BY TIM BONFIELD
The Cincinnati Enquirer
Many people do not know the most common causes or symptoms of stroke -- not even those people at highest risk of having one.
A survey conducted by the University of Cincinnati, published in today's edition of the Journal of the American Medical Association, found widespread ignorance about America's third-leading cause of death.
About 600,000 Americans a year suffer a stroke. Of those, about 160,000 die. Most stroke victims survive but suffer partial paralysis, blindness, loss of speech and other disabilities.
Yet a 1995 survey of 1,800 Greater Cincinnati residents found that only 57 percent could name one of the five leading stroke warning signs: numbness along one side; sudden difficulty speaking; a sudden, massive headache; unexplained dizziness, and sudden loss of vision. Just 28 percent could name two and 8 percent could name three or more.
Meanwhile, 68 percent of those surveyed could name one of the five leading stroke risk factors: high blood pressure, smoking, heart disease, diabetes or mini-strokes -- stroke symptoms that fade quickly. Just 25 percent could list two, while 4 percent could name three or more.
"The bottom line is that people simply don't understand stroke. That's very concerning considering that stroke is the third leading cause of death," said Dr. Arthur Pancioli, a neurologist with UC's department of emergency medicine and lead author of the JAMA article.
Even more alarming, most of the people at highest risk of having strokes do not realize it:
- Only 57 percent of people with high blood pressure realize that hypertension causes strokes.
- Only 35 percent of current smokers realize that smoking is a risk factor.
- Only 13 percent of diabetics knew they were at risk.
The need for better public education has become more urgent, Dr. Pancioli said, because treatments have improved.
Two years ago, a clot-busting drug called tPA was shown to dramatically reduce permanent brain damage caused by strokes, but only when it is administered within three hours of the onset of symptoms. To take advantage of this treatment, people need to know the warning signs of stroke, then call 911 when such symptoms occur, Dr. Pancioli said. In essence, people should react to brain attacks as fast as they react to heart attacks.
"What many people forget about stroke is that it is the leading cause of adult disability," Dr. Pancioli said.
Consider this: Of 100 people who suffer a stroke, about 21 will die within three months, 27 will suffer severe disability, 32 will suffer mild to moderate disability and 20 will recover to near-normal health.
With the use of tPA, the number of people who die remains largely unchanged but the number of full recoveries climbs to about 30, while fewer suffer permanent disability.
Meanwhile, there are effective ways to prevent strokes, ranging from medications that reduce blood pressure to surgery that clears blockages in blood vessels leading to the brain. Blood pressure medication, for example, can cut stroke risk by more than 30 percent, Dr. Pancioli said.
Strokes sometimes are called brain attacks because many are similar to heart attacks.
Many heart attacks occur when plaque buildups cut off blood supply to the heart. Many strokes occur when blockages occur in the the carotid artery, a major blood vessel in the neck that supplies blood to the brain.
Strokes can occur for other reasons, too, such as when blood clots formed elsewhere in the body get stuck in the brain. Sometimes, weak blood vessels in the brain actually burst.
Today's edition of JAMA included six stroke-related studies, including findings that aspirin therapy can help prevent stroke for some patients and that patients seeking stroke surgery appear to fare better at high-volume hospitals.
The public education issues arising from UC's study drew considerable response from medical experts nationwide.
"Lack of knowledge about stroke symptoms and risk factors cut across education, sex and racial groups. . . . Stroke education needs to start at the most basic level," wrote Drs. Phil Fontanarosa and Margaret Winkler in a JAMA editorial.
The UC study confirms "an overwhelming lack of awareness about stroke," said Dr. Fletcher McDowell, vice chairman of the National Stroke Association. The study also "demonstrates the importance of educating the public about the risk factors they can control through moderate lifestyle changes and medication."
The association has launched a five-year campaign to promote stroke awareness, focusing on the groups at highest risk:
- The elderly, because stroke risk doubles every decade beyond age 55.
- African-Americans, because their stroke rate is twice as high as among whites.
- Women, because many do not realize that strokes kill more than twice as many women as breast cancer.
