Too Few Able To Recognize 'Brain Attack'

February 05, 1997

ANAHEIM, Calif., Feb. 6 -- The ability to recognize symptoms and risk factors for stroke, the nation's third leading cause of death and leading cause of serious disability, appears to be woefully inadequate among the general public and people experiencing "brain attack," Cincinnati researchers reported here today at the American Heart Association's 22nd International Joint Conference on Stroke and Cerebral Circulation.

In two studies, scientists at the University of Cincinnati Medical Center surveyed 163 stroke patients and 1,880 randomly selected members of the general population whose ages matched the population at risk for stroke. The researchers found that 39 percent of stroke patients and 27 percent of those in the general public survey did not know a single warning sign of stroke. Furthermore, only 35 percent of the stroke patients could name at least one stroke risk factor, while fewer than half of the general population group correctly identified high blood pressure as a risk factor.

"This is tragic because there is now a proven therapy for strokes caused by blood clots that shut off the flow of blood to the brain," said Arthur Pancioli, M.D., assistant professor of emergency medicine. "But patients have to get to the hospital within three hours of symptom onset. If people can't identify symptoms they won't seek therapy quickly enough."

The new therapy is tissue plasminogen activator (TPA), which received Food & Drug Administration approval in June 1996 to treat ischemic strokes, caused by reduced blood flow that results from clots that obstruct blood vessels. According to the American Heart Association about 80 percent of all brain attacks are ischemic. The drug, long used to fight heart attacks, dissolves clots, restoring blood flow to tissue. But to get TPA, patients must arrive at a hospital early and still have enough time to have a brain scan to rule out strokes caused by burst blood vessels.

Research has shown that TPA must be administered within three hours of the onset of symptoms for it to be effective.

People with hemorrhagic, or bleeding, strokes cannot receive TPA because the drug will promote bleeding.

"We're treating less than five percent of ischemic stroke patients with TPA therapy," Pancioli said. "And the No. 1 reason a patient cannot receive this treatment is that he or she arrives at the hospital too late."

Rashmi Kothari, M.D., associate director of emergency medicine, and lead author of one study, agrees. "TPA has dramatically changed the way we manage stroke."

He led the scientists who surveyed patients' awareness of warning signs and risk factors.

Stroke warning signs include: sudden weakness or numbness of the face, arm or leg, particularly on one side of the body; sudden dimness or loss of vision, especially in one eye; inability to speak or trouble talking or understanding speech; sudden severe headaches; and unexplained dizziness, unsteadiness or sudden falls.

Thirty-nine percent of the 163 stroke patients said they knew none of the warning signs of a brain attack. Among those who knew at least one stroke symptom, the top three responses were: weakness on one side of the body (26 percent); numbness on one side of the body (22 percent); and speech problems (18 percent).

When patients' responses were compared for differences between race and sex: 45 percent of blacks vs. 35 percent of whites could not name any stroke warning signs; 41 percent of women vs. 36 percent of men also were unable to identify any stroke symptoms.

But 35 percent of the stroke patients were unable to name any risk factors for stroke. Only 27 percent knew high blood pressure was a risk factor.

In the other study, in which Joseph Broderick, M.D., Pancioli and their colleagues conducted telephone interviews with randomly selected members of the Cincinnati population whose ages matched the population at risk for stroke, 27 percent could not identify a single warning sign of stroke and only 49 percent identified high blood pressure as a risk factor. Fewer than one-fifth identified smoking as a stroke risk factor. The average age of the men and women who participated in this survey was 63.

The general population responses also were compared for differences between race and sex. The only significant gender differences were: 54 percent of women vs. 42 percent of men knew high blood pressure was a stroke risk factor; 17 percent of women vs. 12 percent of men knew weakness was a warning sign of stroke; and 26 percent of men vs. 22 percent of women identified dizziness as a symptom.

Controllable risk factors for stroke include: high blood pressure; coronary heart disease (also known as coronary artery disease); cigarette smoking; a history of transient ischemic attacks, which are characterized by stroke-like symptoms, but end in as little as five to 10 minutes; and a high red blood cell count (this thickens blood, making clot formation more likely). Other risk factors include excessive alcohol intake and use of cocaine.

Stroke risk factors that cannot be controlled are: age; being male; being African American; having diabetes; having had a prior stroke; and having a family history of stroke.

Pancioli lamented the "tragically fatalistic attitude" toward stroke in the community.

"Many patients have said to me, 'I knew it was a stroke and I knew there wasn't anything you could do for it.' Now, we have a treatment for blood-clot related stroke. We also need to educate people about stroke warning signs and risk factors."

Co-authors of the two studies are: Laura Sauerbeck, R.N.; Thomas Brott, M.D.; Edward Jauch, M.D.; Alfred Tuchfarber, Ph.D.; Rosie Miller, R.N.; and Jane Khoury, M.S.

American Heart Association

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