Think Stroke? Think F-A-S-T!

More than 10 years ago, the FDA approved tPA, the first and only treatment available for acute stroke which - if given quickly enough - reverses the effects of a stroke.

Since then, only a tiny fraction of stroke victims receive this quality of life-saving treatment. The treatment must be given within three hours after the onset of a stroke; after that it's too late.

Often stroke victims don't come to the emergency room right away. So the majority of stroke victims are left dealing with paralysis, speech problems, vision loss and mental difficulties.

Why?

Edward C. Jauch, M.D., M.S., FACEP, assistant professor of emergency medicine at the University of Cincinnati College of Medicine and a member of the Greater Cincinnati/Northern Kentucky Stroke Team, notes that there are several reasons for this delay. Often the subtle symptoms of stroke don't cause patients to become alarmed and seek immediate help.

"Stroke recognition is a real problem," he says. "There's been a huge effort to get information out to the public. Most strokes are painless. It won't wake you up in the night like chest pain." Victims often wait to see if the symptoms - which are most often not painful - will go away. A weakness in one leg, trouble seeing or a sudden severe headache all can indicate stroke, as can sudden difficulty understanding someone or speaking. Another aspect that causes a delay in seeking treatment is the stroke itself: A stroke that affects the right side of the brain also affects a patient's ability to process what is happening to them and respond appropriately.

Jauch describes patients who have insisted their paralyzed hand belonged to someone else. "With a stroke your processing organ is affected - with a heart attack, your brain is unaffected."

He describes one patient, a farmer, who was working all day in his fields on a tractor. When he came home in the evening to his wife he realized he couldn't speak. Because he'd been by himself all day, he hadn't tried to speak. Since no one could pinpoint when the stroke actually occurred, he couldn't receive tPA.

"If you don't have the opportunity to test your speech, you don't realize you're having a problem," Jauch says.

How to catch symptoms

The symptoms of stroke can easily be remembered by the letters FAST. F is for facial numbness or weakness, especially on one side. A is for arm numbness or weakness, especially on one side. S is for slurred speech, or difficulty speaking or understanding. T is for time; it's time to call 911 because "Time is Brain."

"If you don't use 911 to get to the hospital when you're having a stroke, you come in far too late," Jauch says, adding that prehospital emergency personnel can perform tests to rule out other things that mimic stroke, such as low blood sugar. They also can radio ahead to notify the receiving hospital of a potential stroke patient, saving valuable time in arranging a CT scan and activating stroke systems within the hospital.

Eventually, Jauch says, there will be certain medical centers designated as stroke centers, and prehospital emergency personnel will make the decision to take the patient there, in much the same way as they now assess trauma victims and transport them to a trauma center.

Family members can help by taking careful note of when the symptoms began and trying to be specific describing those symptoms. Remember the T for time, and call 911 right away, even if the symptoms seem subtle.

About 80 percent of strokes are ischemic, meaning a blood vessel is blocked in part of the brain. The tPA treatment, Activase® or Alteplase®, unblocks the vessel. Jauch recalls hearing one patient describe it as "Drano for the brain-o."

The other 20 percent of strokes occur when a blood vessel breaks open and bleeds into the brain. Those are more common in older people, and can be caused by vessels thinned by high blood pressure. These patients are not candidates for tPA.

Not just the elderly

Although stroke occurs among the elderly, it is by no means limited to them. Public education projects must target all age groups. The Greater Cincinnati/Northern Kentucky Stroke Team has treated children and young adults with strokes. "It's not always going to be your grandmother," Jauch says.

Stroke can strike people of any age. Smokers, those with diabetes or high blood pressure and African-Americans are at increased risk of stroke.

"The best treatment strategy is really prevention - how do you prevent stroke," Jauch says, adding that controlling blood pressure and diabetes and quitting smoking are key. "If we could control those top three risk factors, we'd have less than half the strokes we have now," he says.

Those who are at risk should be especially aware of stroke symptoms. And they should ask their doctors - ahead of time - what to do and where to go in case of a stroke. "People know what to do and where to go for a heart attack," he says. "The word kind of gets around."

It's a mission for Jauch to get that word out about stroke. Recognize the symptoms, call 911 and get to a hospital. In short, treat the symptoms of stroke as you would a heart attack.

"Time will always be brain," Jauch says.

Related Articles Stroke

External Sources Greater Cincinnati/Northern Kentucky Stroke Team University of Cincinnati College of Medicine National Institute of Neurological Disorders and Stroke

This article was reviewed and updated June 2007.

Search