Recognizing and Responding to Stroke
Early Identification of Brain Attack Expands Treatment Options
Jul 18, 2009
A stroke, or cerebrovascular accident (CVA), is sometimes called a “brain attack.” In the same way that cutting off the blood supply to parts of the heart can cause a heart attack, depriving a section of the brain of its blood supply for more than a couple of hours can cause that area of the brain to die.
Rapid recognition of an evolving CVA will maximize a victim’s chances of recovery, but—because other conditions can mimic a stroke—sometimes even physicians misinterpret the early signs and symptoms of stroke.
Conditions that Mimic Stroke
- Seizure
- Systemic infection (pneumonia, sepsis, etc.)
- Syncope (fainting) or pre-syncope
- Metabolic disturbance (hypoglycemia is most common)
- Brain tumor
- Migraine
- Functional/psychiatric condition
- Dementia
Categories of Stroke
Stroke is commonly categorized according to the mechanism that interferes with the normal flow of blood to brain tissues:
- Ischemic (iss-KEE-mic) stroke occurs when a clot forms in a blood vessel in the brain or when the clot travels from another place in the body and lodges in the brain. Accounts for 87% of strokes in the US.
- Hemorrhagic (hem-oh-RAJ-ic) stroke occurs when a blood vessel breaks inside the brain.
- Subarachnoid (sub-uh-RACK-noid) hemorrhage is bleeding into a space beneath one of the membranes that surrounds the brain; most cases result from rupture of an aneurysm.
Signs and Symptoms of Stroke
Signs are those things that can be seen or demonstrated by an observer; symptoms are the subjective complaints reported by the patient.
Signs:
- Arm weakness (including grip)
- Leg weakness (gait is halting; while seated, patient cannot lift leg when observer applies pressure to top of knee; patient trips over low objects [e.g., carpet edges] repeatedly)
- Facial weakness (smile or grimace is unequal; cannot blow out cheeks without leaking air)
- Difficulty understanding (e.g., cannot follow simple commands: “touch your nose with your right index finger”)
- Difficulty speaking (speech is slurred or inappropriate)
- Abnormal eye movement (both eyes don’t track equally when attempting to follow observer’s finger)
- Visual field defect
- Choking when attempting to swallow
Symptoms:
- Patient complains of arm weakness or leg weakness
- Subjective facial weakness
- Subjective speech disturbance
- Numbness or other abnormal sensation of arm, leg, or face
- Headache
- Dizziness
- Complaints of difficulty swallowing
The following “give me five” guide can help when evaluating a loved one who may have suffered a stroke:
- Walk: Is the person’s balance off?
- Talk: Is the speech slurred or the face drooping?
- Reach: Is one side of the body weak, limp, or numb?
- See: Is the vision partially or totally lost?
- Feel: Are specific areas of the body numb when touched by another person? Does the patient have a headache?
In addition, the following five warning signs of stroke should be committed to memory:
- Sudden numbness or weakness of the face, arm, leg or hand, particularly on one side of the body
- Sudden confusion, difficulty speaking, or trouble understanding
- Sudden difficulty seeing with one or both eyes
- Sudden severe headache without a known cause (such as a history of migraines or cluster headaches)
(From Yew K, Cheng E. Acute stroke diagnosis. Am Fam Phys 2009;80(1):33-40)
What to Do When Stroke Occurs
Whenever a person is believed to have suffered from a stroke, medical attention should be sought immediately. The exact time of onset of signs and symptoms should be noted whenever possible, and 9-1-1 should be called to activate the emergency medical system.
If treated within three hours, many strokes can be partially or completely reversed with “clot-busting” drugs. Beyond three hours, the risks of using drugs to treat stroke outweigh the potential benefits.
Unfortunately, many strokes occur at night, when the time of onset is uncertain. Whenever a person awakens with signs or symptoms of stroke, it is usually assumed that they are beyond the period of time when clot-dissolving medications can be safely used.
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