The collective efforts of medical science, media promotion, government initiative, and a willing public has successfully raised the general level of awareness regarding the early warning signs of impending heart attack to the point survival rates have dramatically improved. Now it’s time to refocus our attention to the second commonest debilitating and lethal vascular events commonly referred to as “STROKE”

The common denominator in cardiac events is the buildup of plaque within the blood supply to the heart leading to vessel obstruction where clumping of blood cells initiates an obstruction or a fragment dislodging and moving further in to the narrowing vessel. If you use the analogy of tree branches to describe the arterial system, each branch leading off the larger trunk represents a diminishing diameter outward to the end. A similar process occurs in SOME strokes but not all. Some strokes may result from plaque breaking loose anywhere from the heart end of the artery network to anywhere in the brain itself. Other strokes may result from bleeding leakage from a vessel in the brain itself usually in relation to increased even uncontrolled blood pressure. There is also the pathology encountered in severe vessel spasm such as occurs in complex migraine where the intense headache is accompanied by a variety of symptoms that can include a gamut of numbness, usually facial, visual changes and off balance to name but a few. And finally, it’s prudent to mention TIA or transient ischaemic attack in which the symptoms and signs look like a stroke but by definition will spontaneously resolve. The red flag about this condition is that the patient experiencing this event will, in about 50 percent of cases, develop a true permanent loss of some neurological function within two years.

There are clues that a stroke is impending and therefore avoidable or at least the long term residual outcome reducible.

F… FACIAL changes…usually one sided. Perhaps a drooping eyelid or a sagging side   of the mouth

A… ARM or leg motor weakness or numbness

S… SPEECH changes, sometimes slurring or garbled word structures.    And finally..

T…TRANSPORT immediately to the nearest emergency department (TELEPHONE for transport) We are all well versed in the fact most emergency departments are being overwhelmed with medical issues that belong in less urgent facilities so I do not apologize for coaching family members how to reach the head of the line. Well trained nurses immediately respond to expressions “I’m having a heart attack” or “my parent is having a stroke, can’t talk or can’t use their arm since this morning”

There are, of course, other potential clues but the FAST scenario identifies the most probable and most likely to be observed by a family member or companion. It’s equally important all people male and female in risk age groupings (arbitrarily 50 and older) undergo regular lipid level assessment and treatment where indicated. Blood pressure monitoring is also key. EVERYBODY with elevated and/or treated blood pressure should have a home monitoring cuff. Patients experiencing unsteadiness with extremes of range of motion of the neck either extension or lateral rotation are advised to see their physician and have a stethoscope placed over the neck arteries to listen for abnormal sounds called Bruits followed by ultrasound of the vessels and possible more extensive investigation. Many cardiac patients are already on an anticoagulant or plavix – like compound so the previously recommended treatment of prehospital administration of aspirin is out of favour considering some strokes are actually bleeds, not clots.

The take away message is the sooner signs of the impending stroke are recognized and the sooner treatment is initiated, the more likely the neurological event can be reversed and permanent disability avoided.

Dr. David Carll

Providing a Fresh Perspective for Burlington and Hamilton.

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