Difficulties in detecting stroke are coming in the way of administering the one effective drug, the tPA. Consequently there are a number of needless deaths in the USA, reports say.

Stroke is the third-leading cause of death in this country, behind heart disease and cancer, killing 150,000 Americans a year, leaving many more permanently disabled, and costing the nation $62.7 billion, according to the American Stroke Association.

But from diagnosis to treatment to rehabilitation to preventing it altogether, a stroke is a litany of missed opportunities. Many patients with stroke symptoms are examined by emergency room doctors who are uncomfortable deciding whether the patient is really having a stroke - a blockage or rupture of a blood vessel in the brain that injures or kills brain cells - or is suffering from another condition. Doctors are therefore reluctant to give the only drug shown to make a real difference, tPA, or tissue plasminogen activator.

It is a thrombolytic agent. It can dissolve blood clots, which cause most heart attacks and strokes. Many hospitals say they cannot afford to have neurologists on call to diagnose strokes, and cannot afford to have MRI scanners, the most accurate way to diagnose strokes, for the emergency room.

Although tPA was shown in 1996 to save lives and prevent brain damage, and although the drug could help half of all stroke patients, only 3 percent to 4 percent receive it. Most patients wait too long to seek help - tPA must be given within three hours. And even when patients call 911 promptly, most hospitals, often uncertain about stroke diagnoses, do not provide the drug.

"I label this a national tragedy or a national embarrassment," said Dr. Mark J. Alberts, a neurology professor at the Feinberg School of Medicine at Northwestern University. "I know of no disease that is as common or as serious as stroke and where you basically have one therapy and it's only used in 3 to 4 percent of patients." With strokes , rapid treatment is crucial. During a stroke, an estimated 1.9 million nerve cells and 7.5 miles of nerve fiber die each minute.

Half of all strokes could be prevented if patients controlled their blood pressure, and others could be prevented by controlling other risk factors, like smoking.