With Strokes, Knowledge Is a Lifesaver
By JANE E. BRODY
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
¶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.
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
“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
“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