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Know the Warning Signs of Stroke

Despite symptoms, many Americans fail to seek lifesaving treatment

MONDAY, May 26 (HealthDay News) -- What would you do if you suddenly became dizzy and had trouble seeing? Watch and wait? Call 911?

Most Americans don't act on warning signs of stroke, including sudden dizziness or loss of balance or coordination and loss of vision in one or both eyes. Yet experts say early treatment could avoid devastating consequences, including death and disability.

A study presented at a recent American Stroke Association meeting found more than half of people experiencing stroke symptoms don't seek treatment.

"What it really tells us is that whether or not it was stroke, they should have gotten it checked out, because it could have been a stroke," said study lead author Virginia J. Howard, an epidemiologist at the University of Alabama-Birmingham. "And when in doubt," she added, "they should talk to their doctor or seek some guidance -- even if they just talk to their doctor over the telephone."

Howard's research team examined data from a large, ongoing study involving white and black U.S. adults aged 45 and older. By the end of the study, some 30,000 people will have been interviewed and had blood work, an electrocardiogram and a medical evaluation. It's all part of a sweeping effort to understand why blacks and people who live in the southeastern part of the United States -- a region known as the "Stroke Belt" -- suffer higher-than-average rates of death from stroke than whites and people in other regions of the country.

Stroke is the nation's third leading killer, claiming the lives of more than 150,000 Americans each year. About 700,000 people have a new or recurrent stroke each year, the American Stroke Association reports.

Eighty percent of strokes are caused by a clot that obstructs blood flow to the brain -- a so-called ischemic stroke. Another type, hemorrhagic stroke, can occur when a vessel ruptures and bleeds into the surrounding brain.

Some people experience a "mini-stroke," called a transient ischemic attack, when blood flow to the brain is temporarily blocked, and these individuals are at greater risk of having a future stroke.

To explain the link between stroke symptoms and behavior, Howard's team asked study participants if they had experienced any stroke symptoms and, if so, whether they'd sought medical care.

Of those who reported symptoms but had no confirmed diagnosis of stroke or mini-stroke, more than half -- 51.4 percent -- did not seek medical care.

It isn't known how many of them actually experienced a stroke. Still, their failure to seek care is very worrisome, one stroke expert said, because tissue plasminogen activator (tPA), a clot-busting drug given to people who've had ischemic stroke, is most effective when administered within three hours of the onset of stroke symptoms.

"It has been estimated -- and figures from our center support this -- that if everyone with a stroke called 911 at the onset of symptoms and were taken to a hospital prepared to treat them, 50 percent of stroke patients would receive IV tPA, rather than the present national average of around 2 percent," noted Dr. James C. Grotta, professor and chairman of the Department of Neurology at the University of Texas Medical School and director of the stroke program at Memorial Hermann Hospital, in Houston.

There are many reasons why possible stroke victims don't seek medical attention.

Often people simply don't recognize the symptoms, explained Dr. Dawn Kleindorfer, an assistant professor of neurology and stroke researcher at the University of Cincinnati. "It's not that they're afraid, they just don't recognize it as an emergency," she said.

The American Stroke Association teaches the public to watch for these warnings signs:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking or understanding.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden, severe headache with no known cause.

But in a study in the journal Stroke, Kleindorfer and her colleagues examined whether a simple acronym, FAST -- meaning "face, arms, speech, time" -- might be better at capturing stroke patients than the typical list of symptoms. Within the populations studied, more than 88 percent of patients had symptoms included in FAST. It missed some stroke patients, especially those with bleeding in the brain, because the acronym doesn't include headache. Still, she thinks it may be a better way to educate the public.

"It may miss a few, but it's easier to remember, and maybe that is more important and we need to study that," Kleindorfer said.

Getting that message to the public is, of course, another challenge.

Kleindorfer has been exploring different venues for education, even local beauty shops. Her research team taught stroke symptoms to hairdressers in African-American-run salons in Cincinnati and Atlanta who, in turn, talked to their clients about stroke. Before-and-after measurements showed a significant increase in the women's knowledge of stroke.

"I think it's working with the community, instead of at the community, and getting more ownership of the problem within communities, especially high-risk communities, that's going to be the way to go," she said.

More information

To learn more about the signs of stroke, visit the Stroke Awareness Foundation.

SOURCES: Virginia J. Howard, M.S.P.H., epidemiologist, University of Alabama-Birmingham; James C. Grotta, M.D., professor and chairman, Department of Neurology, University of Texas Medical School, and director, stroke program, Memorial Hermann Hospital, Houston; Dawn Kleindorfer, M.D., assistant professor of neurology and stroke researcher, University of Cincinnati; American Stroke Association; Aug. 30, 2007, online publication, Stroke

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