Improtant Stroke Info

[mmckee1952]

STROKE: Remember the 1st Three Letters....S.T.R.


STROKE IDENTIFICATION

It only takes a minute to read this...

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE

Thank God for the sense to remember the '3' steps, STR ... Read and Learn!

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.

Now doctors say a bystander can recognize a stroke by asking three simple questions:

S *Ask the individual to SMILE.


T *Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently)
(i.e. It is sunny out today)


R *Ask him or her to RAISE BOTH ARMS.

If he or she has trouble with ANY ONE of these tasks, call emergency number immediately and describe the symptoms to the dispatcher.

New Sign of a Stroke -------- Stick out Your Tongue

NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out his tongue.. If the tongue is 'crooked', if it goes to one side or the other, that is also an indication of a stroke.

A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved.

[GordMay]

Thanks for that good information.

Another version uses the acronym "FAST":

If you think someone may be having a stroke, act F.A.S.T. and do this simple test:

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.
Are the words slurred? Can he/she repeat the sentence correctly?

TIME: If the person shows any of these symptoms, time is important.
Call 911 or get to the hospital fast. Brain cells are dying.

Classic Stroke Symptoms:
* sudden paralysis or numbness of the face, arm, or leg (usually on only one side of the body)
* sudden loss of speech or trouble understanding speech or confusion
* sudden loss of vision (often in one eye only) or double vision
* sudden dizziness or loss of balance or coordination
* sudden severe and unusual headache (often described as "the worst headache of my life" that starts suddenly) with no known cause

[mmckee1952]

Gord,
I took your additional info and passed it along to some other boating webb sites, it's good to get the word out. I myseld had a mini stroke back in 92 and with the quick response I haven't had any bad side effects, although I take a blood thinner, everything is fine.

Good Work,

Mike

[Luan]

Never posted on here since I joined, but couldn't bite my tongue on this one. I'm not a neurologist, but less than a year away from being a fully qualified cardiologist, so I guess I am sort of qualified to comment....

I think the bit about "reversing the effects.... totally" is a bit fanciful. Sure, it is important to present as soon as possible after a stroke. Yes, many people do miss the early warning signs.

However, the neurologist (if it is in fact a neurologist making that claim) is referring to the NINDs trial of intravenous alteplase thrombolysis for actue ischaemic stroke within 3 hours of symptom onset (or patient last being seen normal). In this trial, the percentage of patients with complete recovery or near complete recovery, as compared to placebo, was only 38 vs 21%. That is unfortunately no where near 100%.

Of note, the ECASS III study has now extended this time period to 4.5 hours, but the patients that present earlier are going to do much better.

The other things to mention are that this only applies in a particular type of stroke, and the exclusion criteria is longer than your arm. Also, these studies never showed any mortality benefit - that is, the same number of people died at the end of the study periods.

I must stress that it is still important to present to ED as soon as possible - don't waste your time going to the local doctor.

[GordMay]

Thanks for the expert comments Dr. Luan, and welcome aboard.

[David M]

Lets say you are days away from a hospital. Is there anything that could be done on board after a diagnosis is made? What do emergency rooms do after receiving a stroke patient? Could a layman do the same whatever that might be?

[Paul Elliott]

You certainly want to get help ASAP, but there is hope if you don't. This is anecdotal, but I know two people who had strokes and are now recovering nicely.

The first is a friend who is in his 60's. He was solo on his boat at anchor in Fiji, and had a major stroke. He lay unconcious in the cockpit for hours before being discovered. A friend came by to visit, found him barely alive, and took him to the local hospital. He stayed there for a couple of weeks, receiving good care, and then returned to the USA for further treatment and therapy. Initially he was paralyzed on one side; face, arm, leg, and he felt completely hopeless. He could barely talk.

After several months of therapy, he recovered much of his movement and speech. Soon, he was eady to go sailing again. Now, two years later, a casual observer would never guess that he had had a stroke. He still has some weakness, but has trained hs body to compensate quite nicely. He is sailing through the South Pacific again, and enjoying every minute of it.

