Too often, when young people head to the emergency room suffering from a stroke, they are misdiagnosed, which means they miss out on time-sensitive treatment, new research finds.
In some cases, when patients undergoing a stroke come in with an off-balance walk, slurred speech or many of the other symptoms of a stroke, doctors make the mistaken assumption that they are either drunk or suffering from migraine a seizure or other condition.
The research, presented at the American Stroke Association's International Stroke Conference 2009, reviewed data on 57 patients, ages 16 to 50 years old, enrolled since 2001 in the Young Stroke Registry at the Comprehensive Stroke Center at Wayne State University in Detroit, Mich.
Fourteen per cent were misdiagnosed and discharged from hospital. Only later was it discovered they had suffered a stroke.
Those misdiagnosed included:
- an 18-year-old man who reported numbness on his left side but was diagnosed with alcohol intoxication;
- a 37-year-old woman who arrived with difficulty speaking and was diagnosed with a seizure;
- a 48-year-old woman with sudden blurred vision, an off-balance walk, lack of muscle coordination, difficulty speaking and weakness in her left hand, who was told she had an inner ear disorder.
Dr. Seemant Chaturvedi, senior author of the study and a professor of neurology and director of the stroke program at Wayne State, says the findings are disturbing because accurate diagnosis of stroke in young adults can reduce the number of patients who have continued paralysis and speech problems.
"We have seen several young patients who presented to emergency rooms with stroke-like symptoms within three to six hours of symptom onset, and these patients did not get proper treatment due to misdiagnosis," he said.
"Part of the problem is that the emergency room staff may not be thinking stroke when the patient is under 45 years old," Chaturvedi said.
"Physicians must realize that a stroke is the sudden onset of these symptoms."
He says patients arriving with "seemingly trivial symptoms" like dizziness and nausea should be thoroughly assessed.
Getting a proper stroke diagnosis early is important because the first hours after a stroke are critical.
For example, plasminogen activator (tPA), which helps to break up blood clots, must be delivered within three hours of symptom onset to reduce permanent disability caused by stroke.
Experimental stroke treatment such as intra-arterial clot busters and mechanical clot retrieval may be an option for some patients three to eight hours after symptoms, Chaturvedi adds.
"Some people believe that younger people may respond better to stroke treatments, so that makes it doubly important to recognize when a stroke is happening," added.
But after 48 to 72 hours, there are no major treatments available that can improve stroke outcome.
Stroke is the third leading cause of death and one of the top causes of disability in Canada.
No matter how old someone is, they should get to a hospital quickly if any of these symptoms occur:
- 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; and/or
- sudden, severe headache with no known cause.
