Study: 58,000 in U.S. waking up to strokes
May 9th, 2011
05:27 PM ET

Study: 58,000 in U.S. waking up to strokes

Patients who suffer severe strokes often get a clot-busting treatment – one that must be delivered within just a few hours.

But a new study released in Neurology estimates that some 58,000 patients go to the emergency department every year in the United States after waking up with the symptoms of a stroke.

In those cases, nobody really knows when the stroke began, so doctors do not prescribe the most common treatment for ischemic strokes (those caused by clots, as opposed to a brain bleed)  – a medication called tissue plasminogen activator (tPA).

That’s because after a few hours the risk of hurting a patient outweighs the potential of helping with the treatment.

Ischemic strokes, caused by clots blocking blood from flowing to the brain, make up the vast majority of strokes.

The study author hopes that one day other techniques will reveal when a stroke began.

“Imaging studies are being conducted now to help us develop better methods to identify which people are most likely to benefit from the treatment, even if symptoms started during the night,” said study author Dr. Jason Mackey of the University of Cincinnati.

But those imaging techniques are still in development.

Researchers found that 98 of the 273 wake-up strokes used in their study would have qualified for the clot-busting treatment if medical staff could only have known when the stroke symptoms began.

The study also found people with wake-up strokes to be, on average, slightly older – 72 years of age versus 70 years of age for strokes beginning while awake.

Wake-up stokes were also slightly more severe on average than non-wake-up strokes.

Signs of stroke include sudden numbness in the face or limbs, and sudden difficulty with speech and understanding.

“People think stroke symptoms will go away,” says Mackey. “It’s important to emphasize that 911 be called immediately.”

This study used information about 1,854 ischemic strokes presenting to an emergency department in the Greater Cincinnati region.

soundoff (33 Responses)
  1. Julie Labrouste

    Perhaps the illustrious and all-knowing American Medical Association and Surgeon General should start insisting that people are tested early for Factor V Leiden BEFORE they have deep vein thrombosis, strokes, cerebral/pulmonary embolism, etc. and using THAT way to determine if they have this genetic (clotty) blood disorder which 5% of ALL North Americans have O.O Yeah THINK!?

    May 9, 2011 at 18:33 | Report abuse | Reply
    • Fiona

      Dunno about your insurance, or your doctor, but if I told my doctor there was a history of strokes in my family and I'd like to be tested, she would order a test. If you want a test done, discuss it with your doctor. If your insurance doesn't cover it, cover it yourself if it's that important to you.

      BTW, I had a small stroke many years ago (I remember the numbness on one side of my face and one arm, and a slight sag in one cheek for a bit) and found out what it was only when I had an MRI done twenty years later for something else. I was so young when the incident occurred that i never thought it could be a stroke. I thought it was just a particularly bad migraine. I was also uninsured and unemployed and thought it was wrong to go to emergency if I had no way to pay the bill, so I didn't have that knee-jerk reaction that I needed to get to a hospital immediately. Many people don't realize it when they experience small strokes.

      May 9, 2011 at 20:13 | Report abuse |
    • The_Mick

      Thanks for the advice. I saved the Wikipedia page on Factor V Leiden to my "Health Stuff" folder. My next-door neighbor was extremely active until age 80 when he had his first stroke. He had a couple more and was dead by 82. I'm hoping to make it at least to my late 80's, as every uncle or aunt who didn't smoke did.

      May 10, 2011 at 11:07 | Report abuse |
    • Debbie

      Fiona – that was highly irresponsible of you. What if you had ended up paralyzed as a result of that stroke? You would have been a bigger drain on society than the cost of seeking help for your stroke symptoms. Did you ever find the underlying cause of your stroke? Untreated cardiovascular diseases will lead to many significant health problems down the line. I know, I had a stroke 10 years ago when I was 39. Woke up partially paralyzed. I had insurance, but not great insurance. I had $10,000 of medical bills as a result, and it took awhile to pay them off, but hospitals are willing to work with people and set up long term payment plans. I don't believe in frivolous trips to the hospital, but there is nothing frivolous about a stroke. Early treatment and prevention for most major illnesses (including cardiovascular diseases) is much more economical than the long term health care costs of treating the full blown effects.

      May 10, 2011 at 15:28 | Report abuse |
    • Cabell

      Debbie: You are being ignorant and offensive. Fiona clearly stated that she thought she had a particularly bad migraine, which would not have benefited in any way from an (expensive) trip to the ER. One of the many side effects of a for-profit healthcare system in which coverage is not guaranteed is that people will not seek medical care if they have any doubt that it is not necessary for their survival.

      I had a DVT at the age of 23, and if I hadn't had health insurance, I doubt I would have gone to the ER–I wouldn't have risked thousands of dollars of medical debt for "no reason." I would have ended up dead or permanently disabled, and it wouldn't have been my fault for being unable, at age 23 with no medical degree, to diagnose the symptoms of a DVT. It would have been the fault of a country that happily denies its citizens any guarantee of basic medical care if they make the mistake of not being well-off.

      It's very nice that you were able to eventually pay your medical bills, but no one should be placed in the position of having to decide if their symptoms are "serious enough" to take the chance that they'll need a $10,000 payment plan.

      May 10, 2011 at 22:58 | Report abuse |
    • -JMW

      So you want to screen 400 million people with an expensive genetic test? And do what? Anti-coagulate all people with positive results, even if they've never had a clotting episode? And then what? Treat all the bleeding complications in all the people taking anticoagulants? And where will the money come from for all of this, in a system that is already bankrupting the economy....?

