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Interactive Learning : HealthCast Transcripts

Episode 10 : Stroke Identification and Action to be Taken

Release Date: January 23, 2007

Dr. David Meyerson: Hi, I'm Dr. David Meyerson, cardiologist at Johns Hopkins and your host for this week's Vascular Disease Foundation's HealthCast. We have been so privileged to bring you wonderful public service information from a foundation that is geared towards giving you peer-reviewed science in digestible terms and the Vascular Disease Foundation has been so grateful to allow us to bring this information to you. I'm here in studio with Dr. Kerry Stewart. He is Director of Clinical and Research Exercise Physiology at Johns Hopkins, also a Professor of Medicine and we were actually going to talk to you about something slightly different today. We were going to talk a little bit about abdominal aortic aneurysms and about aneurysms of the chest and blood vessels and something called aortic dissection, but something, Kerry, something came to me just today from my father. He sent me an email and it talks about stroke identification and my father's a pretty bright guy, he's totally intact and very smart and his name is Raymond Meyerson. He's in Boynton Beach, Florida. Hi dad. In any event he is --

Dr. Kerry Stewart: Hi dad.

Dr. David Meyerson: -- he wrote me this email and this is very serious. It has to talk about recognizing a stroke and this email he said, "David, is this true?" And basically, it says three ways to recognize a stroke and it was the first three letters in stroke, S-T-R. It said ask the individual to smile. Ask the person to talk or speak a simple sentence and ask them to raise both arms, so the S, the T and the R. And he said, "How true is this? Is this of value?" And there was this little vignette and the little vignette was that someone was at a barbeque and she stumbled and took a little fall, reassured everybody that she was just fine. They wanted to call paramedics and she declined and they got her cleaned up, got her a new plate of food and later on she ended up having a massive stroke and passing away and this went on to talk about the sooner you begin to recognize the symptoms of stroke, the better off you are. Kerry, we've talked incessantly about in terms of heart attacks, the earlier you get to the hospital, if you're having chest pain, the more heart muscle can be saved. We've talked about that incessantly, haven't we?

Dr. Kerry Stewart: We absolutely have and I think this is an extremely important topic because, in fact, stroke is the number three cause of death in this country behind the disease of the heart and cancer, stroke and about one out of every fifteen deaths per year is due to stroke.

Dr. David Meyerson: And we all have people in our families who have had or somebody we know, who's had a stroke and the new things, the most exciting things that groups like the American Heart Association and other major groups throughout the country would like people to know that the sooner you recognize the symptoms of a stroke and get to a hospital, the sooner they can actually turn off the stroke and prevent the disability just like they can turn off a heart attack and that to me is very exciting news, Kerry.

Dr. Kerry Stewart: I agree entirely. In many cases, it's very much up to the patient as to what the final outcome might be and like you said, if someone gets to the hospital as soon as possible once they recognize the symptoms, or someone with them recognizes the symptoms, getting to that hospital, particularly if the hospital is a designated stroke center, there are many things that can be done that can interrupt the stroke and perhaps, well certainly minimize damage or perhaps save someone's life.

Dr. David Meyerson: Absolutely. And my response to my father, it read a little bit like, "Dear Dad, well after reading this, here's my response. As a public education tool, this simple idea is largely excellent and quite correct." Now we would have to point out that we're mostly talking about the kind of strokes that are caused by blood clots. The same ones that cause the problems as we've talked about with peripheral vascular disease, peripheral arterial disease that you and I spoke about recently and others, but not the kind of strokes that are caused by bleeding inside the head. Those present a little bit differently. All strokes must be managed immediately and so the hint of getting to the hospital immediately is key, but how you turn the stroke off whether it be a bleeding stroke or a blood clot stroke, they work two different ways. But in any event, so we talked about the woman -- in my email back to my father, I said Kerry, I said that, "When somebody comes in for an evaluation and they say they've tripped or they've fallen or they've hit themselves, we are very careful to begin to try and parse out was it just something clumsy, did they actually trip over a throw rug or were they wearing new shoes or sneakers that the rubber sole caught and they didn't move properly or frankly, did they get dizzy because of a medicine that they were taking or did they have a heart rhythm disturbance for example, or did they have a threatened stroke?" Kerry, transient ischemic attacks, those are those threatened mini stroke where you could have disability or clumsiness of an arm or a leg for a minute or if your speech is garbled and let's talk about that smile test for a minute. Remember the first one in the S-T-R was smile. So Kerry, if you ask somebody to smile, we would expect somebody's facial symmetry, both sides of the face should go up. Isn't that correct?

