Posted on 03/07/2005 7:37:13 PM PST by FairOpinion
Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients.
Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology.
Eighty percent of strokes are ischemic, caused by the narrowing of the large or small arteries of the brain, or by clots that block blood flow to the brain. They are often preceded by a transient ischemic attack (TIA), a “warning stroke” or “mini-stroke” that shows symptoms similar to a stroke, typically lasts less than five minutes, and does not injure the brain.
The study examined 2,416 people who had experienced an ischemic stroke. In 549 patients, TIAs were experienced prior to the ischemic stroke and in most cases occurred within the preceding seven days: 17 percent occurring on the day of the stroke, 9 percent on the previous day, and 43 percent at some point during the seven days prior to the stroke.
“We have known for some time that TIAs are often a precursor to a major stroke,” said study author Peter M. Rothwell, MD, PhD, FRCP, of the Department of Clinical Neurology at Radcliffe Infirmary in Oxford, England. “What we haven’t been able to determine is how urgently patients must be assessed following a TIA in order to receive the most effective preventive treatment. This study indicates that the timing of a TIA is critical, and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack.”
Rothwell also noted that clinical guidelines should be amended accordingly.
The study included two population-based studies (Oxford Vascular Study and Oxfordshire Community Stroke Project) as well as two randomized trials (UK-TIA Aspirin Trial and European Carotid Surgery Trial).
The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as dementia, dystonia, epilepsy, migraine, and stroke.
For more information about the American Academy of Neurology, visit http://www.aan.com.
Thanks for the heads up. A TIA is explained at http://www.mydr.com.au/default.asp?article=2440
Do you have low blood pressure?
If I were you, I would see a neurologist and ask for an MRI -- that way you'll know for sure, and if it doesn't show anything, great, and if it does, you can treat and prevent something worse. But if an MRI doesn't show anything, you still need to get to the bottom of this -- a neurologist may have some ideas of what it could be, even if the MRI is OK, but I would definitely have an MRI. Run, don't walk to get one.
I think you need to go to as many doctors as it takes to find out what it is.
A neurologist is a good start -- insist on getting a referral from your GP, if your insurance doesn't allow you to go straight to a neurologist.
Good luck and don't take no for an answer from your GP.
Is your doctor aware that your granmother had strokes? Some aneurysms can be genetic, so it would be worthwhile to discuss this more thoroughly with your doctor. What tests have you had?
But .. dementia is a series of miniscule strokes - which show no outward physical signs.
I can tell when my mom is having an episode - but it's only because of her actions - which don't ever seem to exhibit typical stroke symptoms. She's agitated and walks back and forth to my room at 10-15 min intervals. Can't tell me what she wants - or says she wants nothing. Then she turns around and walks back to the living room where she sits in her chair and continues watching her TV.
I have at times noticed a sluring of her speech - but not during her walking back and forth.
Ten years ago, a crucial study proved that a drug could limit the damage from one of nature's biggest train wrecks: a blood clot stuck inside the head. TPA remains the sole drug approved for strokes. Yet only about 3 percent of victims get it. Usually that's because they don't seek help until it's too late for the drug to do any good — three hours after symptoms start.
However, fresh research documents disturbing problems that keep this lifesaving treatment from reaching the roughly one in five stroke victims who do seek help in time. Studies presented at an American Stroke Association conference last week found that:
_ Operators answering phones at hospitals often don't recognize stroke symptoms and discourage callers from coming in for help.
_ Ambulances routinely take people to the nearest hospital instead of one with the necessary equipment and expertise to give TPA.
_ Emergency room doctors are afraid of the drug's potentially serious side effects, and are unwilling to use it even when test results clearly show they should.
_ Even specialized stroke centers designed to speed the drug to patients are missing many chances to get it right.
"It's like we've built a cascade of system failures here. Every place along the stream is another place something can go wrong," said Dr. Larry Goldstein, director of Duke University Medical Center's stroke program and member of a task force aimed at improving the situation.
The courts may provide added incentive to do so: Hospitals increasingly fear lawsuits if they fail to give the drug in time.
TPA was so powerful at dissolving blockages threatening to destroy regions of the brain that the first patient to get it, a 67-year-old man, regained the ability to walk and talk half an hour after it started flowing through his veins.
"The nurses at the bedside started crying. It was very dramatic," recalled Dr. William Barsan, who treated him.
The consequences of missed opportunities are huge. Stroke is the third leading cause of death in the United States, behind heart disease and cancer. It's a chief reason for disability and forces many people to spend their final days in nursing homes, unable to walk, talk or see as they once could.
About 700,000 strokes occur each year, and nine out of 10 are due to a clot. Little could be done for them until doctors tried TPA, a medication used to dissolve clots causing heart attacks, for stroke.
The 1995 study, funded by the federal government, proved that it worked. Stroke victims treated with TPA were twice as likely to have a good outcome as those who were not. The Food and Drug Administration approved it for stroke the next year, and a move grew to treat strokes as "brain attacks," emergencies requiring swift treatment to prevent permanent damage.
Dr. Lee Schwamm, associate director of Massachusetts General Hospital's stroke program, called it a landmark event. "It signaled the end of therapeutic nihilism, the idea that if you were having a stroke it was just too bad, that you ought to go in a dark room and come out when it's over."
However, there is a dark side to this miracle-working medication. About 6 percent of stroke patients who get it develop bleeding in the brain, which is fatal half the time. This can be avoided by not giving it to those with bleeding ulcers, very high blood pressure or certain other conditions.
