Need For Speed: Two New Studies On Stroke "No matter what kind of stroke or mini-strokes patients have, the best course of action in all cases is to call 911, so that an ambulance or other emergency medical team can arrive and transport the patient to the hospital. Driving to the hospital oneself, or being driven by a friend or loved one, is less ideal because of delays that can occur en route or upon arrival at the hospital. Even at major hospitals with dedicated 24-hour stroke teams, such as U-M, it can take an hour or more to use diagnostic tests to assess what type of stroke a patient is having and to start tPA treatment. At smaller hospitals, it can be more than an hour -- and intra-arterial tPA, which can be given up to six hours after the start of a stroke, may not be available. So, a person experiencing a stroke really needs to get to a hospital within two hours of the start of a stroke to have the best chance of receiving tPA ... "

One-Fifth of Hospitals Give Bad Emergency Advice on Stroke: Too often, personnel do not tell callers to phone 911, study finds "Americans who think they're having a stroke face better than a one-in-five chance of getting the wrong -- and potentially fatal -- advice when they call local hospital personnel, a new study shows. Although experts say the best thing to do when suspected stroke symptoms appear is to immediately call emergency 911, in 22 percent of cases, hospital personnel who answered the phone advised that patients call their family doctor. … There are two messages in the new study, Schwamm said. "The first is that if you or someone you see is having a stroke, call 911, and say, 'I think I'm having a stroke,' " he said. "The second is to find out [beforehand], by calling hospitals in your area, if a hospital has an acute stroke team, if it is equipped to care for a stroke. The education message needs to go to everyone involved." "

Stroke Symptoms Common But Often Unreported "Many Americans suffer a stroke and don't know it or don't do anything about it, a new study finds. Researchers say that as many 18 percent of adults with no history of stroke had experienced at least one stroke symptom in the past."

Stroke victims pay neavily for delays "STROKE victims are robbing themselves of critical minutes by calling a relative or friend instead of an ambulance, new research shows."

Stroke Warning Signs Often Occur Hours or Days before Attack

Stroke's Deadly Toll: 2 Million Brain Cells Each Minute

The Claim: A Stroke Can Be Diagnosed in Three Steps "... an email message ... claims that an untrained bystander can tell whether people have suffered a stroke by asking them to smile, raise both arms slowly and recite a simple sentence. But because the symptoms of a stroke vary widely, the three-step test can detect some victims but will miss many others ... Some of the more common symptoms of a stroke, for example, are problems seeing, an unusual headache, sudden numbness and trouble with coordination or walking - all of which the three-step test overlooks."

Too Many Ignore Symptoms of Mini-Stroke " 'Anyone feeling the symptoms of a TIA should go directly to an emergency room,' she advised. 'If you call your family doctor, you're wasting time,' she said. 'If you call your primary-care physician you'll be told to go to an emergency room anyway. Immediate action is necessary, Brooks said, because after a TIA, 'you are at increased risk especially over the next 90 days, but also of having a major stroke in the next 48 hours to seven days.' "

Treating mini-strokes rapidly cuts later risk "Treating patients quickly for mini-strokes could dramatically cut the risk of a major stroke later, report two studies that could change standard treatment and potentially save millions of people from stroke’s damaging effects. In research published Tuesday, British and French doctors found that patients treated within 24 hours of having a mini-stroke cut their chances by 80 percent of having a more serious stroke in the next three months. … In the U.K., most patients who have small strokes are referred by their doctors to specialist clinics. Many wait several weeks before being treated. In the United States too, many people are sent home within a day if their symptoms seem to resolve. … Doctors increasingly say that small strokes should be seen as warning signals for a more dangerous stroke later on, in the same way that chest pain can be a red flag for an imminent heart attack."

US stroke patients don't reach hospital quickly enough

"Weekend effect" raises risk of stroke mortality " … patients should remember: 'Time is brain,' lead investigator Dr. Gustavo Saposnik said in an American Heart Association press release, 'so the sooner the patient seeks medical attention, the higher the chance of better outcome, no matter the day, time or living area.'"

