"My face was beginning to twist, and my right side was beginning to collapse," said Gary, 69. "I turned to a woman sitting next to me and said, 'I need help badly.'"

She was taken to St. Barnabas Hospital, one of a growing number of state-certified stroke centers, facilities with the expertise, equipment and procedures to treat stroke patients fast - the most crucial factor in stroke care.

EMS workers alerted the hospital they were bringing in a stroke patient and the team gathered.

A CAT scan showed Gary was having an ischemic stroke, in which a clot blocks blood flow to the brain. She was treated with tPA, a medication that breaks up clots and must be given within three hours of a stroke's start.

Today, Gary shows no signs of paralysis or brain damage.

Dr. Jerry Balentine, medical director of St. Barnabas, said minutes can make the difference between a stroke survivor's requiring a wheelchair instead of a walker, or having hand paralysis instead of numbness in one finger.

"In hospitals that don't have stroke teams, treatment can't necessarily happen fast enough," Balentine said. "By the time everything is done, you've lost your window of opportunity."

St. Barnabas and New York Westchester Square Medical Center are the first two stroke centers designated in the Bronx by the New York State Health Department, which began the program in 2003 with 10 pilot hospitals in Brooklyn, nine in Queens and one in Manhattan.

Every year, about 700,000 people have strokes across the country, and about 160,000 cases are fatal. In 2003, 1,855 people in New York City died of stroke.

"There is growing evidence across the nation that shows early diagnosis and treatment of patients dramatically improves their ability to survive a stroke and fully recover," said Robert Kenny, a spokesman for the state Health Department.

Kenny said programs at Montefiore Medical Center, Jacobi Medical Center, Bronx-Lebanon Hospital and Lincoln Medical Center in the Bronx have all been approved, but require on-site surveys before they are certified.

In stroke centers, neurologists must be available 2-4/7, doctors must see patients within 15 minutes of their arrival, and CAT scans must be readily available and read by a neurologist.

Before giving tPA, doctors must be sure the stroke is caused by a clot and not a hemorrhage, which causes about 20% of strokes, because the medication can worsen bleeding.

The state's certification process is rigorous, said Dr. Mark Alberts, director of the stroke program at Northwestern Memorial Hospital in Chicago and a member of the Brain Attack Coalition, a national organization that developed stroke center guidelines.

"This will help patients and their families decide which hospital to go to if they are having a stroke," Alberts said.

"It's just like if they were in a car accident, they'd want to go to a trauma center, or if they were having a heart attack, they'd want to go to a cardiac center."

Originally published on August 28, 2005