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Public release date: 27 May 2008
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Know the Warning Signs of Stroke
Despite symptoms, many Americans fail to seek lifesaving treatment.
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 and treatment.
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 and treatment, visit the
Stroke Awareness Foundation.
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