All Strokes Are Not Created Equal

Strokes have made the news a lot in the past couple of years. There are organizations like Power to End Stroke who are working to increase people's awareness of stroke symptoms and risk factors. I have three or four different refrigerator magnets that list stroke symptoms, from a variety of places.

I think it's great. The more people know about it, the better, and the more likely someone having a stroke will get the help they need.

Interestingly, though, the strokes I've heard about and/or seen have not followed these lists very well.

My first experience with strokes was when I was a teenager and my mother had a stroke. I did not live with her at the time. She was at work when it happened, and she described it as "the wrong words came out." Clearly some sort of aphasia. She said that at first, she didn't know what had happened, and it wasn't until a coworker told her that her face was "crooked" that anyone, herself included, thought to get her any help. Both of these are well known "stroke symptoms"- difficulty speaking and an uneven or drooping face. But she didn't have ALL the symptoms that are usually listed. No one sided weakness, no difficult moving or walking or gripping, no "slurred speech."

I know now, of course, that people don't always have all of the symptoms, since where, exactly, the stroke occurs and what it might impair will vary widely. But at the time, she and her co-workers didn't really consider a stroke until the symptoms had been present for quite a long time, because it didn't match the image they had of "a stroke."

Another experience was when my sister had a stroke. I don't know what her symptoms were. In her case, I only know a couple of details. One is that when the other people in her family went to bed that night at about 11:00pm, she was fine, and they found her, unable to move, the following morning. She said later that she had been lying there unable to move, and unable to get help, for several hours before anyone woke up. When I heard that, it worried me, since what I had heard about strokes was that if you "caught them early" the person had a good chance for recovery, but if it was longer than about three hours, there wouldn't be anything that could be done. She had not been found for at least six hours.

She recovered extremely well. I believe there is a little residual weakness in one of her arms, but that's it. Walking, talking, no problem.

Since then, I've had a number of patients present with symptoms of a stroke, some very obviously so, others more subtle, and others, still, with a confusing combination of symptoms that probably included a stroke AND some other things going on.

So if the symptoms may not match the image people generally have of "a stroke," and if how well someone recovers can't be predicted, then what do we really know about strokes?

The answer is not very much. And a lot. At the same time.

Much of it comes down to people all being individuals.
Some of it is a better understanding of a wide variety of possible signs and symptoms, instead of only three or four, not all of which might be present every time.

It's definitely interesting.
How the brain works is right up there with how the heart works, as far as being totally fascinating.
I especially find it fascinating to see how people recover, and how they don't. What heals, or what does the brain or body find ways to adapt to, and which things seem to be more difficult?

Clearly, another case of not enough hours in a day, or days in a year, or years in a life to learn everything.

Maybe some day we'll have better ways of diagnosing a stroke in the field, and better ways of treating them. Medical science has made a lot of advances, but sometimes, with this, it comes down to "wait and see."