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Subtle Stroke Symptoms Often Ignored

Few Aware of Less Obvious Stroke Warning Signs

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March 20, 2003 -- The symptoms of a stroke may be as dramatic as the sudden inability to move or talk, but more subtle signs like dizziness and numbness are just as significant and often missed, according to a new study. Researchers say failing to recognize these stroke symptoms may lead to dangerous delays in receiving medical care and render some of the most effective stroke treatments useless.

Experts say timing is critical to stroke care and reducing brain damage. Some therapies, such as clot-busting drugs that can restore blood flow to the brain and reduce stroke-related disability, may be given only within three hours of the start of stroke symptoms, according to U.S. treatment guidelines.

Major symptoms of stroke include difficulty speaking, weakness in the limbs, and loss of consciousness. But other, less dramatic symptoms may also signal a stroke:

  • Weakness in the face (such as a droopy eyelid or lip)
  • Nausea
  • Dizziness
  • Numbness
  • Loss of balance
  • Slurred speech
  • Headache

In the study, researchers examined tape recordings of emergency calls of stroke patients admitted to a German hospital over the course of a year. The calls were analyzed for mention of stroke symptoms and the length of time it took emergency response workers to respond.

The results appear in the March 21 issue of Stroke: Journal of the American Heart Association.

Researchers found speech problems were reported in about a quarter of the cases, limb weakness in 22%, and an altered state of consciousness in about 15%. A fall was the main reason for the emergency call in 21% of the cases.

But callers seldom mentioned subtle stroke symptoms. Facial weakness was cited in 10% of cases, numbness in 8%, and dizziness in about 6% of cases.

"Many patients wait to see if symptoms improve or disappear," says researcher René Handschu, MD, of the Freidreich-Alexander-Universitaet Urlangen-Nurnberg in Germany, in a news release. "From the patient's point of view, numbness of one limb or even dizziness and nausea is not so bad that you will bother all your neighbors by calling an ambulance with lights and sirens."

In fact, only about 20% of the callers mentioned stroke or transient ischemic attack (TIA) as the possible cause of the symptoms. Researchers say that finding reflects a lack of knowledge about stroke symptoms.

The study also shows that the average time between the start of stroke symptoms and placement of a call for an ambulance was 38 minutes. It then took an average of 12 minutes for the ambulance to arrive, and 51 minutes for the patient to arrive at the hospital. Once at the hospital, clot-busting drugs were delivered in about 40 minutes.

"In sheer numbers, the biggest delay is prehospital," says Handschu. "We can work on further reduction of in-hospital delays of treatment but we reach limits. The most important factor in reducing delay is the patient himself."

The study found that patients who delayed emergency calls were usually older, living alone, unaware of the severity of their symptoms, or unable to call. That's why researchers say it's also important for friends and family members of persons at risk to gain a greater awareness of stroke symptoms.

"There is a striking need for educational efforts to improve recognition of especially non-dramatic and atypical stroke symptoms in the general population but also in family members of patients at higher risk for stroke," says Handschu.

SOURCE: Stroke: Journal of the American Heart Association, March 21, 2003. News release, American Heart Association.

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