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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 U.S. 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 that organ. Hemorrhagic strokes occur when a blood vessel in the brain ruptures, resulting in bleeding which causes swelling and hematoma and ultimately impairs brain function. Over the years, e-mail forwards and social media shares have dispensed advice to readers and users about how to identify and respond to a stroke: Examples: [Collected via e-mail, 2004] [Collected via e-mail, 2004] The advice given in these much-circulated e-mails appears to be sound, although it needs be pointed out that it has yet to be endorsed by the American Stroke Association. It was drawn from a report presented in February 2003 at the American Stroke Association's (ASA) 28th International Stroke Conference, and news of it can be found on the American Heart Association's (AHA) 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, though positive, arose from a very small study. If the study's findings hold up, it would mean that recognizing a stroke has taken place would be something just about anyone could do and would be a skill worth mastering in light of the importance of getting medical attention for stroke victims at the earliest possible moment. Focal neurological signs such as slurred speech, unilateral facial droop, blurred vision, discoordination, and partial or total paralysis are often indicative of some sort of brain dysfunction and would be recognized as important markers by those in the medical profession. However, expecting laypeople to diagnose that something has gone terribly wrong in a loved one on the basis of that checklist would be reaching for too much; in that key moment few would be likely to remember what they were supposed to be looking for. The e-mailed advice, as circulated in 2006, contains this additional suggestion: While that is also likely true, as a test it is far less valuable than the original three because there is room for interpretation of the results. How crooked is crooked, after all? How far to one side does the tongue have to go before its having done so can be regarded as a clear sign of a stroke having occurred? Better to discard this fourth suggested 'test' in favor of remembering the first three. By distilling the assessment process down to three simple tests (smile, raise both arms, speak a simple sentence), anyone is likely to remember what to ask of someone they suspect has just undergone a stroke and to correctly interpret the information so gleaned. (The tests are pass/fail, after all, so if the person they were administered to couldn't smile, couldn't raise her arms, and was incoherent, the party observing all this wouldn't be at a loss for what to make of the results — she'd conclude her friend had undergone a stroke.) And it is important laypeople learn to recognize such events, because a new drug has been shown to limit disability from strokes caused by clots (ischemic) provided victims receive it within three hours of the onset of stroke symptoms. Tissue plasminogen activator (tPA) is a clot-busting drug administered intravenously in cases of ischemic stroke; however, only one in fifty stroke patients has a chance of this drug helping them because currently only 2 percent of them reach an emergency room in time for tPA to be given. (It's possible tPA's effectiveness can be boosted by simultaneous massaging of the clot with ultrasound. Early results from a 2004 study performed in Houston on coupling this drug with such treatment are most encouraging.) A 2005 updating of the e-mail included this statement: While getting appropriate medical care for a stroke victim as soon as possible is extremely important, doing so does not come with a 100% guarantee that a stroke identified and treated within a 3-hour timeframe will not cause permanent damage. The warning signs of a stroke are: Ergo, for once there's a Send this to everyone you know! missive afoot that really does contain highly useful and important information. Yet the Internet, while sometimes used to disseminate actual fact (such as the above), is also often used to spread utter nonsense. Consider the following piece of cyber advice about strokes, which we first saw in December 2003: As mentioned earlier in this article, there are two types of acute stroke: ischemic and hemorrhagic. However, there are also two kinds of strokes: acute and transient ischemic attack (TIA). The former is the sort that takes lives or leaves those it strikes with permanent and all too often heartbreakingly serious disabilities. With the latter, the focal symptoms resolve within 24 hours, leaving no permanent neurological deficit. With that in mind, the miraculous recovery described in the e-mail above would have been due to the patient having weathered a TIA episode, not to having had his blood drained from his fingers and ear lobes. Because the underlying patholophysiology is the same between acute stroke and TIA, it's important to seek immediate medical attention for all stroke victims. TIA is also often a warning sign heralding increased risk of stroke. (In high risk demographics, the risk of stroke goes up ten-fold after a TIA.) As for not moving a stroke victim because so doing might cause irreparable bursting of the brain capillaries, the initial insult (stroke) has already occurred, so transport is unlikely to cause further harm. With regard to pricking fingers to get them bleeding as a possible counter to strokes, according to Dr. Rupinder S. Sahsi of Guelph, Ontario, a medical doctor of our acquaintance, I see no physiological reason why minute amounts of peripheral blood loss would have any effect on cerebral blood flow. In other words, pricking a stroke victim's fingers to get each of them to drip blood isn't going to do anything to aid that person. However, taking the time to stab the victim's fingers before bothering to transport him to a hospital, with even that done at a low speed, will cause harm, because when it comes to obtaining proper treatment for stroke victims, time lost is brain lost. Our physician friend counsels: Do not wait for the symptoms to resolve before taking a casual drive to the hospital in your vehicle, as suggested by this e-mail. Getting a stroke victim to an emergency room in time for tPA therapy to be begun is the most important thing you can do to help prevent further brain damage. Do not waste any of that brief window of opportunity by driving at a snail's pace or by stopping to stab the person's fingers and ear lobes. Additional information: Stroke Fact Sheet (Centers for Disease Control) Stroke Statistics (National Center for Health Statistics)
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