Stroke Identifcation

[Anuwolf]

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My father recieved this email from a coworker.

I thought I'd ask the Brain doctors in here to see if this is actually true?

Heres what the email says:
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My friend sent this to me and encouraged me to post it and spread the word. I agree. If everyone can remember something this simple, we could save some folks. Seriously. Please read:

STROKE: Remember The 1st Three Letters... S.T.R.

STROKE IDENTIFICATION:
During a BBQ, a friend stumbled and took a little fall -- she assured everyone that she was fine (they offered to call paramedics) and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food -- while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital -- (at 6:00 PM, Ingrid passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don't die. They end up in a helpless, hopeless condition instead.
It only takes a minute to read this...

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE
Thank God for the sense to remember the "3" steps, STR . Read and Learn!

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.
Now doctors say a bystander can recognize a stroke by asking three simple questions:

S * Ask the individual to SMILE.
T * Ask the person to TALK to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. . . It is sunny out today)
R * Ask him or her to RAISE BOTH ARMS.

NOTE : Another 'sign' of a stroke is this: Ask the person to stick' out their tongue. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke. If he or she has trouble with ANY ONE of these tasks, call 911 immediately !! and describe the symptoms to the dispatcher.

A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved.

 

[Nerdoscience]

Well, it's mostly true. What it doesn't say is that some "strokes" clear up on their own whithin 24 hours (TIAs), some slowly recover, and some get worse from complications like bleeding and swelling. Also, some strokes are completely different from the kind described above. And the 3 hour window for treatment is for t-PA, a clot busting drug, which has significant risk of complications and doesn't always get rid of all the symptoms. There are other treatments with wider windows, some of which are under investigation right now.

Having said all that, what thed chain e-mail says is essentially true, and is exactly what doctors want ALL laypeople to know. If somebody feels crushing chest pain radiating to their jaw and arm, they KNOW they might be having a heart attack. Some day, it is hoped that the same will be true of the most common signs and symptoms of stroke.

 

[UCLA-Neuron]

S*T*R: It sounds like Cincinnati Prehospital Stroke Scale. According to one study, laypersons were able to identify these stroke symptoms with 94% sensitivity and 83% specificity. Not too bad.

Liferidge AT, Brice JH, Overby BA, Evenson KR. Ability of laypersons to use the Cincinnati Prehospital Stroke Scale. Prehosp Emerg Care. 2004 Oct-Dec;8(4):384-7.

 

[mendel121]

http://www.snopes.com/medical/disease/stroke.asp

Always a good idea to checkout snopes.com whenever you get an email like this, they do a great job debunking the bad ones, and backing up the good ones - this one looks like a little of both -

http://www.snopes.com/medical/disease/stroke.asp

 

[Nerdoscience]

There's nothing "bad" about the forward at all, except that it oversimplifies the matter. This is the lesser of two evils, since simplifying it makes it more accessible to the general public. I really like the snopes.com link's explanation of the forward.

 

[PainDr]

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

This is absolutely untrue and very misleading. I certainly hope this neurologist didn't actually say that to the family, lots of unnecessary guilt. TPA is an amazing medication, but it is not the be all and end all of stroke care. First of all, only a small percentage of stroke patients even qualify for TPA. I was always amazed by how often strokes occur during sleep, which almost always disqualifies someone (start time is the last time either the patient or a family member can attest that the patient was neurologically intact). Even if they're in the 3 hour window, there are many other contraindications which may preclude treatment. Also, TPA has a high risk of morbidity (high risk of intracranial bleeding). Secondly, in those who do receive care, many don't survive and of those who do, most end up with at least mild residual deficits. So for someone to say they can totally reverse the effects of a stroke is grossly inacurate. I seriously doubt this neurologist actually said that. He/She probably made some reference to the 3 hour window and the family exaggerated what was said. Lastly, if this person had been taken to the hospital during her initial insult, she would not have been a candidate for TPA as her deficits were obviously very mild. However, having said that, had she been taken to a large academic center, she probably would have been admitted for a stroke work up, in which case, when her symptoms worsened, she might have been a candidate depending on her condition. It should also be known that the practice of many private and small hospitals is to discharge such a patient and arrange for outpatient stroke work up, in which case her outcome might not have been any different. BTW, I trained with a stroke neurologist (fellowship trained) and an Interventional/ICU neurologist (also fellowship trained), and just finished residency one year ago, so I doubt the standards have changed much.