Mi­nor stroke needs quick med­i­cal at­ten­tion, too

When stroke strikes, act FAST. Face: has it fallen on one side? Arms: can they raise them? Speech: is it slurred? Time: if you no­tice any of these signs, it’s time to call (for an am­bu­lance).

The Borneo Post - Nature and health - - Alert - By Will Boggs MD

MI­NOR strokes and “mini-strokes,” or tran­sient is­chaemic at­tacks (TIAs), need early med­i­cal at­ten­tion, just like ma­jor strokes, but a pub­lic ed­u­ca­tion cam­paign in the UK had lit­tle suc­cess con­vinc­ing the pub­lic to act fast af­ter these events. “Al­though the cam­paign worked well for be­hav­iour af­ter more ma­jor stroke, pa­tients were still slow to act on, or ig­nored com­pletely, the symp­toms of mi­nor events,” said Dr Peter M. Roth­well from John Rad­cliffe Hospi­tal, Univer­sity of Ox­ford.

“It was al­most as though the mes­sages from the cam­paign about ma­jor stroke had falsely re­as­sured them that the more mi­nor event that they had ex­pe­ri­enced was prob­a­bly noth­ing to worry about,” said Roth­well, se­nior au­thor of a study on the cam­paign´s im­pact. “If you have a mi­nor ‘warn­ing’ event, the risk of a more ma­jor stroke over the next week is about 10 per cent if you are not treated,” he said in an email. “How­ever, that risk is re­duced by 80 per cent if sim­ple med­i­cal treat­ments are started ur­gently.”

If you have sud­den, tem­po­rary neu­ro­log­i­cal symp­toms that you haven’t had be­fore, he ad­vises, “Don’t de­lay. . . get checked.” Also, he said, “The most im­por­tant im­me­di­ate thing that you can do your­self if you have a ‘TIA’ is to take an as­pirin (same as is ad­vised af­ter a sus­pected heart at­tack). Take an as­pirin and seek med­i­cal at­ten­tion.” Roth­well’s team looked at the im­pact of the Face, Arm, Speech, Time (FAST) pub­lic ed­u­ca­tion cam­paign on the like­li­hood that pa­tients would seek med­i­cal at­ten­tion within three hours of their symp­toms.

The cam­paign warned, “When stroke strikes, act FAST. Face: has it fallen on one side? Arms: can they raise them? Speech: is it slurred? Time: if you no­tice any of these signs, it’s time to call (for an am­bu­lance).” Fa­cial weak­ness, arm symp­toms and speech dis­tur­bance were less com­mon among peo­ple with mi­nor stroke or TIA than among those with ma­jor stroke, and only about 35 per cent of pa­tients with TIAs who didn’t seek med­i­cal at­ten­tion had any of these signs.

Sur­pris­ingly, fewer pa­tients cor­rectly at­trib­uted their symp­toms to TIA or mi­nor stroke af­ter the FAST cam­paign (28 per cent) than be­fore it (37 per cent), and five per cent of pa­tients did not even re­port their symp­toms un­til the next rou­tine ap­point­ment with their doc­tor.

“Cam­paigns rightly stress the need to seek emer­gency med­i­cal at­ten­tion if you have signs of a ma­jor stroke,” Roth­well said. “The symp­toms of TIA and mi­nor stroke are very sim­i­lar - but just less se­vere and more tran­sient (of­ten last­ing only min­utes). Cur­rent cam­paigns would re­ally only need to add that mes­sage at the end of the TV ad­ver­tise­ment or poster – ‘and don’t ig­nore symp­toms that might be a small ‘warn­ing stroke’ ei­ther - that is an emer­gency, too.’”

“For any of the stroke symp­toms, ma­jor, mi­nor, or tran­si­tory, time re­mains of the essence,” said Dr Vic­tor Loh from Na­tional Univer­sity Health Sys­tem, Sin­ga­pore, who re­cently de­tailed the out­pa­tient man­age­ment of TIA, but was not in­volved in the study.

“Per­haps af­ter the pri­mary mes­sage of need­ing to head to hospi­tal within the time win­dow for pa­tients with ma­jor stroke, the sec­ondary mes­sage needs to be em­pha­sised: that even if symp­toms are mild or tran­si­tory, early re­view and in­ter­ven­tion can dras­ti­cally re­duce the risk of a ma­jor stroke,” he said by email. – Reuters

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