Thursday, October 12, 2006

Spotting a Stroke

Most information circulated in chain emails is rubbish. Very occasionally you get one which does appear to have some potentially useful information, although spam emails are probably not the best way to spread it.

If someone has either a stroke, or a heart attack, identifying what has happened and getting medical help promptly can make a huge difference to their chances of survival and subsequent quality of life if they do survive. So it is not surprising that some of the chain emails flying around cyberspace have been on how to survive a heart attack or identify when someone you are with has had a stroke.

While it has not been officially endorsed, there is some evidence based on reputable research at the University of North Carolina-Chapel Hill School of Medicine, on a small study, to support the advice which has recently been circulating in chain emails with titles like “How to spot a stroke”, or “A simple test for stroke.” These obviously originated in the USA – there is a reference to calling 911 (the US equivalent of 999.)

On checking the facts behind these emails I found that the American Stroke Association has issued a statement which is reproduced at the bottom of this post.

The original draft of this post simply quoted the statement: I am not a medical professional or expert and it seemed simpler to repeat the words of those who are rather than put my own "spin" on it.

However, I've since had some verbal feedback that readers were very unclear about whether my blog entry was intended to endorse "The Smile Test" or oppose it. And on re-reading the American Stroke Association press statement I can see how that confusion arises. The problem can be summarised in one word - lawyers.

Ambulance-chasing lawyers have a lot to answer for, and even more in the states than here. Bodies like the ASA have to bear in mind that if they give advice based on any evidence which is less than overwhelming, someone follows it, and the patient still dies there is a strong possibility that they will get sued. So statements by such bodies have to be hedged around with qualifications to make it harder to bring a legal action against them them. Unfortunately such language often also makes them harder to stand.

Essentially the ASA statement is saying that the research quoted in the chain emails really did take place and really did have the results described, but they have not taken a position for or against "The Smile Test" because this evidence is based on a small sample. So it may be worth trying these three tests but you should not take the results as Gospel. The officially recognised warning signs that someone may have suffered a stroke, and which you should look out for, are as follows:

* 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

and if you experience those symptoms, or someone else does, call 999.

The full text of the ASA statement is as follows.

"The American Stroke Association does not endorse “The Smile Test,” also known as “a simple test for stroke,” – which was widely distributed through emails.

The facts: A scientific poster presented at the 2003 International Stroke Conference titled “Untrained Adults Can Identify Symptoms of Stroke by Directed Use of the Cincinnati Prehospital Stroke Scale” suggested that asking three questions could help bystanders identify a stroke:

Ask the individual to smile

Ask him or her to raise both arms

Ask the person to speak a simple sentence coherently.

This presentation by researchers at the University of North Carolina-Chapel Hill School of Medicine was one of 450 presentations made at the conference hosted by the American Stroke Association. The poster showed positive results but was a very small study. The research was funded by a grant from the American Stroke Association. However, the American Stroke Association has not taken a position on this topic nor endorsed this test.

Stroke warning signs are:

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 9-1-1 immediately if you experience symptoms. Time lost is brain lost.

One version of the chain e-mail reads:


During a BBQ a friend stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) and just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up,

Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm, Ingrid passed away.) She had suffered a stroke at the BBQ - had they known how to identify the signs of a stroke perhaps Ingrid would be with us today.

It only takes a minute to read this-

Recognizing a Stroke

----- A neurologist says that if he can get to a stroke victim within hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed an getting to the patient within 3 hours which is tough.


Thank God for the sense to remember the "3" steps. Read and Learn!

Sometimes symptoms of a stroke are difficult to identify.

Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer brain damage when people nearby fail to recognize the symptoms of a stroke.

Now doctors say a bystander can recognize a stroke by asking three simple questions:

1. *Ask the individual to SMILE.

2. *Ask him or her to RAISE BOTH ARMS.

3. *Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. . . It is sunny out today) If he or she has trouble with any of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.

After discovering that a group of non-medical volunteers could identify facial weakness, arm weakness and speech problems, researchers urged the general public to learn the three questions. They presented their conclusions at the American Stroke Association's annual meeting last February. Widespread use of this test could result in prompt diagnosis and treatment of the stroke and prevent brain damage."

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