Wednesday, January 18, 2006

Stroke Recognition: 3 Steps

My grandfather had a stroke when I was a small child. Until the time he died, when I was 18, he could barely move or make himself understood. So you can understand why I found important the claims in a recent e-mail I was forwarded that doctors can often totally prevent or reverse the effects of a stroke if able to treat the patient within three hours and that, while bystanders frequently fail to recognize a stroke in time, there are three simple steps to check for stroke symptoms.

I'm generally very skeptical of unattributed claims forwarded by e-mail, but a little quick checking around supports the information here. Barbara Mikkelson on Snopes.com called this e-mail last November "much-circulated," so it's possible anyone reading this blog has already seen the information. For those who haven't, though, and those who'll find some supplementary sources useful, consider the following.

WebMD lists these as symptoms of a stroke:
  • Sudden numbness or weakness of the face, arm, or leg, especially if it occurs on one side of the body
  • Sudden confusion, trouble speaking, or understanding speech
  • Sudden trouble seeing in one or both eyes, or double vision
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden severe headache with no known cause
  • Drowsiness, nausea, or vomiting
That same page, though, quotes an expert as saying, "Sometimes, the person having the stroke is the last to know what's happening." And obviously bystanders are dependent on the victim to know if there actually is headache, confusion, numbness, or nausea, for instance. A lot depends then on the perception and judgment of the bystanders. As Mikkelson notes,
Focal neurological signs such as slurred speech, unilateral facial droop, blurred vision, discoordination, and partial or total paralysis are often indicative of some sort of brain dysfunction and would be recognized as important markers by those in the medical profession. However, expecting laypeople to diagnose that something has gone terribly wrong in a loved one on the basis of that checklist would be reaching for too much; in that key moment few would be likely to remember what they were supposed to be looking for.
Therefore, these three steps can be particularly helpful:
  • ask the individual to smile.
  • ask him or her to raise both arms.
  • ask the person to speak a simple sentence.
Mikkelson again:
By distilling the assessment process down to three simple tests (smile, raise both arms, speak a simple sentence), anyone is likely to remember what to ask of someone they suspect has just undergone a stroke and to correctly interpret the information so gleaned.
The questions in question were apparently "drawn from a report presented in February 2003 at the American Stroke Association's (ASA) 28th International Stroke Conference." (I didn't even know there is such a thing as the American Stroke Association. I believe I might need to give them some money.) Mikkelson goes on to point out,
News of [that report] can be found on the ASA web site and the American Heart Association's (AHA) web site. However, as the ASA says in its official statement about the report, though the research was funded by a grant from the ASA, that body has not taken a position on the topic nor endorsed the test because the results, though positive, arose from a very small study.
The article about the report is definitely worth a look and very encouraging if recognition has been such a problem historically. Mikkelson's right, though, about the ASA non-endorsement. They're damn emphatic about it. Certainly, if the symptoms the ASA and WebMD list are noted, 911 should be called immediately. When uncertainty exists, however, those three questions might help to clarify the situation.

WebMD on that three-hour window:
During a stroke, experts urge people to get to the hospital as soon as possible, preferably within one hour after symptoms appear, so that they can be evaluated and perhaps receive treatments that must be given within a window of time. One drug, t-PA, can dissolve blood clots and restore blood flow during an ischemic stroke, but doctors must start delivering it intravenously within three hours after symptoms begin.
More on tPA here. And a stark reminder here that, while strokes grow more likely as we grow older, they can happen at any age. We do well to be aware.

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