When Stroke Hits, Call 911

 

A Pop In My Head

Heart Attack and Stroke Prevention in Women

Learn To Recognize A Stroke

Stroke Warning Signs

Strokes and TIAs

The Clock Is Ticking for Stroke Patients

The Warning Signs Of A Stroke

What is a "TIA" and how would I know if I was having this type of attack? "With a TIA all symptoms return to normal with no residual deficit in less than 24 hours; it may be as brief as a few minutes. If these symptoms occur call your doctor immediately or call 911 and go to the nearest emergency room."

Wrong Diagnosis - Symptoms of Stroke

 

Adult Stroke (Circulation 2005)

Awareness of stroke warning signs--17 states and the U.S. Virgin Islands, 2001. (MMWR Morb Mortal Wkly Rep. 2004)

Clinical Characteristics of Patients With Early Hospital Arrival After Stroke Symptom Onset (Journal of Stroke and Cerebrovascular Diseases 2005)

Diagnostic challenge - Is this really a stroke? (Aust Fam Physician. 2006)

Early CT Findings in Unknown-Onset and Wake-Up Strokes. (Cerebrovasc Dis. 2006) "Background: Approximately one quarter of the acute ischemic stroke patients notice the event at awakening. Such patients with stroke at awakening are usually excluded from thrombolysis, since the time of stroke onset cannot be definitely identified. We compared the hyperacute CT findings of awakening stroke patients with those of stroke patients with known onset to assess whether the time of stroke onset is shortly before awakening. ... Conclusion: Based on our CT findings, stroke at awakening seems to be developing shortly before in a large subset of patients, making them potential candidates for acute stroke therapies."

High-risk mini strokes (Bandolier Journal ) "A transient ischaemic attack (TIA) is usually defined as causing symptoms for less than 24 hours, but it is unlikely that brain or eye is actually ischaemic for more than a few minutes. What we observe is the clinical effects of reversible impairment of neuronal function resulting from a short period of ischaemia. The risk of stroke after a TIA is about 12% in the first year and then about 7% a year thereafter, with risk of stroke, heart attack or vascular death being about 10% a year. This is about seven times the risk in the background population. But there is also a high risk of stroke in the seven days after a TIA, possibly as high as 10%. ... The likelihood of chance associations related to TIA and subsequent seven-day stroke was eliminated by using only factors previously significantly found to be independent predictors of stroke in the three months after a TIA. These were age, clinical features characterised (motor weakness and speech disturbance), duration of symptoms, diabetes, and hypertension. ..."

[How to diagnose acute stroke?] (Tidsskr Nor Laegeforen. 2007) "RESULTS AND INTERPRETATION: The diagnosis depends on rapidly developing symptoms or new symptoms on awakening. Symptoms associated with a high probability of stroke are acute unilateral paresis, lateralisation of symptoms to one hemisphere, high neurological score on NIH and symptoms corresponding to a certain vascular territory. Simple screening tools increase the pre-hospital probability of stroke. In hospital a definite diagnosis is based upon CT or MRI findings. Diffusion-weighted MRI is highly sensitive in acute ischemic stroke."

Is the ABCD Score Useful for Risk Stratification of Patients With Acute Transient Ischemic Attack? (Stroke. 2006) "BACKGROUND AND PURPOSE: A 6-point scoring system (ABCD) was described recently for stratifying risk after transient ischemic attack (TIA). This score incorporates age (A), blood pressure (B), clinical features (C), and duration (D) of TIA. A score <4 reportedly indicates minimal short-term stroke risk. ... CONCLUSIONS: Although the ABCD score has some predictive value, patients with a score <4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction despite transient symptoms."

Low public recognition of major stroke symptoms. (Am J Prev Med. 2003)

[Knowledge about stroke in patients admitted in a French Stroke Unit] (Rev Neurol (Paris). 2004)

Knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population. (Stroke. 2001)

Level of Physical Activity in the Week Preceding an Ischemic Stroke (Cerebrovascular Diseases 2007) "Conclusion: Stroke patients are less physically active in the week preceding an ischemic stroke when compared to age- and sex-matched controls."

Mortality of stroke patients treated with thrombolysis: Analysis of nationwide inpatient sample (Neurology 2006) "US community experience in the use of thrombolysis has higher rates of complications and mortality than in controlled clinical trials."