      I realize you, or someone close to you, had a tragedy related to this disorder. But you can't advocate healthcare policy based on this, you need to consider costs and analyze statistical data to know how best to approach the situation.

      May 11, 2011 at 07:39 | Report abuse |
  2. death is better

    If you have to have a stroke, pray that it just kills you outright. Living partially paralyzed (as in poor breathing, swallowing and coughing) or partially vegetabilized is a hell that nobody should experience directly or as a long-term caregiver. Sometimes death is better than life. I had two grandparents stroke out. One lived without true awareness for 8 years and the other about 2 weeks before he contracted aspiration pneumonia and died. He couldn't swallow properly or cough or feed himself. His hell was brief. I never want to live through that. Full occlusion please.

    May 9, 2011 at 22:08 | Report abuse | Reply
    • tusu

      So many people recover from strokes and here you are advocating people avoid help. you should be charged with a crime.

      May 10, 2011 at 07:05 | Report abuse |
    • Auntie Warhol

      tusu: dib did not advocate people avoid help; quote: "pray that it just kills you outright". I agree. I watched my grandfather live a horrible life in a wheelchair for almost 20 years after a major stroke. He told me he wished for his own death many times over that period.

      May 10, 2011 at 07:55 | Report abuse |
  3. windrider2

    Yep, I'm one of the 58,000. I had an ischemic stroke sometime during the night and woke up mid-day with left side paralysis. I was very very fortunate that it wasn't severe and I recovered almost completely. So many others are not so fortunate.

    May 10, 2011 at 00:44 | Report abuse | Reply
  4. Chris

    Did anyone else think this article was going to be about something else entirely?
    "Waking up to strokes"
    "Oh! Good morning, honey."

    May 10, 2011 at 08:34 | Report abuse | Reply
    • SoulCatcher

      If only 58,000 of us are waking up to "strokes" no wonder we have a divorce problem. LOL.

      Honestly though, this article could use a lot more information on prevention and treatment.

      May 10, 2011 at 09:19 | Report abuse |
  5. Ho-Do

    We need better stroke education. I had a stroke hit me on January 3rd, but did not realize it was a stroke. I had sudden numbness in left arm/leg that lasted for only one minute!! I thought that it was not a stroke since the numbness did not last. Three days later, the same thing happened while at work. I then went to the emergency room (they didn't find anything). While there, I had four more "attacks" of numbness. In total, over the next 4 days, I had 40 attackes of numbness that disappeared after one to two minutes. The last attack created permanent numbness (but very slight). It took an MRI with Contrast to finally detect the stroke.
    My point is: I did not know that the stroke would cause such short-lived numbness. Had I known, I would have sought out help after the first attack. Age- 49. Determined cause: Protein S Deficiency.

    May 10, 2011 at 09:36 | Report abuse | Reply
  6. handyman

    Not all hospitals treat strokes while they are happening.

    May 10, 2011 at 09:40 | Report abuse | Reply
  7. Bubba Schmo

    62.3% of people who read CNN news articles die of hypocondria.

    May 10, 2011 at 12:17 | Report abuse | Reply
  8. Bubba Schmo

    ...46% of the 54% of statistics are 84.2% incorrect 72% of the time.

    May 10, 2011 at 14:29 | Report abuse | Reply
  9. stone

    My sister had a stroke in her sleep at 16. Its been almost four years since then. Was pretty severe. She recovered only about 80%. To this day they still have been unable to give a cause. Just have a bunch of problems that they can't decide caused the stroke or are because of the stroke. Its been a very frustrating experience. I'm a little disappointed in this article. It gave me false hope for an answer.
    She's still my hero. Her recovery has surprised most of her doctors.

    May 10, 2011 at 14:57 | Report abuse | Reply
  10. Tina

    I suffered from 2 Minor strokes last year and I am in my upper 20's. I was told i would have a full recovery.. and I did... it took weeks of therpy and now i could use my left arm/hand. The cause was undetermined in the hospital, but later on after a few follow ups, turns out I have a blood clotting disorder, called APS.. I am now on blood thinners and take extra when I travel abroad..

    May 10, 2011 at 15:47 | Report abuse | Reply
  11. billy

    Every morning I wake up I have to stroke.

    May 10, 2011 at 19:16 | Report abuse | Reply
  12. ThatGirl

    My sister took a 2-hour nap last October and woke up with left-side numbness. She's 37 years old. Six weeks later, my dad had the exact same thing; he's 55 years old. Both went to the ER, however, the cause was never found. They both suffered a stroke called a lacunar infarct. Later we read that the number of stroke patients is increasing rapidly. My dad was able to recover almost 100%, but my sister still has tingling and numbness on her left side. 🙁

    May 11, 2011 at 03:17 | Report abuse | Reply
  13. -JMW

    The downside to tPA:

    People need to know a few things. First, strokes can be difficult to diagnose. I see dozens of people who are "numb" and "tingly" every day and the overwhelming majority are NOT having a stroke, but rather "stroke phobia". Finding the true stroke out of the dozens of hypochondriacs can be very challenging. Second, treatment for stroke is poor. The only FDA approved medication is a clot dissolving agent called tPA. Up to 13% of people receiving this drug will suffer a life-threatening bleeding complication. Most people have no significant improvement. A small percentage will have slightly more neurologic functioning at 9 months out, after rehab has been completed, than people who did not receive the drug.

    In other words, some given the drug will bleed and die, and a few might be slightly better off in several months. Does this sound like a worthwhile treatment to you? Think about this when you rush to the hospital.

    May 11, 2011 at 07:48 | Report abuse | Reply
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