Patients unfamiliar with stroke symptoms - Advances & Insights

What the news
Dr. Vaishnav means for you

Anand G. Vaishnav, MD
Neurosurgery

What you don't know can kill you
This study presents two very important points: (1) the population needs to be more aware of the symptoms of stroke, and (2) people need to be educated to understand the dire importance to seek treatment immediately after experiencing any stroke symptoms.

"The longer a patient delays evaluation and treatment, the more likely the damage from the stroke will be permanent."

Remember a stroke is acute; an all of a sudden onset of focal weakness or numbness. Many people have problems with speech, loss of vision in one eye, or sudden confusion. However, depending on the specific location of the stroke, the initial symptoms can differ with everyone.

The majority of the people in this study did not realize they were having a stroke when they experienced these symptoms, most felt the symptoms would just go away on their own. By the time most of these patients went to the emergency room, it was too late to administer the treatment.

Don't delay - stroke is an emergency
The longer a patient delays evaluation and treatment, the more likely the damage from the stroke will be permanent and the chances of dying are increased drastically. I can’t stress to people enough the importance of calling 9-1-1 and getting to an emergency department the moment the onset of stroke symptoms is felt. Almost half of the patients surveyed in the Mayo Clinic study did not know time is of the essence when treating a stroke.

Minutes count
Intravenous tPA (tissue plasminogen activator) is the only FDA-approved clot-busting drug that improves the likelihood of partial or complete recovery for acute, ischemic stroke. Intravenous tPA is only effective if it is given within three hours of the onset of stroke symptoms. After three hours, brain damage becomes too severe.

"Only an estimated 3 to 5 percent of stroke victims arrive at the emergency department in time to be considered for [treatment]."

If a patient gets to the hospital within the three-hour timeframe, tPA will be administered intravenously. Unfortunately, only an estimated 3 to 5 percent of stroke victims arrive at the emergency department in time to be considered for tPA. Ten percent of the medication (depending of the weight of the individual) is given in the first two minutes; the rest is given over the period of one hour.

At UK and in most other hospitals, emergency physicians will typically call a stroke neurologist/stroke team physician to administer tPA. If the patient gets to the emergency department with only a few minutes to spare before the three-hour time limit, tPA will then be administered by an in-house pharmacy team in the presence of an ER attending physician after consultation via telephone with the stroke team.

Treatment varies for less common hemorragic stroke
In a hemorrhagic stroke, treatment is different. Hemorrhage can be caused by rupture of blood vessels by very high blood pressure or a rupture of an intracranial aneurysm. The aneurysm must be treated immediately either by a direct surgical clipping or by treatment (similar to an angiogram) from inside the blood vessels. A neurosurgeon will most likely be called to perform this procedure.

Risk factors
Several risk factors can increase a person’s chances of having a stroke. Risk factors that patients can control include high blood pressure, smoking, cholesterol, obesity, excess alcohol and physical inactivity. Risk factors we cannot control include age, gender (males are more likely to have a stroke), race (Blacks, Hispanics/Latinos and Asians are at higher risk than whites), family history of stroke or heart disease, and a prior stroke or heart attack. It is important to alter behavior in the areas that we can reduce risk, such as quitting smoking.

If you are at high risk for a stroke, talk to your doctor about preventive treatments such as taking an antiplatelet agent (e.g. aspirin). If your arteries are blocked, your physician may consider a carotid endarterectomy or rarely a stent to decrease your chances of recurrent stroke. Whether or not you are considered high risk, it is still very important to know the symptoms of stoke and if you experience any symptoms of stroke, seek treatment immediately.

Dr. Vaishnav is a neurologist at UK Chandler Hospital and the medical director of the UK Stroke Unit, part of the Kentucky Neuroscience Institute. He is also an assistant professor of medicine at UK College of Medicine.

Patients unfamiliar
with stroke symptoms

An American suffers from a stroke every 45 seconds, accounting for nearly 700,000 Americans each year. Stroke kills more than 150,000 people a year and is the number three cause of death in the U.S. behind heart disease and cancer. Despite this large impact on American lives, a recent study indicates most people may not be sufficiently educated on the topic.

Fifty-nine percent of the stroke patients surveyed did not think they were having a stroke following the onset of their symptoms.

Study finds lack of awareness
A study, conducted by Mayo Clinic physicians, was presented at the October 2006 conference of the American College of Emergency Physicians. In this study the researchers surveyed a total of 220 patients arriving at the Emergency Department with acute brain ischemia between August 2005 and July 2006 and asked them what they knew about strokes and what motivated them to get to the hospital.

Even though all of the patients included in the study had a discharge diagnosis of acute ischemic stroke, the authors found that 59 percent of them did not think they were having a stroke following the onset of their symptoms. In this study, women recognized they were having a stroke less often than the men studied. More than half of the patients studied (54.1%) delayed going to the ED, offering most often the reason that they thought the symptoms would resolve on their own, and they didn’t want to bother anyone.

The majority of the patients studied did not know the warning signs of a stroke. Additionally, the patients were unaware time was of the essence and that they should seek treatment immediately, despite being highly educated and medically sophisticated.

The researchers embarked on the study because they were puzzled as to why stroke patients were showing up in the ED long after the onset of symptoms, particularly given the fact a $162-million public awareness campaign had been launched by the American Stroke Association in 2003 with a message that speed of treatment can lessen the consequences of a stroke. The researchers concluded that ongoing patient education is needed to decrease this time delay.

Types of stroke
There are two major types of stroke: hemorrhagic stroke and ischemic stroke. Hemorrhagic stroke occurs from bleeding into the brain, causing damage. It occurs in about 12 percent of all patients who have a stroke.

Ischemic stroke is far more common, accounting for nearly 88 percent of all strokes. An ischemic stroke is any damage to the brain as a result of lack of blood flow in the brain or in blood vessels leading to the brain. It is caused when blood flow is blocked by a blood clot that either builds up in the brain (cerebral thrombosis) or travels to the brain from another location (cerebral embolus) such as the heart.

Tests to diagnose a stroke
Diagnosis of a stroke is determined by history, physical examination by the treating physician, and brain imaging studies such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), among others .

Once a stroke is diagnosed, the physician will attempt to find out the cause of stroke. The three most common causes of stroke are:

High cholesterol, smoking, obesity, diabetes and lack of physical activity also contribute to development of strokes.

For more information, or to make an appointment with a UK HealthCare physician, please call UK Health Connection at 1-800-333-8874