Strokes still largely misunderstood
despite often debilitating, deadly consequences
Howard Manly | 7/11/2013, 10:57 a.m.
Even worse, the respondents were unaware of the risk factors that can precipitate stroke. While most cited high cholesterol and smoking as factors, more than half failed to recognize lack of physical activity, excessive alcohol consumption and diabetes as causes.
Decreased awareness is not confined to the stroke belt. Several years ago, the Centers for Disease Control and Prevention (CDC) sponsored a study in 13 states and the District of Columbia to examine people’s awareness of the warning signs of strokes and the importance of seeking emergency care.
The CDC found that awareness varied by race, gender and educational status. Whites, females and more educated people were more likely to be aware of warning signs and more likely to call 911.
But overall, the results of the study were not good. Not even half of those interviewed could name the five major warning signs of stroke. Only 60 percent cited the headache as a warning of stroke. More puzzling is that 40 percent of the respondents incorrectly identified sudden chest pain as a symptom. Chest pain is attributed to a heart attack, not a stroke.
Though the death rate from stroke is falling, Dr. Natalia S. Rost, associate director of the Acute Stroke Service at Massachusetts General Hospital, is not leaping for joy just yet. Survival rates have improved largely due to advanced medical techniques rather than from control of risk factors.
There are five major symptoms of stroke: one-sided weakness, trouble speaking, trouble with vision, loss of balance or severe headache with no known cause.
But Rost warns not to wait for all to occur before seeking medical help. The five symptoms do not have to occur in unison to cause concern. “Even a single sign is worrisome,” she said.
Strokes start suddenly and without warning. “One minute you’re fine,” Rost explained. “The next you’re having trouble with your vision.”
Some experience transient ischemic attacks (TIAs), commonly called mini-strokes. In a TIA, a person can experience one or all of the symptoms of stroke. The symptoms typically last a few minutes and then subside.
Just 15 minutes
Researchers at the University of California, Los Angeles, recently found that for every 15 minutes faster that treatment with tPA for a stroke is received, a patient’s likelihood of discharge home improves by 3 percent and the likelihood of walking at the time of discharge improves by 4 percent. More significantly, death is 4 percent less likely.
That does not mean that you have dodged a bullet. People should consider TIAs as a warning. Up to 40 percent of all people who suffer a TIA will go on to experience a stroke, according to the National Stroke Association.
Treating strokes is a matter of timing. Those with ischemic strokes may be eligible for treatment with a clot buster called tissue plasminogen activator, or tPA, that helps re-open the vessel. But for optimal results the drug has to be administered within three hours of the onset of symptoms. A select few may still benefit after four-and-a-half hours.
“They have a better chance of recovery,” Rost explained. “Within three months patients who received tPA have better outcomes.”
Timing is not the only factor. The hospital of care is important as well. The Joint Commission is a nonprofit organization that accredits and certifies health care organizations and programs in the U.S. The Commission, as well as individual state health departments, have designated certain hospitals — Massachusetts General Hospital, for example — as primary or certified stroke centers. These hospitals are better staffed and equipped to diagnose and treat strokes more effectively.
Some research has shown that patients treated at approved stroke centers experience better outcomes. Furthermore, those who are eligible for tPA treatment are more apt to receive it at these centers.
The good news is that stroke is largely preventable. The culprits that increase its risk are high blood pressure and high cholesterol, obesity, diabetes, inactivity, smoking and heavy drinking. With increased awareness and effective treatments, the incidence should drop.
That’s when Rost will leap for joy.