With Strokes, Knowledge Is a Lifesaver

Published: December 12, 2006

Until two months ago, Todd McGee, 34, was a healthy man in top physical condition — a builder, surfer and devoted father of a 15-month-old. The last person anyone would expect to have a stroke.

Yet a stroke has left him nearly unable to speak, with months, maybe years, of therapy ahead. Partly because of his age and partly because of the lack of a hospital with an M.R.I. machine where he lives, no one recognized the symptoms of a stroke until it was too late to administer a treatment that could have limited the damage and speeded his recovery.

This treatment, with a drug called t-PA (for tissue plasminogen activator), can help dissolve a brain-damaging clot in the 80 percent of victims who have strokes caused by them. But it must be administered within three hours of a stroke to be effective, and the sooner the better.

About only one stroke victim in five who could benefit from t-PA receives it, primarily because people don’t realize a stroke is happening and wait too long to get to the hospital.

Many Are at Risk

Knowing who is at risk of a stroke, recognizing the symptoms and getting prompt medical help can make a great difference in whether those afflicted live or die and, if they live, how severe the consequences will be. Although about 90 percent of strokes occur in people over 55, they affect young adults, children and even babies.

In older adults, risk factors for stroke are nearly identical to those for heart attacks: uncontrolled high blood pressure, smoking, diabetes, high serum cholesterol and heart disease.

Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati Medical Center, said that in people under 50, trauma — often relatively minor trauma — to the carotid artery that feeds the brain is the main cause of stroke. Such trauma can occur as a result of a whiplash injury in a car accident, for example, or leaning back over the sink in the beauty salon or getting chiropractic manipulation of the neck, he said.

Strokes are especially common among African-Americans, which prompted a team at the Cincinnati medical center to put in place a stroke education program in beauty salons frequented by African-Americans, where the beauticians are taught to tell their clients about stroke risk factors and symptoms.

Every year, about 700,000 Americans have strokes and 275,000 die as a result, making strokes the third leading cause of death after heart disease and cancer. Mr. McGee is among about 5.4 million stroke survivors in the United States, many with lasting difficulties with speech or movement. Though Mr. McGee has regained the ability to walk, he still is unable to speak (beyond “yes,” “no” and “hello”), write, type or use his right arm. It will take time, determination, and intensive physical, occupational and speech therapy before Mr. McGee has any real sense of how close to normal his life will be.

Signs and Symptoms

Because a stroke injures the brain, the person who is having one may not realize it. And stroke symptoms sometimes come and go, leading the person to think nothing is seriously wrong. Thus, it may be up to family members or bystanders to take quick action in calling 911.

In reviewing Mr. McGee’s symptoms, it is easy to see why he, his partner and hospital personnel missed the cause of the problems. His first symptom was severe vomiting, which he thought was from the same “bug” that had afflicted his partner, Sue, and their daughter two days earlier. Then he got a headache, and not just any headache — “by far the very worst headache in my life,” he told Sue, who said he yelped at every bump in the road on the way to the hospital, where he was given an unrevealing CT scan and a potent painkiller and sent home.

Next, during a phone conversation, Mr. McGee began slurring his words, which he thought was a reaction to the medication. But soon after, the right side of his body went numb and he could not hold up his right arm. He went back to the hospital, where medical staff suggested that the numbness might be related to the headache, but considered it serious enough to transfer him to a major medical center.

Two days after the first signs of trouble, Mr. McGee’s problem was finally diagnosed as a major stroke, resulting from two clots caused by damage to the carotid artery, most likely from repeated trauma during surfing.

Unlike heart attacks, which can cause crushing chest pain or radiating pain that compels the victims to seek medical attention, strokes usually have more subtle symptoms. But according to the National Institute of Neurological Disorders and Stroke and the American Heart Association, stroke symptoms should be easy to recognize because they happen suddenly:

¶Numbness or weakness of the face, arm or leg, especially on one side of the body.

¶Confusion or trouble speaking or understanding speech.

¶Trouble seeing in one or both eyes.

¶Trouble walking, dizziness, or loss of balance or coordination.

¶Severe headache with no known cause.

Dr. Dawn Kleindorfer, Dr. Broderick and colleagues at the Cincinnati medical center believe that a major stumbling block in getting a quick diagnosis and treatment for stroke lies in people’s inability to remember these symptoms. So they are teaching beauticians and others, including children who may recognize symptoms in their parents or grandparents, the signs of a stroke using the acronym FAST:

¶Face weakness or numbness, droopy mouth or crooked smile.

¶Arm or leg weakness or numbness.

¶Speech difficulty in understanding or speaking.

¶Time to call 911.

And time is of the essence. Ideally patients should get to the hospital within one hour to allow time for a diagnosis and treatment with t-PA in case of a clot-caused stroke.

Undiagnosed Warnings

In a study of 18,462 Americans published Oct. 9 in The Archives of Internal Medicine, Virginia J. Howard, an epidemiologist at the University of Alabama at Birmingham, and her collaborators found “a high prevalence of stroke symptoms” among people who had never received a diagnosis of stroke or its premonitory problem, a transient ischemic attack, which is a ministroke that leaves no lasting disability.

Nearly 18 percent of the study group reported having had at least one stroke symptom. The major symptoms of stroke — sudden weakness on one side of the body, sudden loss of vision or sudden inability to understand speech — were most common among African-Americans and those with lower incomes or education.

“These undiagnosed or unrecognized events could have a substantial impact on cognitive functioning or personality and could also be powerful harbingers of subsequent major strokes,” the researchers concluded. They recommended that head imaging studies be done for anyone found to have had a stroke symptom.

“People shouldn’t fear seeking medical attention, especially if they have a family history or risk factor for stroke,” Ms. Howard said in an interview. “Strokes are largely preventable. Even if it’s a false alarm, doctors would rather see the person. It could be some other neurological condition that needs attention.”