But many emergency room doctors have been afraid to give TPA without neurologists to back up their judgment, and most hospitals don't have neurologists in the ER.
Studies show the consequences.
Dr. Toby Gropen, neurology chief at Long Island College Hospital in Brooklyn, examined what happened at 14 New York hospitals participating in a state program to boost stroke care. They more than doubled TPA use, but from a mere 2.4 percent to 5.2 percent.
"We're moving in the right direction. It's a start," he said.
Schwamm studied more than 21,000 patients treated at 99 hospitals participating in the stroke association's "Get With the Guidelines" campaign. When it started, only one-third of the most ideal candidates for TPA were getting it. That improved to 61 percent a year later, but that meant four out of 10 still missed out.
Barsan, chief of emergency medicine at the University of Michigan, and the American College of Emergency Physicians surveyed 1,105 ER doctors on their willingness to use TPA.
"Even under ideal conditions where we told physicians, 'you've got a valid CAT scan which shows there's no bleeding, there aren't any snakes under the rocks,' 40 percent said they were unlikely or unwilling to treat those patients," he said.
There are problems before patients arrive, too. Dr. Brent Jarrell of Cabell Huntington Hospital in West Virginia studied how hospital operators and helplines in several states responded to hypothetical calls describing classic stroke symptoms.
"Roughly 25 percent of the people were referred back to their primary care doctor," he said. "The kind of the feeling, when you talk to them, is that they were trying to keep people away from the hospital."
One in five operators couldn't identify a single stroke warning sign.
Many efforts are under way to improve things. Last year, the Joint Commission for Accreditation of Healthcare Organizations started accrediting stroke centers meeting strict standards, such as seeing every patient within five minutes of arrival. So far, 88 hospitals in 28 states have earned the title and hundreds more are seeking it.
Some states — Florida, New York, Maryland and Massachusetts — have their own stroke center criteria, and some regions require EMS programs to take patients to the nearest stroke center instead of the closest hospital.
Stroke centers are also required to do community education to boost awareness of symptoms.
Unlike heart attacks, "stroke is almost never painful," so people often don't seek help, said Dr. Joseph Broderick, a University of Cincinnati neurologist. Signs like dizziness or numbness in an arm may be chalked up to things like sleeping in a funny position.
The stroke association task force issued a detailed plan last week for how hospitals and communities can improve stroke care.
An independent panel also recently re-analyzed information from the landmark 1995 study to more firmly establish the risk of side effects that so troubled emergency room doctors. Its conclusion: the drug's risks were smaller and its benefits even greater than the study originally found.
Stroke experts believe TPA use will rise as doctors become confident in their ability to pick the right patients to get it. But the only way to develop such judgment, they say, is to start using the drug.
http://sfgate.com/cgi-bin/article.cgi?f=/n/a/2005/02/07/national/a084209S09.DTL
Funny you should ask that... lol. Because, for years, this has plagued me. Then my husband bought a blood pressure machine to test his own hypertension, and when I took mine, it was on the low side. So I figured that maybe (hopefully) that's the problem. (That would be good news).
Thanks for the article.
The major problem is indeed that doctors are reluctant to take immediate action.
This is a poorly written article not to list the symptoms.
Thanks. The tests the doctor took were for my heart, thyroid, etc., etc. Everything looked fine. I never thought of a neurologist, but I think now that I probably just need sleep... lol... insomniac here.
Another thing I was reading is that it could be migraines that just don't generate pain.
I'm guessing it would be much harder for any of us to recognize a true TIA because those symptoms listed could indicate anything.
It can't hurt to get some tests done. The fact that your grandmother had two strokes is enough reason to find out for sure. Did you read my post #20 with the description my mother-in-law gave? Any way, do it for your own peace of mind.
You also forgot a subtle symptom, which is:
When r ading, one g ts the fe ling th t th y can't
qu te see all of the ch r ct rs in a se tenc .
That is scary, the description your MIL gave. I admit, I'm a big chicken when it comes to doctors. I try to avoid them... lol. Maybe I should go again.
Thanks for the advice.
I have had recurring blurred vision in one or both eyes for 20 years now (started shortly after I had a hystectomy at 33). I had a CAT Scan or MRI right after the first episode; but, they couldn't find anything. One doctor told me my eyes were retaining fluid. Most doctors I have mentioned it to have no idea what causes it. It worries me a little; but, not a life changing problem.
You're very welcome. I'm sure things will be fine. By the way, I'm going to give your home school info to my son and daughter-in-law. My grandson is in a Christian pre-school but it looks like they may have to close the grade school. So, thanks. Have a good night and God Bless. I have to get up early for work.
As I said, I like to eliminate the worst, then you can relax and work your way through the less serious possibilities.
Since you had these for years, it's most likely not TIA, but neurologists deal with migraines as well and they are more likely to be able to assess it and eliminate or confirm possibilities of what causes them.
I think it would be a good idea for you to go to a neurologist and just make sure.
The low blood pressure is certainly a possibility, but I wouldn't just assume that's what it is, without ruling out other more serious possibilities, just to err on the side of caution.
bump
I think I read that diabetes could also cause blurred vision.
I think when there is something wrong, there is a cause, and it's a good idea to track it down, sometimes you have to push the doctors and see some specialists. Did you see an ophtalmologist?
If it's not TIAs, then it sounds like iron deficiency. I used to experience the same thing as a child & teenager. In fact, I still take iron.
I thought it might be iron deficiency, too, because my mother has that and used to get B12 shots as a kid. I was iron deficient when I was pregnant. But the tests the doctor took said the iron levels were fine now.
Btw, I love your screenname. :-)
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