(October 17, 2007 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a particular medical condition.
This week, we have Dr. Michel Melanson, a Neurologist and the Residency Training Program Director in Neurology at Kingston General Hospital.
We asked Dr. Melanson what he would do if a friend or family member exhibited slurred speech, or other symptoms of a stroke.
Dr. Melanson: Now there are many causes to slurred speech, some of which can be slow at onset and things such as multiple sclerosis, brain tumors and such, and these should be investigated appropriately. However, probably the most common cause of slurred speech is going to be a stroke. To recognize symptoms of a stroke is quite important, since there are some treatments that are available if the person arrives at the emergency room within three hours. So, one of the first and major points of recognition is that of a very sudden onset. Patients with strokes, acute strokes, usually develop their symptoms immediately, and those symptoms will persist for a period of time, and sometimes if the stroke is complete, there will be no reversal of those symptoms. In the case of slurred speech, oftentimes patients will develop other symptoms along with their slurred speech. For instance, they may have some numbness on one side of their body, they may have some dizziness or nausea and vomiting. There can be some double vision. There can even be some change in the level of consciousness over a person who is having a stroke with slurred speech. All of these symptoms are red flags and should indicate that this person should arrive to the emergency room immediately.
The best way is to simply call the paramedics, get an ambulance to the emergency room as soon as possible. Once a person arrives with an acute stroke to an emergency room, the important things to mention to the triage team are what are your past medical histories, have you ever had a stroke before, do you have any heart disease, and what other medications you’re on. Describe the symptoms best you can and you’ll be assessed by a neurologist and by the emergency team. And likely, within a few minutes of your arrival, you will be brought to the CT scan, or MRI suite, for imaging of your brain. The diagnosis of stroke is a clinical one, but one has to assure that there’s nothing else going on that could be causing the slurred speech. The CT scan is usually the first approach and it is simply to look for changes, early changes in the brain that could be the result of a stroke, and also to rule out other causes of stroke, such as hemorrhage. The treatment that we’re proposing for acute strokes is not something we would give to someone who has had a bleeding in the brain – it’s only for somebody who has had a blocked artery that we’re trying to unblock with this medication called TPA [Tissue Plasminogen Activator]. Generally speaking, we would give this drug within three hours of a stroke. If it’s given beyond that time, the chances of worsening, or the chances of it not improving a person, are greater. Therefore, time is of the essence. The outcome is variable and we can’t guarantee a good outcome with these measures, however, it is the best treatment available right now, and it does help patients recover some of their deficits, and sometimes completely recover from their deficits.
I would like to show you what an acute stroke would look like on a CT scan. Here is an example of somebody who had come in, typically with slurred speech, perhaps with some clumsiness of their hand and arm on the right side, and this appearance is that of an acute stroke, or an early stroke. If we look at another type of stroke—this is in another territory—one can see that there is a bit of swelling around the brain here. And there are special types of scans that can actually look at the blood flow going to those areas of the brain, and you can see in red here are areas where there’s lack of blood flow. And this is a territory that’s at risk for having very significant damage. The reason that there’s lack of blood flow to that region is because there’s a blockage in the artery, as you can see here, there’s good blood flow here, and here there’s a blockage. And this is what the medication TPA is supposed to do. It is to relieve or break up that blood clot in order to restore blood flow to that area of brain. And so the outcome should be, in the best of circumstances, a blocked artery, we give the TPA, and the artery opens up and then you have good blood flow, and restored blood flow to the area. It doesn’t necessarily prevent a stroke, but it lessens its severity and lessens the amount of impairment a person can have after a stroke.