Patient Recognition of and Response to Symptoms of TIA or Stroke. (Neuroepidemiology. 2006) "Results: The median delay time from symptom onset to admission to hospital was 4.5 h. While 41% of participants delayed less than 3 h, more than 45% delayed greater than 6 h. Independent predictors of delay time included mode of arrival at hospital with those taking an ambulance having a median delay time of 2.7 h vs. 15.4 h for those arriving by private car (p = 0.04). Gender also predicted delay with women delaying longer (p = 0.001). The first response of others was also an independent predictor of delay time (p = 0.003) with those who called the emergency services number or took the patient to hospital resulting in the shortest patient delays. Finally, if the patient appraised their symptoms as serious they had a shorter delay time (p = 0.02)."

Posterior headache as a warning symptom of vertebral dissection: a case report. (J Headache Pain. 2005)

Public awareness of warning symptoms, risk factors, and treatment of stroke in northwest India. (Stroke. 2005)

Stroke Among Patients With Dizziness, Vertigo, and Imbalance in the Emergency Department. A Population-Based Study. (Stroke. 2006) "BACKGROUND AND PURPOSE: Dizziness, vertigo, and imbalance are common presenting symptoms in the emergency department. Stroke is a leading concern even when these symptoms occur in isolation. The objective of the present study was to determine the "real-world" proportion of stroke among patients presenting to the emergency department with these dizziness symptoms (DS). ... CONCLUSIONS: The proportion of cerebrovascular events in patients presenting with dizziness, vertigo, or imbalance is very low. Isolated dizziness, vertigo, or imbalance strongly predicts a noncerebrovascular cause. The symptom of imbalance is a predictor of stroke/TIA."

Stroke Symptoms and the Decision to Call for an Ambulance (Stroke. 2007) " Conclusions— Stroke was reported as the problem (unprompted) by <50% of callers. Fewer than half the calls were made within 1 hour from symptom onset. Interventions are needed to more strongly link stroke recognition to immediate action and increase the number of stroke patients eligible for acute treatment."

Stroke-related headache: a clinical study in lacunar infarction. (Headache. 2005)

Subarachnoid haemorrhage. (Lancet. 2007) " Subarachnoid haemorrhage accounts for only 5% of strokes, but occurs at a fairly young age. Sudden headache is the cardinal feature, but patients might not report the mode of onset. CT brain scanning is normal in most patients with sudden headache, but to exclude subarachnoid haemorrhage or other serious disorders, a carefully planned lumbar puncture is also needed. Aneurysms are the cause of subarachnoid haemorrhage in 85% of cases. The case fatality after aneurysmal haemorrhage is 50%; one in eight patients with subarachnoid haemorrhage dies outside hospital. Rebleeding is the most imminent danger; a first aim is therefore occlusion of the aneurysm."

Sudden deafness as a sign of stroke with normal diffusion-weighted brain MRI. (Acta Otolaryngol. 2005)

The Impact of a Concurrent Trauma Alert Evaluation on Time to Head Computed Tomography in Patients with Suspected Stroke. (Acad Emerg Med. 2006)

Time is brain--quantified. (Stroke. 2006) "CONCLUSIONS: Quantitative estimates of the pace of neural circuitry loss in human ischemic stroke emphasize the time urgency of stroke care. The typical patient loses 1.9 million neurons each minute in which stroke is untreated."

Timing of TIAs preceding stroke: time window for prevention is very short. (Neurology. 2005)

Transient Ischemic Attack: A Dangerous Harbinger and an Opportunity to Intervene. (Semin Neurol. 2005)

Transient ischemic attacks: Part I. Diagnosis and evaluation. (Am Fam Physician. 2004)

Warning Headache of Subarachnoid Hemorrhage and Infarction due to Vertebrobasilar Artery Dissection. (Clinical Journal of Pain 2006) "Objectives: The authors describe the clinical features of headache in patients with vertebrobasilar artery dissection (VBAD) and emphasize the importance of recognition of warning headaches preceding subarachnoid hemorrhage. ... Conclusions: The present study confirms a high frequency of headache in patients with VBAD. Sudden severe occipital and nuchal pain, even without subarachnoid hemorrhage or any neurologic deficit, should be considered as a warning sign of subarachnoid hemorrhage. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography should be performed urgently for screening of patients with a warning headache to prevent resultant life-threatening major vascular events."