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Study Shows Many People Having a Minor Stroke Delay Prompt Treatment
By Salynn Boyles
WebMD Health News
Reviewed by Laura J. Martin, MD
April 15, 2010 -- Most people having minor strokes don't recognize the symptoms, and a large percentage fails to seek timely treatment, a new study shows.
Researchers in the U.K. interviewed 1,000 patients treated for minor stroke or transient ischemic attack (TIA), a condition characterized by stroke-like symptoms that generally last just a few minutes and cause no lasting impairment.
The study found that roughly 70% of patients did not understand the cause of their symptoms and slightly less than half sought medical attention within three hours of first having symptoms.
Lack of awareness about how to identify symptoms of minor stroke was high regardless of patient age, sex, education, or economic status.
TIAs are warning signs of possible serious and disabling strokes. About one in 20 people who have a TIA will have a major stroke within a few days and one in 10 will have one within three months, stroke specialist Larry B. Goldstein, MD, tells WebMD.
Goldstein, who was not involved with the study, directs the Duke Stroke Center at Duke University.
"Patients and even health care professionals often dismiss the symptoms," Goldstein says. "TIAs are probably one of the most misdiagnosed conditions. But recognizing a TIA and determining its cause can reduce the risk for damage from major stroke."
Know Your Stroke Symptoms
The symptoms associated with TIAs or minor strokes are the same as for major strokes, but they may last only a few minutes.
They include any one or combination of the following:
- Sudden numbness or weakness in the face, arms, or legs, especially on one side of the body
- Sudden trouble speaking or understanding
- Sudden vision problems in one or both eyes
- Dizziness, loss of balance, or sudden trouble walking
- Severe headache with no obvious cause
In an effort to educate the public about stroke symptoms, the National Stroke Association launched the "Act F.A.S.T." campaign early last year.
Act F.A.S.T. stands for:
- Face. Ask the person to smile. Does one side of the face droop?
- Arms. Ask the person to raise both arms. Does one arm drift downward?
- Speech. Ask the person to repeat a simple sentence. Does he or she have trouble or are the words slurred?
- Time. Time is critical. Call 911 immediately.
Call 911 With Stroke Symptoms
Calling 911 is important because patients who arrive at the hospital by ambulance tend to be evaluated far more quickly than those who walk into hospital ERs on their own, says Michael A. Sloan, MD, who directs the Comprehensive Stroke Center at Tampa General Hospital.
"For someone having a stroke, or even a TIA, minutes count," Sloan tells WebMD. "Each second that passes can mean 32,000 brain cells lost."
Prompt treatment with clot-busting thrombolytic drugs during a major stroke can prevent death and long-term disability.
For many years the cutoff for using intravenous tPA (a clot-busting drug) was thought to be three hours, but Sloan says it is now clear patients respond as long as four and one-half hours after strokes occur.
Prompt evaluation following a TIA is also important because it is now possible to predict major stroke risk fairly accurately with a model that scores factors such as high blood pressure, diabetes, age, and duration and presentations of symptoms, Sloan says.
"Using this model we can tell patients if their risk is very low or very high," he says.
In the study, published in the journal Stroke, roughly three out of four patients said they went to their primary care doctor following TIA symptoms instead of seeking emergency care.
TIA patients were more likely to delay seeking treatment if they did not experience motor or speech impairment, if symptoms lasted only a few minutes, or if their symptoms occurred on a Friday, weekend, or holiday.
Surprisingly, almost one in three patients who had already had a stroke did not seek medical care in a timely manner.
Stroke is the third leading killer and the leading cause of long-term disability in the U.S., according to the American Heart Association.
The study findings "indicate a lack of public awareness that TIA is a medical emergency," study researcher Arvind Chandratheva, MRCP, says in a news release.
Health Solutions From Our Sponsors
Chandratheva, A. Stroke, April 15, 2010; online edition.
Larry B. Goldstein, MD, director, Duke Stroke Center, Duke University Medical Center, Durham, N.C.
Michael A. Sloan, MD, director, Comprehensive Stroke Center, Tampa General Hospital; spokesman, American Heart Association.
News release, American Heart Association.
American Heart Association web site: "Transient Ischemic Attack."
National Institute of Neurological Disorders and Stroke web site: "TIA Information Page."
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