Stroke is the 3rd leading cause of death and the leading cause of permanent disability in the United States.

A majority of strokes are ischemic, caused by lack of blood flow in the brain, usually due to a blockage or a blood clot.  Time is of the essence when diagnosing a stroke as the window for treatment to reverse the damage from an ischemic stroke is measured in hours. 

A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Parkinson’s disease, ALS (Lou Gehrig’s disease), dementia, multiple sclerosis and stroke. The American Academy of Neurology(AAN) is an association of more than 22,000 neurologists and neuroscience professionals who are dedicated to promoting the highest quality patient-centered neurologic care.

New guidelines published in the July 13,2010 issue of Neurology, the medical journal of the AAN say Doctors should use a diffusion MRI scan to diagnose stroke instead of a CT scan.
“While CT scans are currently the standard test used to diagnose stroke, the Academy’s guideline found that MRI scans are better at detecting ischemic stroke damage compared to CT scans,” said lead guideline author Peter Schellinger, MD, with the Johannes Wesling Clinical Center in Minden, Germany.

According to the guideline, diffusion MRI should be considered more useful than a CT scan for diagnosing acute ischemic stroke within 12 hours of a person’s first stroke symptom. In one large study, among others, that was reviewed for the guideline, stroke was accurately detected 83% of the time by MRI versus 26% of the time by CT.

“Specific types of MRI scans can help reveal how severe some types of stroke are. These scans also may help find lesions early,” Schellinger said. “This is important because the research suggests finding lesions early may lead to better health outcomes.”

Other studies have proven the usefulness in early diagnosis of other medical conditions in the emergency room, but there are doubts as to the use of MRI in clinical settings.  “This guideline gives doctors clear direction in using MRI first, ultimately helping people get an acute stroke diagnosis and treatment faster”, says Schellinger.

Considering that up to 45% of public stroke knowledge is derived from family and friends, children may be a previously ignored avenue for stroke symptom detection and action.  Due to the crucial and short window of successful treatment for stroke patients, the Hip-Hop Stroke program educates children to detect and act quickly when signs of stroke are seen. 

Developed by the National Stroke Association in partnership with Olajide Williams, MD, and James M. Noble, MD to reach out to Hispanic and African-American communities. “Stroke is 2-3 times more common in African-Americans than in whites”, Williams said, “and African-Americans are also twice as likely to die from stroke complications.”

The program was first introduced in 2005 and has branched out to seven other cities nationwide. About 15,000 elementary school students have participated learning through lyrics from hip-hop rapper and musician Doug E. Fresh about signs and symptoms of stroke in a lively way to help them retain the information.  To help in recognizing the occurrence of stroke in parents, grandparents or other adults, children are taught the mnemonic FAST –

F  - facial droop,
A - arm weakness,
S - slurred speech,
T -  time to call 911

“This is an innovative possibility to teach kids about the warning signs of stroke and help get the message through to their parents, said Ralph Sacco, MD, chairman of neurology at the Miller School of Medicine at the University of Miami.  He adds, “There is some evidence that teaching kids about the signs of strokes pays health dividends.”

Lewis B. Morgenstern, MD, director of the Stroke program at the University of Michigan Health System in Ann Arbor, designed and tested a stroke education program with colleagues at the University of Texas in Houston, targeting schools and communities, and they reported a shift in the knowledge about stroke. “They increased the number of people who knew the warning signs and people got medical attention much earlier in those communities”, Dr. Sacco said.

On their website, The American Stroke Association lists these warning signs of stroke:
*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

Life Saving Actions:

*Not all the warning signs occur in every stroke. Don't ignore signs of stroke, even if they go away!
*Check the time. When did the first warning sign or symptom start? You'll be asked this important question later.
*If you have one or more stroke symptoms that last more than a few minutes, don't delay! Immediately call 9-1-1 or the emergency medical service (EMS) number so an ambulance (ideally with advanced life support) can quickly be sent for you.
*If you're with someone who may be having stroke symptoms, immediately call 9-1-1 or the EMS. Expect the person to protest — denial is common. Don't take "no" for an answer. Insist on taking prompt action.

Laura Lamp King