The other case is a young woman in her late 30's. About a year ago she had a major stroke with serious paralysis. She had had previous small strokes, but these had been undiagnosed because of her young age. The early-warnings of the big one were ignored, again because of her age. It took over 12 hours before she was taken to the hospital. She was wheelchair-bound and unable to talk for many weeks. She is now in therapy, is walking well with a cane and speaking with a very slight impairment, and every day she continues to improve.

What I learned from this is:

* Don't ignore any symptoms. It can happen to anyone, at any time.
* Take your blood-pressure meds.
* If you have a stroke, don't give up. It is possible to get better.
* If someone you know has a stroke, be there to support and encourage them. You can make a difference.
* Enjoy your life.

[MarkJ]

Originally Posted by David M

Lets say you are days away from a hospital. Is there anything that could be done on board after a diagnosis is made?

My mum had a stroke. But it took her 3 days to realise it. So rapid inset is not always the case.

As for first aid when cruising offshore, it would be great to have the doctors opinon on this, but put them in bed and feed them aspirin. Water, plain food and darkness too.

The off shore sailor just has to make do.



Mark

[cal40john]

Originally Posted by MarkJ

My mum had a stroke. But it took her 3 days to realise it. So rapid inset is not always the case.

As for first aid when cruising offshore, it would be great to have the doctors opinon on this, but put them in bed and feed them aspirin. Water, plain food and darkness too.

The off shore sailor just has to make do.



Mark

Not saying that trying aspirin is a good or bad idea, it's just that you're rolling the dice. Strokes due to clots might be helped with blood thinners. Strokes due to a vessel blowout will be made worse with a blood thinner. One website I found says that 15-20% of strokes are due to hemorrhage, so 5 to 1 odds says you might help with aspirin.

John

[Luan]

I agree with John. There are two types of stroke, and the medical treatment for each are completely different, hence the value of presenting early - so you can get a CT head.

Haemorrhagic stroke is when you get a bleed into the brain - often manifest by a sudden onset of severe headache and nausea, as well as the focal neurological deficit (the weak arm, speech impairment, etc). The intravenous medication I was referring to above will make this type of stroke worse. Much, much worse. Aspirin is also not useful here, and will probably make the situation worse too.

Ischaemic stroke is when you get a blockage to a blood vessel. This is the one that is often missed by patients, as the presentation may not be as dramatic. Ischaemic stroke can transform to haemorrhagic stroke. This is where the thrombolysis if given early enough is useful, and aspirin is useful for prevention longer term.

If I were on a boat (alas a very big if at the moment - anyone want to take a poor doctor around the world?), I would lie the person down flat - there is anecdotal evidence that lying flat is better - more blood to the brain. I would make sure that their airways are clear. I would not give aspirin, as aspirin is beneficial if given before 48 hours, and only in ischaemic stroke. I would get to a medical facility as fast as possible. I would also not feed the person, unless I was certain they had good control of their swallowing functions - you don't want to make them aspirate and give them pneumonia. If I had to feed them, I would give think fluids.

I'm not sure if there is any benefit in leaving a person in the dark - they have a stroke, not a migraine or meningitis....

[GordMay]

I’ve read that Hyperbaric Oxygen Therapy* (HBOT) might help decrease swelling in brain tissues, relieve hypoxia (oxygen starvation), and improve micro circulation in ischemic stroke patients.

What is the current medical thinking on it’s efficacy for stroke treatment?

*HBOT patients inhale 100 percent oxygen while inside a hyperbaric chamber, that is pressurized to 2-3 atmospheres. HBOT has been found useful in the treatment of a number of conditions, such as decompression sickness, and carbon monoxide poisoning.

[Luan]

I am not sure if there is any active ongoing trials, as the enthusiasm seemed to die down after the published paper in Stroke in 2003, which found that the treatment may make things worse. There was a Cochrane review in 2005 - Hyperbaric oxygen therapy for acute ischaemic stroke

[skipmac]

On the surface it might seem that introducing oxygen to a stroke victim, either hyperbarically or at standard pressure via face mask would increase blood oxygen levels in the brain.

However high concentration O2 is a vasoconstrictor (shrinks the blood vessels) which will further reduce blood flow and depending on the exact cause of the stroke could worsen the situation.