Getting exercise isn't all that hard. Just 30 minutes a day spent stretching, jogging and sweating a little, will increase one's circulation and help to prevent strokes. (photo by Lan Chun-hsiao)

Strokes "come like the wind" and are very hard to prevent, but there are warning signs. Once family members discover that a loved one has grown suddenly numb and lacks strength, has impaired vision, feels dizzy, speaks unclearly, has a lopsided face or crooked mouth, or has even fallen deeply unconscious, then the chances are as high as 70% that their loved one has had a stroke.

At these moments, time is of the essence, and the first three hours after the stroke hits are key. Why three hours?

"People have 100 quadrillion brain cells," says Yin Jiu-haw of Cheng Hsin General Hospital. "When an ischemic stroke occurs, there is often a central area of the brain that is damaged because of a lack of blood. If those cells go without blood for more than 10 minutes, they will die and be impossible to recover. Because of the disruption to the metabolism, surrounding cells will shut down, but they can recover with treatment."Yin explains that the "three golden hours" refers to the period during which the surrounding cells can be saved. If thrombolytic agents are given within three hours to dissolve blood clots and restore circulation, a near 100% recovery is possible.

Yin stresses that if more than four and a half hours pass before the patient reaches the hospital, the same treatment will be much less effective. And after six hours, the use of thrombolytic agents isn't recommended. "That's because brain cells are tricky and fragile. Initially, they lacked blood. But if the blood flow were suddenly restored, the cells might not be able to handle so great a stimulation, and the brain might start hemorrhaging."

According to the Department of Health, only about 3.5% of patients in Taiwan with strokes caused by an acute lack of blood to the brain get thrombolytic agents within three hours. That compares to 5% in Japan and 6% in the United States.

The figure is so low because family members lack sufficient understanding. They mistakenly believe that the states of numbness or incapacity will soon improve or pass, and they don't immediately bring their loved one to the hospital. What's more, even if the victim is brought to the hospital, the emergency room often doesn't immediately ask neurologists, radiologists and physical therapists to consult on a diagnosis, thus delaying treatment. And finally, doctors take too long to examine patients, wasting precious time.

With this in mind, 40 medical centers located all over Taiwan have in recent years integrated medical resources to establish "stroke centers" that can provide treatment within that small window of time. Take the following case at National Cheng Kung University Hospital in Tainan. In 2009 a middle-aged man suddenly couldn't move the limbs on the right side of his body, had blurry vision and fell into a daze. His workmates urgently brought him to the hospital. Within 50 minutes the stroke team had performed a neurological assessment, conducting a CT scan and other tests. Then, after obtaining the consent of family members, they injected thrombolytic agents. Within 20 minutes the patient had markedly better vision and fuller consciousness. He then spent 24 hours in the intensive care ward before it was ascertained that his brain had suffered no hemorrhaging and he was transferred to a regular ward. A few days later he was released from the hospital able to perform all functions of daily living, with only a slight impairment of vision.