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Common Drug May Limit Stroke Damage

Acetaminophen could cool fever after stroke

THURSDAY, July 5, 2001 (HealthDayNews) -- Keeping a cool head in a crisis is given new meaning by a just-released study from the Netherlands.

High doses of acetaminophen, more commonly known as Tylenol, can reduce brain damage after a clot-caused stroke by lowering body temperature, report neurologists at the University Hospital Rotterdam. Because a fever in the first day after a stroke is a strong sign of how bad brain damage will be, the study was designed to find out if lowering body temperature, even in victims who didn't have fevers, would improve outcomes.

The findings are reported in the July issue of Stroke: Journal of the American Heart Association.

About 750,000 Americans have strokes every year, and nearly 160,000 die as a result. Symptoms include sudden blurred or decreased vision in one or both eyes, the loss of balance or coordination, difficulty speaking or understanding simple statements or weakness, numbness or paralysis in a specific body part. About 80 percent of all strokes are caused by clots (ischemic strokes); the other 20 percent are caused by broken or leaking blood vessels.

A research team led by Dr. Diederik W. J. Dippel, a senior resident in neurology, enrolled 75 ischemic stroke patients whose body temperature was between 96.8F and 102.2F right after their strokes. Half the patients received early treatment and acetaminophen six times daily for five days, while the other patients received similar early treatment but were given placebos instead of acetaminophen.

After 24 hours of treatment, patients given acetaminophen had temperatures that averaged 0.72F lower than those receiving placebos. By the fifth day of treatment, body temperatures were similar in both groups.

"If acetaminophen really prevents [low-grade fevers], it could turn out to be a very promising treatment. Though its effects may be modest in size, it is cheap and has almost no harmful effects," says Dippel.

"Currently we are working on a study to confirm these findings," he says.

The researchers say even a small decrease in body temperature could have important clinical implications. Previous research has shown that every 1.8F increase in temperature in the 12 to 24 hours after a stroke is linked to a two-fold increase in the risk of death.

"In fact, lowering body temperature seems to protect the brain more than any of the drugs that have been developed that protect the brain during a stroke," says Dr. Stephen Phillips, director of the Acute Stroke Service at the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, and a spokesman for the Heart and Stroke Foundation of Canada.

Phillips says acetaminophen doesn't conflict with drugs like TPA (tissue plasminogen activator) or other clot-dissolving drugs often given to stroke patients and frequently is prescribed later on as a painkiller. "It doesn't affect clotting at all" as aspirin would, says Phillips. Aspirin tends to thin the blood and delays clotting.

Phillips says if future studies confirm the findings, early treatment with acetaminophen likely would become a standard of care for stroke patients. "We're always looking for inexpensive treatment that is safe and easy to give, and that can be given to a majority of people with the problem," says Phillips.

Dippel says, "Our next challenge will be to investigate whether acetaminophen not only reduces body temperature in stroke patients, but actually contributes to a better outcome."

What To Do: You can find out more about stroke from the National Stroke Association, the American Heart Association or the National Institute of Neurological Disorders and Stroke.

SOURCES: Interviews with Diederik W.J. Dippel, M.D., senior resident, Department of Neurology, University Hospital Rotterdam, Rotterdam, The Netherlands, and Stephen J. Phillips, M.D., associate professor of medicine, Dalhousie University, director, Acute Stroke Service, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia; July 2001 Stroke: Journal of the American Heart Association
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