Wake Up Stroke: Now What Do You Do?

I can't believe that we're already a third of the way through the month but it turns out that May is National Stroke Awareness Month, which explains the number of studies that have been published of late looking at this devastating disease.  

For a quick review, how many of you remember the FAST (face, arm, speech & time) mnemonic?  Should you be so unfortunate as to notice any of these symptoms, you need to get thee to an emergency department or stroke center immediately. 

If you can get evaluated within 3-4.5 hours of onset of stroke symptoms, you have a better change of receiving thrombolysis (clot busting drugs). 

But what if you wake up with one of the FAST symptoms?  How much time has elapsed since your stroke started?  You can't tell because it started while you were asleep!  Which means you probably won't be given thrombolytics out of fear for converting an ischemic stroke (think clogged pipe) into a hemorrhagic one (think burst pipe).  And if you don't get a clot busting drug, your long-term outcome isn't as good.  

This is exactly what the authors noted in a study published this week in which 14% of the stroke victims presenting to the emergency department woke up with stroke symptoms.  One solution, as proposed by cynics to prevent a stroke, is to avoid going to sleep!  Of course, that's not practical.  But why go to the emergency department if it's not likely that you'll receive optimal (thrombolytic) therapy?  Because we need to evaluate what caused the stroke in order to minimize the risk of another stroke occurring. 

If you're lucky enough not to have had a stroke, now would be a good time to review my December 4th and February 3rd posts regarding how to prevent strokes.