Dr. Kerry Stewart: Well absolutely and if someone can't control both sides of their face, they can't smile or they can't make other gestures, that could be an early sign that there is a stroke.

Dr. David Meyerson: And the most important thing that we're trying to say -- so if you're clumsy, if you start to drop an object that you ordinarily would never drop like you have a knife or fork in your hand and you wouldn't drop it or the speech is a little bit garbled or you're seeing these symptoms in a loved one or if you asked them to smile and one side of the mouth goes up in a normal smile and one side does not or if they can't stand up or if they can't find the words that they are looking for. If they can't speak coherently in the sentence. Let's go back to that, the S-T-R that was asking them to smile, to talk, raise their arms, move their legs, things of that nature. But when somebody has these that happen transiently, in other words, they have a disability that lasts for just a few seconds, this may be a critical warning because the next event, they may have minutes or hours, you can never tell how much time they have, but if they get to the hospital, get to a good doctor's evaluation, pardon me, and find out what was the cause of this. And if it was a transient ischemic attack which is a threatened mini stroke, if you will, and they get the right therapy, they may never ever get the stroke to start with. And that's, I think -- Kerry, everything about the Vascular Disease Foundation is trying to minimize disability and keep people active and normal and healthy and I think this public education piece on stroke recognition is so right down the middle of the Vascular Disease Foundation runway. What do you say about that?

Dr. Kerry Stewart: I think you're exactly right. The Vascular Disease Foundation disease deals with all types of blood vessel diseases and in fact, as you recall, we had a guest a few episodes ago, I can't remember which number it was right now, but Dr. Michael Jaff talked a lot about carotid artery disease which is one of the diseases that can lead to stroke.

Dr. David Meyerson: Absolutely.

Dr. Kerry Stewart: And he very nicely outlined some of the diagnostic methods that are available to physicians that help to diagnose for a stroke. So that if you do have a transient ischemia attack and you get to your doctor, they can do some tests to find out in fact if that those symptoms were due to blockages, for example, in the carotid arteries or blood clots coming from other sources to the extent that that can be identified early, that can interrupt the possibility that one will have a full-blown stroke.

Dr. David Meyerson: And let me just reiterate something that Kerry just said and that is that if you have the transient ischemic attack, that's that threatened mini stroke, again I'll just repeat it. You clumsy of a hand or your hand doesn't work for a few minutes, maybe the arm is even limp to the side, maybe you leg can't support weight for a little bit, maybe your balance is off, maybe your speech is garbled, you can't smile, there's an asymmetry, a lack of symmetry of your face when you try to smile. If your eyesight transiently disappears and comes back and a part of your visual area, it doesn't have to be all of your sight, but parts of your visual field, these are things that should be dealt with. Here's the point, when you experience this or when you see a loved one experience this, you don't then say, "Relax, go to sleep, we'll see the doctor tomorrow." Because what happens is that that, what was a warning could then, by the time they wake up the next day be the permanent stroke with a disability that we would not like to see somebody suffer with a stroke. And of course, if they have what looks like a stroke immediately, one side of the body is not moving and/or they can't speak or something of that nature, then you want to make every effort, every effort possible to get them to the hospital immediately because everybody knows that with a heart attack, we always say time is muscle and that is that when you're having chest pain, in order to turn off the heart attack and the doctors can use blood clot dissolving medicines or much more often these days, we go right into the artery that nourishes the heart muscle with a catheter, we open up that artery and we put a little stent in and the stent looks like a spring from inside a ballpoint pen. Opens up the blood vessel, allows normal flow, prevents the heart muscle damage so that hopefully, if they have gotten to the hospital soon enough, a stented coronary artery will allow them to have normal heart muscle function and you don't lose horse power in that precious engine that we call the heart. The same thing is true of the brain. Kerry, it's even more important in the brain because the brain is more susceptible to damage from lack of blood supply even quicker than the heart muscle is.

Dr. Kerry Stewart: That's exactly right. If there's a few minutes of deprived blood flow to the brain, you start getting tissue damage that can't be reversed.

