Health Matters SEPTEMBER 13, 2008

Many fail to spot symptoms of stroke; these aids can help

By JOHANNA BENNETT

Stewart Pickell was one day shy of his 56th birthday when he felt lightheaded.

It was a hot June morning, and he had just left an air-conditioned hair salon. So Mr. Pickell went about his day. But later, he fell down on his front steps when his right foot briefly went numb. At work that night, Mr. Pickell, then the manager of the gym used by Canada's national basketball team, didn't feel right.

Last year, 780,000 Americans suffered a stroke. Yet many suffer needless disability or die because they ignore the warning signs. Steven Levine, a neurologist at Mount Sinai Medical Center in New York, explains why it's important to act fast. (Sept. 13)

His leg started dragging. So his wife took him to the hospital. By then, he couldn't walk to the car. Mr. Pickell arrived at the emergency room with his mouth slightly drooping. A nurse told him he was having a stroke.

"My neurosurgeon told me I had probably been stroking all day," recalls Mr. Pickell, now 58, who lives in Winnipeg, Manitoba. "I was in denial. Never in my wildest dreams did I ever think I was having a stroke."

Warning Signs

Last year, 780,000 Americans suffered a stroke, when a blocked or ruptured blood vessel interrupts the flow of oxygen-rich blood to parts of the brain, causing neurological damage. Yet many Americans suffer needless disability -- and many die -- because they ignore or fail to recognize warning signs. The five major symptoms are sudden numbness or weakness in the face, arm or leg, trouble speaking, vision problems, trouble walking, and a sudden, severe headache.

In a study published earlier this year, researchers at the University of Alabama-Birmingham found that 42% of Americans over the age of 45 who had stroke symptoms didn't seek medical care. And in a study published last fall, researchers at the Mayo Clinic College of Medicine in Rochester, Minn., found that older stroke patients wait on average almost three hours before going to the hospital. Some wait more than a week.

Those numbers are prompting health-care organizations -- which have long focused on preventing stroke -- to expand and enhance campaigns to educate people, including children, about recognizing a stroke.

"People can control their destinies and the destinies of loved ones if they can recognize the symptoms and call 911," says Lewis Morgenstern, director of the stroke program at the University of Michigan School of Public Health in Ann Arbor, Mich.

The Journal Report

See the complete Encore report. Most strokes occur when a blood clot or plaque blocks a blood vessel or artery, cutting off blood flow and oxygen to the brain. Such attacks are known as ischemic strokes. About one in six victims suffers hemorrhagic strokes, or bleeding in the brain.

Three-Hour Window

So the faster you get proper medical attention, the better your chances are of surviving and minimizing neurological damage. Three hours is the magic number: If you get to the hospital within that time frame, doctors may be able to administer tissue plasminogen activator, also called tPA, which can dissolve stroke-causing clots.

Many patients, though, don't beat the clock. Stroke remains the third leading cause of death in the U.S., with about 150,000 victims annually, according to the American Stroke Association, a division of the American Heart Association. Even more are permanently disabled.

Stroke symptoms vary depending on the type of stroke or the part of the brain attacked. They can remain constant, or gradually get worse. "Mini-strokes" called transient ischemic attacks -- harbingers of an impending stroke -- have symptoms that dissipate. So, many patients wait and hope that the discomfort subsides.

Today, such reluctance is particularly frustrating, says Steven Rudolph, director of the stroke center at Maimonides Medical Center in Brooklyn, N.Y. , because medical advances in the past decade have revolutionized stroke treatment.

The Benefits of tPA

Available since 1996, tPA remains the only drug approved for stroke treatment. If tPA gets administered in the first hour after symptoms begin, patients are four times as likely to suffer minimal or no disability than people treated right at the three-hour mark, says Steven Levine, director of cerebrovascular education at Mt. Sinai School of Medicine in New York. Yet just 2% to 4% of patients receive the drug at all.

One of them was Diane Fite, a Houston physician who suffered a stroke in 2006. "I was so fortunate," says Dr. Fite, 55. "I got the tPA. I recovered. I was back to work full time a month later." Mr. Pickell, on the other hand, was in the hospital for a week, spent 12 weeks in a rehabilitation hospital and remains on medical disability.

Here's a look at some of the latest efforts to help improve recognition of a stroke -- and where you can find more information:

The American Stroke Association (www.strokeassociation.org) tries to make stroke symptoms easy to remember with "Give Me Five For Stroke," a simple five-word list: walk, reach, talk, see and feel.

The National Institutes of Health (www.stroke.ninds.nih.gov) has an eight-minute video about what to do if someone has a stroke. At the Web site of the Joint Commission on Accreditation of Health Care Organizations (www.qualitycheck.org), you can find hospitals with the staff and resources to aggressively treat strokes.

The National Stroke Association (www.stroke.org) has a mnemonic device -- F.A.S.T, which stands for face, arms, speech and time. Check out its Web site for back issues of its magazine "Stroke Smart," brochures, education programs for children and a score card that ranks your risk level.

At the Stroke Network (www.strokenetwork.org), an online support group for stroke victims, you can email questions to a neurologist or take a 10-question quiz to test your knowledge of strokes.