Roadblock in Treating Stroke Symptoms

Patients May Misjudge Severity of Symptoms, Delaying Treatment

From the WebMD Archives

March 23, 2006 -- New research shows why some people delay seeking treatment for stroke symptoms.

Those patients may size up their symptoms and wrongly decide their problem isn't urgent enough to get emergency care. That may be a dangerous mistake.

So says a study of 209 patients hospitalized for ischemic stroke, the most common type of stroke. In ischemic stroke, blood flow to the brain is blocked. Clot-busting drugs can help, but those drugs must be given within the first few hours after symptoms start.

The new study, published online in Stroke, shows that patients' attitudes about their symptoms -- and help from bystanders -- affected how quickly patients sought medical care.

Stroke is the No. 3 cause of death for American men and women, according to the CDC. Stroke is also a major cause of disability.

Stroke Survivors Interviewed

All of the patients were treated at the same public hospital in Israel. The researchers included Lori Mandelzweig, PhD, of Sheba Medical Center in Tel Hashomer, Israel.

The patients were interviewed two to 10 days after being hospitalized for ischemic stroke. If their condition prevented interviews, patients' family members were interviewed.

The interviewers asked how much time passed from the start of stroke symptoms to first contact with medical personnel and hospital arrival. Other questions covered help from bystanders and whether patients called for ambulances when they noticed stroke symptoms.

Patients were about 61 years old, on average. Sixty-nine percent were men.

After noticing the start of symptoms, patients took anywhere from half an hour to nine hours to seek help and 1.3 hours to more than 14 hours to get to the hospital. The researchers considered hospital arrival to be late if it happened more than three hours after symptoms started.


Severe or Not?

Patients who thought their symptoms were severe were less than half as likely to delay seeking treatment, according to the study.

"Regarding the perception of severity of symptoms, we found that patients who perceived their symptoms to be severe were more likely to seek help quickly than those who perceived their symptoms as not severe," Mandelzweig tells WebMD in an email.

"I must point out, however, that the patient's perception of severity does not necessarily reflect the true clinical severity of the symptoms, but it is often what motivates him to [seek medical help]," she continues.

"It is also likely that a patient who perceives his symptoms as severe may be more inclined to contact an ambulance, which is clearly the preferred contact for quick transport of stroke patients to the hospital," Mandelzweig says.

Help From Bystanders

Patients were more than 80% less likely to delay seeking medical help if someone else noticed their symptoms and urged them to get help.

Bystanders could be a big help to stroke patients, Mandelzweig notes.

"Stroke is a bit tricky when it comes to patient's perceptions, because the organ that is affected is the brain. Consequently, as a result of the stroke, perception may be altered to some extent in some cases," she says.

"This problem emphasizes the importance of intervention of others, who are often able to assess the patient's condition more accurately and objectively, and advise the patient to seek help immediately. They may also be instrumental in getting the patient to the hospital quickly and providing the emotional support that the patients need to cope with the traumatic event," Mandelzweig says.

Stroke's Warning Signs

The reasons why some patients delay seeking stroke treatment are complex, Mandelzweig says.

Her study notes that people may need to be urged not to try to gauge the severity of stroke symptoms and that bystanders can help people get prompt care.

The American Stroke Association lists these warning signs of a possible stroke:

  • Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
  • Sudden confusion, trouble speaking, or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden, severe headache with no known cause

Call for emergency medical help at the first sign of those symptoms. Don't wait to see if they go away and don't judge for yourself how bad they are.

WebMD Health News Reviewed by Louise Chang, MD on March 23, 2006


SOURCES: Mandelzweig, L. Stroke, March 23, 2006, online edition. Lori Mandelzweig, PhD, Sheba Medical Center, Tel Hashomer, Israel. CDC: "Stroke Fact Sheet." News release, American Stroke Association.
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