Want to Save Some Lives? Here is a Simple Formula for Identifying Strokes

By Don Hazen, AlterNet. Posted December 22, 2008.

• 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. 

In addition, some are suggesting another sign of a stroke -- a "crooked" tongue. If there is the possibility of a stroke, ask the person to 'stick' out his or her tongue. If the tongue is "crooked" -- if it goes to one side or the other -- that could also an indication of a stroke, although in some cases, this might be harder to identify. (See below analysis on this by Snoops.com.)

Now, like most complex medical issues, as one digs deeper, not everything is as it seems at first blush. First of all, many emergency rooms, particularly outside of urban areas are not equipped to deal with strokes or administer the tPA clot-buster.  For example, there are only 32 stroke centers in all of California and just one in Los Angeles, at UCLA Medical Center.

So try to make sure the emergency room you may take someone to is a stroke center. If going via ambulance, try to direct the EMT people to a stroke-center hospital.  Special equipment and staff are needed to diagnose strokes, and the clot-busting drug can be very dangerous.

On top of the very challenging time factors -- recognizing symptoms, getting emergency response, going to an equipped hospital and getting fast diagnosis, including a CT scan -- physicians disagree about whether tPA is an appropriate course of treatment. 

According to Valerie Ulene, writing for the Los Angeles Times, "... time constraints aren't the only reason tPA isn't given. Some doctors who are unconvinced of its benefits will not administer the drug. In a survey of 1,000 emergency room physicians conducted in 2004, 40 percent reported that they were not likely to use tPA, even under ideal conditions. Officially, the American Academy of Emergency Medicine does not support tPA as the standard of care for strokes. The organization points to the drug's potentially serious side effects, particularly bleeding into the brain. ...  

" ' ... tPA can, in some patients, do more harm than good,' " she quotes Ovbiagele. "However, it's the only current hope for stroke victims. 'There are no other approved options for the treatment of acute ischemic stroke,' Ovbiagele says. 'It's tPA or nothing.' " 

Each year, an estimated 600,000 Americans experience strokes, which are interruptions of the blood supply to any part of the brain, resulting in damaged brain tissue. Of these victims, 160,000 die, making stroke the third-leading cause of death in the United States. Those persons this dread killer does not immediately send to the grave are often left with lifelong debilitating infirmities of speech, movement and even thought.

A stroke is a serious medical event, both because it can (and does) kill, and because it can inflict long-term harm on those lucky enough to survive it. There are two types of acute stroke: ischemic and hemorrhagic. Ischemic strokes account for 80 percent of all such "brain attacks" and occur when a blood clot lodges in a vessel responsible for supplying blood to the brain, killing off part of the brain. Hemorrhagic strokes occur when a blood vessel in the brain ruptures, resulting in bleeding, which causes swelling, hematoma and, ultimately, impairs brain function.

The advice given in this much-circulated e-mail appears to be sound, although it needs be pointed out that it has yet to be endorsed by American Stroke Association. It was drawn from a report presented in February 2003 at the American Stroke Association's 28th International Stroke Conference, and news of it can be found on the ASA Web site and the American Heart Association's Web site. However, as the ASA says in its official statement about the report, though the research was funded by a grant from the ASA, that body has not taken a position on the topic nor endorsed the test, because the results, although positive, arose from a very small study.

See more stories tagged with: health, strokes, stroke identification, stroke symptoms, tpa, tissue plasminogen activa

Don Hazen is the executive editor of AlterNet.

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