Since mid-December 2005, Israeli Prime Minister Ariel Sharon, 77, has been hospitalized twice for stroke, including a massive one that has left him gravely ill. In contrast, Dick Clark, 76, made a bittersweet television comeback on New Year's Eve after having suffered a debilitating stroke more than one year earlier. With slurred speech, he said, "I had to teach myself how to walk and talk again. It's been a long, hard fight. My speech is not perfect but I'm getting there."
These two prominent men's medical crises have turned the media spotlight on a potentially devastating disorder. But experts lament that vast numbers of Americans still don't understand the basic facts about stroke, nor are they familiar enough with the warning signs of a "brain attack" to seek quick treatment.
In fact, public awareness of stroke symptoms lags far behind that of heart attack symptoms, several neurologists tell WebMD, even though the knowledge could be lifesaving. "People know that if they have chest pain or shortness of breath, they could be having a heart attack," says Jose Merino, MD, a neurologist and staff physician at the National Institutes of Health who conducts stroke research. "But with symptoms of stroke, people don't know them." One National Stroke Association survey estimates that one in three Americans can't name even one symptom of stroke.
Signs of Stroke
With stroke, arteries to the brain become blocked or rupture, causing brain tissue to die. Symptoms include:
- Sudden numbness or weakness of the face, arm, or leg, especially if it occurs on one side of the body
- Sudden confusion, trouble speaking, or understanding speech
- Sudden trouble seeing in one or both eyes, or double vision
- Sudden trouble walking, dizziness, loss of balance, or coordination
- Sudden severe headache with no known cause
- Drowsiness, nausea, or vomiting
If such symptoms appear, "Don't wait. Call 911 immediately," says Kyra Becker, MD, a stroke neurologist at the University of Washington Stroke Center at Harborview Medical Center in Seattle. "Every single minute counts. With each passing minute, more and more brain cells die." In other words, "Time is brain."
In some cases, a stroke is so incapacitating that a family member or bystander must call for help. Margo Warren, a spokeswoman for the National Institute of Neurological Disorders and Stroke, says, "Sometimes, the person having the stroke is the last to know what's happening."
More Stroke Education Needed
Lack of awareness plagues even groups that one would least expect, experts say. Neurologists say it's not uncommon to see people who have already had one stroke but still don't know the list of warning signs -- even though they're at risk for subsequent strokes. "They know what symptoms they had, but they can't name the rest," says Becker. Doctors are partly to blame, Merino adds. "The medical system is not doing the education."
What's more, stroke symptoms are often "negative symptoms," says Claude Hemphill, MD, MSc, an associate professor of neurology at the University of California, San Francisco, and director of San Francisco General Hospital's Neurovascular Stroke Program. "If you have crushing chest pain, you know to go to the hospital. We still see people who can't move one side of their body and wait to see if they'll feel better and they go to bed. Or they'll ask a family member to massage them and take them to the doctor if it doesn't improve."
Seek Treatment - Fast
But waiting can be costly. Stroke is the third leading cause of death in this country, behind heart disease and cancer, according to the National Institutes of Health. Every year, about 700,000 people in the U.S. suffer a stroke, and nearly 163,000 will die as a result. Stroke also leads to more serious and lasting disabilities than any other disease. These problems include paralysis, trouble with speech or thinking, personality changes, and trouble with performing daily tasks, such as walking, eating, dressing, and toileting.
Stroke can happen at any stage of life, even in fetuses and children, but it becomes more likely with age. Stroke occurs most often in people over age 65.
Most strokes -- about 80% -- are ischemic ones that occur when a clot blocks blood flow to the brain. About 20% are hemorrhagic strokes that occur when a blood vessel breaks and bleeds into the brain (Sharon's doctors reported that he suffered a massive hemorrhagic stroke).
During a stroke, some brain cells die immediately because they are deprived of oxygen and nutrients from the blood or because sudden bleeding damages them. However, other cells don't die right away but can linger for several hours in a weakened state. Prompt treatment may be able to save these cells and reduce damage and disability.
Besides ischemic and hemorrhagic strokes, people can also have transient ischemic attacks, or TIAs, in which blood flow to the brain is blocked temporarily. These "ministrokes," in which symptoms may last for only a few minutes, are a serious warning sign that an actual stroke may be on the way. Because TIA symptoms disappear, it's easy for people to dismiss them when they should call 911 and seek treatment to prevent a full-blown, debilitating stroke.
During a stroke, experts urge people to get to the hospital as soon as possible, preferably within one hour after symptoms appear, so that they can be evaluated and perhaps receive treatments that must be given within a window of time. One drug, t-PA, can dissolve blood clots and restore blood flow during an ischemic stroke, but doctors must start delivering it intravenously within three hours after symptoms begin.
Besides the lack of awareness of stroke symptoms, psychological issues get in the way of timely treatment, too, Becker says. "There's a huge issue of denial. People can't believe they're having a stroke. Or they're embarrassed to have an ambulance pull up and everyone's watching what's going on."