24 Jul 2015

Face, arms, speech: is it a stroke?

4:24 pm on 24 July 2015

Doctors are getting aggressive with the country's third biggest killer.

Health Minister Jonathan Coleman meets a stroke patient at Wellington Hospital.

Health Minister Jonathan Coleman meets a stroke patient at Wellington Hospital. Photo: Supplied

GPs now have a new way to spot if patients might be about to have a full-blown stroke - so they can get them to hospital faster to save their lives.

Health Minister Jonathan Coleman has been back doing what he used do when he was a GP: mixing and mingling with patients.

On a visit to Wellington Hospital, he told them about a new checklist which makes it easier for doctors to diagnose mini-strokes - and prevent patients from going on to suffer a severe stroke.

Dr Coleman said he could have done with the guide when he was in practice.

"This would have made life much simpler because often these patients are very complex to sort out.

"I mean, is that tingling that someone's got in the arm, is that something to do with the way they've been holding their hands on the bike handlebars, or are they having a stroke? This is a tool that enables you to make a much clearer assessment".

"One of the benefits of this is going to be that rather than GPs having to send patients into hospital for expensive and uncomfortable investigations ... actually the right decision can be made in the doctors' surgery, and you end up with the right patients being referred for further investigation, but for many patients treatment or reassurance will be able to be given in the primary care setting," said the Minister.

Jonathan Coleman at Wellington Hospital with a stroke patient.

Jonathan Coleman at Wellington Hospital with a stroke patient. Photo: Supplied

What are the signs?

What GPs will be looking for is what is called a transient ischemic attack - or TIA.

The head of the Stroke Foundation Mark Vivian explained the difference between the two.

"A TIA and a stroke are almost the same thing. The only difference is that the signs of a stroke will go away within 24 hours - usually within two or three - if it's a TIA.

"If it lasts longer than a day it's a stroke. So, you really have to take the TIA symptoms, the signs, very, very carefully."

"There's a very useful mnemonic for recognising a stroke. It won't pick up absolutely every one of the signs, but most of the signs of a stroke will be picked up by face, arms, speech. And if any of those are there we say it's time to go to hospital," said Mr Vivian.

"So the mnemonic is fast. If one side of your face is droopy or people can't smile evenly, that could very well be an indication of a stroke or a TIA. If they can't hold their arms out straight in front of them, if one arm falls down or is droopy, that's quite probably a sign of a stroke or a TIA.

"And the last sign is speech. If their speech is interrupted for no apparent reason, their speech is slurred or it's jumbled or they get their words back to front or they can't understand what somebody is saying to them, that could very well be the sign of a stroke as well".

"Very quickly, as soon as you can, get to hospital if those symptoms occur in your life", Mr Vivian said.

Save one stroke for every dozen

The lead neurologist at Wellington Hospital, Dr David Abernethy said the new approach to spotting a mini-stroke was going to be a life-saver.

"If you have a stroke there's a tremendous human cost. About 20 percent of people will die from their stroke and about half of them will be permanently disabled."

"Using an aggressive approach to intervention and TIA, you can save one stroke for every 12 patients who goes through your system", said Dr Abernethy.

Changes to the way doctors handle stroke diagnosis have been lead by the Capital and Coast District Health Board neurologist, Anna Ranta.

Anna Ranta

Anna Ranta Photo: Supplied

"The thing that kicked it off really was my experience working at MidCentral DHB, getting a lot of referrals from general practitioners that I thought didn't make the best use of my expertise. I thought that referrals could be more appropriate in the way that the high-risk patients could get to me faster."

Dr Ranta said surveys were done canvassing the opinions of doctors who had used the software, and those who had not.

"The GPs who hadn't used the tool were slightly suspicious and were thinking it was kind of tick-box medicine and they were being replaced. While the GPs who used it realised it wasn't and was an augmentation of what they were doing and they're absolutely pivotal in the process.

"It's not a tool that can be used by consumers", she said.

GPs get their hands on the new stroke diagnosis software from today.

But if you want to reduce the chance of having a stroke, the familiar health message is: get your blood pressure checked, quit smoking and get some exercise.

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