Getting the Jump on Stroke Diagnosis

Teaching lay people early signs of attack can make difference in care

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

SUNDAY, Aug. 10, 2003 (HealthDayNews) -- With strokes, minutes matter. They can make the difference between life and death.

But how can you recognize the early signs of such a brain attack, either in yourself or a loved one?

Pretty easily, researchers from the University of North Carolina have found.

When they gave 100 people simple instructions on how to recognize stroke symptoms, those folks quickly spotted the signs of stroke. That means lay people could dramatically shorten the time it takes for patients to get the care they need, says one of the study's authors. Since less than 20 percent of stroke victims get to the hospital in time for optimal care, that could be very good news indeed.

"Initial symptoms of stroke may be mild, leading the patient or those around him not to take the situation seriously enough. But if you can use lay people as the eyes and ears for possible strokes, you can get a person into the pipeline for treatment sooner," says Amy Hurwitz, the first author of the study, which was partially funded by the American Stroke Association.

In the study, participants were told over the phone by emergency service workers of a simple examination that health-care professionals use, called the Cincinnati Pre-Hospital Stroke Scale (CPSS). It identifies possible stroke victims by arm weakness, slurred speech or facial weakness.

Once told what to look for, using volunteer stroke survivors as subjects, the study participants were 97 percent accurate in detecting arm weaknesses, 96 percent accurate in catching speech deficits and 74 percent accurate in finding facial weaknesses.

Hurwitz says the relatively low score on detecting facial weakness could be traced to the difficulty of assessing a stranger's smile. If a relative or friend were doing the assessment, as is usually the case when someone has a stroke, chances are that person could detect a difference in facial expression, she adds.

Hurwitz, a third-year medical student, and her colleagues, who included study designer Jane H. Brice, an assistant professor of emergency medicine at the university, were very encouraged by the results.

"We weren't surprised that people would be able to follow the instructions, but we were surprised by how successfully they were able to do so," Hurwitz says.

Key to the most effective care, she adds, is to call 911 immediately. "We don't suggest that people run this test themselves but rather call 911 if they suspect a stroke," and the dispatcher will talk them through the test, she says.

Teaching people to be on the alert for signs of stroke could dramatically improve care for strokes, say health professionals, because time is of the essence in treating this ailment.

When a stroke occurs, most often when a clot forms in the bloodstream, the brain is deprived of oxygen. The more quickly the clot can be broken up, restoring blood flow to the brain, the better the chances for survival without disability.

At the present time, an effective clot-busting drug is available that does just that, but it must be administered within three hours of the onset of symptoms, say doctors, a timetable that eliminates most stroke victims.

"The most common reason people are not treated is time. One study has found that only 17 percent of patients get to the hospital within three hours of the onset of symptoms," says Dr. Larry Goldstein, director of Duke University's Medical Center for Cerebrovascular Disease.

"And, in fact, you need to get to the hospital in two hours because it takes at least an hour for the triage process -- history, examination, a CT scan has to be taken and interpreted, and then the drug is given," he adds.

But training lay people in the importance of detecting strokes early and contacting 911 as soon as possible could help, Hurwitz says.

"You need to start counting from the time symptoms first appear," she stresses.

The first thing is to detect the symptoms, no matter how mild, and realize there could be a problem, Hurwitz says. Then call 911 and explain the symptoms and that you suspect a stroke. Don't wait to call your doctor or drive yourself or the patient to the hospital. The 911 dispatcher will know better which facility you should go to, so you can get to the right hospital as quickly as possible and the staff there will be alerted to your arrival.

"People are afraid of being wrong or of being thought hypochondriacal, but if you have these symptoms, call for help," she says. "Some people will test positive [on the CPSS] who aren't having a stroke, but because early treatment for stroke is so important, they should call regardless."

More information

The American Stroke Association explains what happens when you suffer a stroke. The National Institute of Neurological Disorders and Stroke outlines the risk factors for stroke.

SOURCES: Amy Hurwitz, M.A., University of North Carolina School of Medicine, Chapel Hill; Larry Goldstein, M.D., director, Center for Cerebrovascular Disease, Duke University Medical Center, Durham, N.C.

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