Stroke Misdiagnosis in Young Adults on the Rise

Piazza dei Miracoli (English: Square of Miracles), formally known as Piazza del Duomo (English: Cathedral Square), is a walled 8.87-hectare area located in Pisa, Tuscany, Italy. (Dr. Noorali Bharwani)
Piazza dei Miracoli (English: Square of Miracles), formally known as Piazza del Duomo (English: Cathedral Square), is a walled 8.87-hectare area located in Pisa, Tuscany, Italy. (Dr. Noorali Bharwani)

A 2009 study by the Department of Neurology and Stroke Program at Wayne State University/Detroit Medical Center found that among 57 young stroke victims, one in seven were given a misdiagnosis of vertigo, migraine, alcohol intoxication, seizure, inner ear disorder or other problems – and sent home without proper treatment.

While the majority of strokes strike people over the age of 65, the incidence of strokes in individuals 50 and younger is on the rise. Because people associate stroke with the elderly, symptoms in younger victims can often be missed or dismissed – even by medical professionals.

What are the signs of stroke?

Recognizing the signs of stroke can be the first step to getting correct treatment. Experts recommend you use the mnemonic device FAST.

Face: is it drooping?

Arms: can you raise both arms?

Speech: is it slurred or jumbled?

Time is of the essence: to call 9-1-1 right away.

How can you be diagnosed and treated early?

For a good outcome early intervention and treatment is important.

A person has symptoms, the paramedics are called and the person is brought to the hospital. The ER physician does clinical examination and investigations and comes to a diagnosis. All this should not take more than one hour.

Once the diagnosis is made the standard of treatment is administration of medication called tPA (tissue plasminogen activator) intravenously. When tPA is promptly administered, it can save lives and reduce the long-term effects of stroke. It needs to be used within three hours of having a stroke.

According to Alberta Health Services, Alberta’s stroke treatment is now reported to be among the fastest in the world. Alberta’s quality improvement program cuts time for life saving drug treatment from 70 to 36 minutes. A similar effort in the United States saw average door-to-needle times in participating hospitals drop from 74 minutes to 59.

The accepted benchmark has been to treat patients within 60 minutes of their arrival at the hospital. The Grey Nuns Hospital in Edmonton currently holds the provincial record with the fastest door-to-needle time – six minutes.

The medication (tPA) was introduced 20 years ago. But the results are not perfect. Although tPA is successful in recanalyzing the blocked artery in up to 78 per cent of cases, this rate of success is dampened by a high rate of acute repeat occlusion leading to an ultimate rate of 33 per cent partial and 30 per cent full recanalization.

Doctors are working on newer methods to treat stroke patients. Now doctors are able to pull a clot from the brain of patients while they are having a stroke. It is called an endovascular procedure or a mechanical thrombectomy. The procedure should be done within six hours of acute stroke symptoms. The entire procedure takes about 10 minutes. This treatment is not available in all centers across Canada.

The message is clear. Whether the patient is young or old, for the best possible results, it is important to identify stroke symptoms and seek treatment immediately.

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