the game. We found one from the seventh inning. It was two hours earlier. The patient was immediately treated with tPA, and made a significant recovery prior to discharge to rehabilitation.
Twitter is not generally regarded as a medical tool. While this case demonstrates a dramatic use, many physicians find it useful to follow medical journals, societies, FDA, and many other medical resources.
One more tool in stroke treatment. Twitter.
Steven Rudolph is a neurologist who blogs at Thoughts on Technology and Medicine.