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Comment by huhtenberg | Hacker News Reader

Remember this -

  You have FOUR HOURS to get a person with a stroke to the emergency.

If you do, their chances of survival are dramatically higher.

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I think many people that haven't personally faced what a stroke is in one way or another don't realize how dangerous and life changing the disease is. Also, they don't understand how to detect it.

I have seen it several times. The first time it happened to my grandfather, nobody in the family realised what's wrong only that he seemingly was losing memory and repeating things he just said. Several hours passed until we thought we should perhaps call the medics - stroke was immediatelly recognized by the doctor and the emergency saved my grandfather only with very mild consequences afterwards. The second time my grandfather got a stroke, he started stuttering and had difficulty speaking. Again, we did not believe it could be stroke, because, you know, he might just be feeling bad. And again, the emergency saved him within a few hours. During the third and final stroke that we know of family was already aware and he was taken to the hospital early but he was released just a couple hours later with instructions to stay in bed and rest. Overall, about 6 to 8 hours passed until he got the required medical care. After that stroke he spent almost five years doing nothing, just existing - with almost completely blank mind. If only the doctors were professionals and we, the family, would have paid better attention, he would have been saved.

TL;DR: pay attention to the people you know. If something is slightly off and the person himself does not seem aware of it, this is definitely a strong signal that it might be a stroke.

Problem is, there are tons of other diseases that look like stroke. Migranes, epilepsia, etc. IF you have one of those, going to ER every time you have something weird going on will suck you dry of money and your doctor will probably start treating you like an hypochondriac. There is no subsystem in US health care to handle this. Your primary care physician probably sucks and not available when you need them the most. ER does not care, prone to misdiagnosis and like to dope people on drugs before figuring out what's wrong. Been there, seen that, and it makes me really angry.

>> "Problem is, there are tons of other diseases that look like stroke. Migranes, epilepsia, etc. IF you have one of those, going to ER every time you have something weird going on will suck you dry of money and your doctor will probably start treating you like an hypochondriac."

But shouldn't the doctors have though, "Ok, this man has had two strokes. These symptoms could be of something much more mundane but as he has had two strokes we will take very precaution"? I don't want to start the free health care debate but is that a problem? We have free health care and doctors seem to be willing to admit you for a night even if there is a very high likely hood you're fine. Do finances come into it more in the US and actually effect patient care?

My understanding is that early presentation to hospital with ischaemic stroke does not improve survival [1]. The reason for early presentation is that if thrombolysis with clot busting drugs is administered early then long term neurological outcome is better. Survival alone is not improved however.

As discussed in another comment, the earlier the better. The idea is for as little time as possible to have elapsed between blocking off the blood supply and opening it up again. The reason for this is that when part of the brain becomes ischaemic, a central core dies instantly but around this there is a halo or penumbra that is not dead but at risk. This penumbra of tissue dies off over time, and can be saved if the blood supply is reconstituted. The penumbra can be visualised using quite clever MRI [2]. Having said that, trials that have tried implementing this kind of imaging to guide thrombolysis have not been positive, as compared to just thrombolysing everyone.

[1] http://www.ncbi.nlm.nih.gov/pubmed/23791822 [2] http://en.wikipedia.org/wiki/Perfusion_scanning#MR_Perfusion

My dad had a cerebral stroke a few years ago. As everyone else was trying to arrange an emergency ambulance, his doctor was on the phone with him asking him to stay awake. Apparently, he said "if you fall asleep, you'll die." Fighting to stay awake for those few hours was one of the hardest things he's ever had to do.

This advice to not fall asleep is pretty prevalent (at least on TV). Is there a basis for it?

Would love to know this too. I have always thought it might have to do with being able to communicate with the medical staff to get a better assessment.

Not sure about strokes, but it used to be believed that a person with a concussion must be kept awake, but it turns out not to make a difference. It's still a fairly common trope in movies and on tv, though.

One source on that: http://www.uamshealth.com/?id=10724

It's useful to detect problems not prevent them. One of the symptoms of interracial pressure, a significant risk with head injury, is drowsiness. But, other symptoms are also fairly easy to detect in a responsive patent. However, in cases of significant head injury this can be directly monitored allowing the patent to sleep.

http://www.nlm.nih.gov/medlineplus/ency/article/000793.htm

PS: From you link "If the person who is injured is awake and holding a conversation, you can let him or her fall asleep as long as they are not developing any other symptoms such as dilated pupils or issues with walking. "

The most important thing about staying awake is that a more complete neurological exam can be performed. There's always ways to wake someone up, but the unfortunate part is that any treatment may alter the results of neuro tests

The only equation that matters is

Time = Brain

every second a stupendously large number of neurons die. at 4 hours the damage is complete, there will be total wipe-out of the infarcted area. you really want to get to emergency within half an hour.

Note, this is for an ischaemic stroke. If you have a haemorragic stroke (usually in the elderly and in those with ruptured aneurysms) there will be little that is possible except supportive care

As someone who had two grandparents have strokes absolutely this, prompt medical attention significantly reduced both the damage and the recovery/rehabilitation time.

If you think even remotely it's a stroke then straight to the hospital you go.

https://www.youtube.com/watch?v=yXONEHmupy0 (UK National Health Service Advert about strokes)

Gatsky addresses this in more technical terms [1], but this is more an issue of long term outcomes if they survive than of survival. Not that this is less important (some people would say it is more important!) -- just different.

[1] https://news.ycombinator.com/item?id=8348741

Thrombolysis works only for ischemic strokes. The much worse hemorrhagic stroke doesn't even have that window. Fortunately, it is somehow rarer.

So, time for a quick Throne of Thunder raid, then.

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