Dr. David Meyerson: And that's the whole point. If you get to the hospital soon enough, you don't waste time and you must get to the hospital, I would say within ninety minutes of those symptoms, the guidelines are a little bit more lenient with that, but I'd rather that somebody just got there. Stop what you're doing, take your loved one or get yourself to the hospital, get evaluated because if you are in the process of having a stroke, especially if it's one of those strokes that are caused by blood clots, that have happened either from the carotid arteries like in the program that we talked about previously, or sometimes the clots can actually form in diseased arteries of the brain, well up into the brain tissue and it doesn't matter where the clot is that limits the blood flow to the brain, but as Kerry said a couple of minutes ago, if you're limiting blood flow to the brain, a segment of the brain is going to be at risk for dying and brain tissue dies more quickly and becomes more dysfunctional than heart muscle, quicker in time. So that the sooner you get to the hospital, the sooner you look at these symptoms, the sooner they're evaluated properly by a neurologist and an ER, emergency medicine physician and an internist and anyone who's qualified to make this evaluation promptly, you can save your life, you can save the life of a loved one, you can save death, you can save striking disability. This ability -- again Vascular Disease Foundation is about maximizing people's potential, letting them walk away from things that could have otherwise harmed them. We've talked about how to improve your life if you have claudication, blockages of the arteries in the lower extremities and all the things that can be done. With stroke, it's even more important to seek help immediately. I think that's a good message for our show today, Kerry. We can really save people, save lives of our listeners and their loved ones by them listening to this very carefully.

Dr. Kerry Stewart: Well, I think we're certainly giving people the information that they need, but again as we've tried to emphasize in all of our HealthCasts, our purpose is to provide the education, but we urge the family members, the individuals, if you see these signs, if you experience any of these symptoms, it really is up to you in many ways to take action. It's your effort to get yourself to the hospital, your family's effort to get you to the hospital. That would really make a difference. We provide the information, but this is one incidence where the individual has a lot of control over what may happen to them in the long-term.

Dr. David Meyerson: Well, we can lead a horse to water --

Dr. Kerry Stewart: That's exactly right.

Dr. David Meyerson: -- maybe we can make them think.

Dr. Kerry Stewart: Well, hopefully not only will we give them the education, but we're making them take action if this unfortunate event does occur.

Dr. David Meyerson: So I want to thank on behalf of the Vascular Disease Foundation and Dr. Kerry Stewart and myself, I'd like to thank Raymond Meyerson of Boynton Beach, Florida for submitting this question, unbeknownst to him about this three letter test for recognizing a stroke. Again, it says here ask the person to smile. If the face is not symmetric, if one side goes up and one side doesn't, that might be the sign. If they're speaking garbled words. If one side of the body doesn't work. If they can't raise an arm or a leg. If they're sense of equilibrium is lost, they can't walk properly. They can't put ideas into sentences, they can't repeat simple sentences. These- there could be other things that could cause this. Sometimes you could be a diabetic with very high blood sugar and have some of these very same symptoms. But sometimes you may have taken a medicine that's too strong for you and has lowered your blood pressure really substantially, but you know what, you don't -you let the emergency room doctor and their consultants try to help you decide what caused this because early attention means prevention of disability and Kerry, anything else you would like to add for today?

Dr. Kerry Stewart: Well, I'd like to add that you've done a great job of summarizing what these symptoms are, but let me also point people to some references on the internet.

Dr. David Meyerson: Perfect.

Dr. Kerry Stewart: At the Vascular Disease Foundation, you can find out more information about stroke and carotid artery disease. That's and another great source of information is through the American Heart Association and its affiliate the American Stroke Association and that website is and they have --

Dr. David Meyerson: Now let's just be careful with that, because that's www. -- now stroke association is all strung together with no --

Dr. Kerry Stewart: One word, one word.

Dr. David Meyerson: One word. www.strokeassociation and if you -- you have to pay attention because this one is dot org, not dot com --

Dr. Kerry Stewart: Right.

Dr. David Meyerson: -- it's dot org.

Dr. Kerry Stewart: Right, and if you have trouble slurring your words when you pronounce stroke association, that's okay, but it's

Dr. David Meyerson: So you know, I'm very excited that we can give people -- people who have heard this broadcast will know what the warning signs are of a transient ischemic attack, they will remember that if it happens, that's as important -- it's as important to get medical attention immediately after that because they may have an hour, they may two hours, you never know. They may have ten minutes until the next event occurs which is more permanent, and so the earlier you take heed of these warnings, the better, the higher the function you will preserve and the better everybody will be for it. Your loved ones will love you for having done that. You will be delighted that you did and maybe you can even save somebody's life that you really care about. For the Vascular Disease Foundation and for Dr. Kerry Stewart, I'm Dr. David Meyerson, have a great day.


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