Ignoring warning signs of stroke may be risky

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A survey conducted by the American Stroke Association has found that one in three American adults experienced a symptom consistent with a warning or “mini” stroke, but almost none took the recommended action.

The survey was conducted as part of the American Heart Association/American Stroke Association’s Together to End Stroke and included 2,040 adults. Thir; of these 35% reported having experienced at least one sign of a warning stroke, called a transient ischemic attack (TIA) or mini stroke, where the symptoms are similar to a stroke but last for few minutes and not beyond 24 hours. Rather than immediately call 911, these individuals were more likely to wait, rest or take medicine.

• Sudden, severe headache with no known cause was the most common symptom reported (20%). The second most common was sudden trouble walking, dizziness, loss of balance or coordination (14%).
• Those who experienced trouble walking, dizziness, loss of balance or coordination, or numbness or weakness of the face, arm or leg were most likely to call 911 (5%).
• About 77% of people surveyed had not heard of a TIA.
• Though 55% said they would call 911 first if they suspected themselves or someone else was experiencing symptoms of a TIA, but only 3% of people who reported having experienced a TIA-like symptom did.

About 15% of strokes are heralded by a TIA. People who have a TIA are significantly more likely to have a stroke within 90 days.

The American Stroke Association recommends calling for emergency help immediately, even if symptoms are relieved. The acronym FAST can be used to recognize the warning signs of stroke.

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call 911.

Warning signals should not be ignored as “time is life” in medical science. Stroke is an emergency and getting timely help and treatment is extremely important. Early treatment improves the chances of recovery.

If a patient presents to the emergency with symptoms of mini stroke, then

• Rule out brain hemorrhage as soon as possible
• Check glucose and correct high or low sugar. If the blood sugar is over 180 mg/dL start insulin.
• Maintain normothermia for at least the first several days after an acute stroke
• Obtain emergent brain imaging (with CT or MRI) and other important lab studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke
• For patients with acute ischemic stroke who are not treated with thrombolytic therapy, treat high blood pressure only if the hypertension is extreme (systolic blood pressure >220 mmHg or diastolic blood pressure >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre-eclampsia/eclampsia)
• For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended so that systolic BP is ≤185 mmHg and diastolic BP is ≤110 mmHg
• Antithrombotic therapy should be initiated within 48 hours of stroke onset.
• Continue statins in patients on statin therapy prior to stroke onset.

(Source: AHA/ASA News Release, May 1, 2017)

Dr KK Aggarwal
National President IMA & HCFI