Is it a stroke? Diagnosing by email

Source: Down Maine Veterinary Clinic

Click photo for larger view.

There’s an email that makes the rounds on the Internet about three signs for identifying a stroke: Can the person smile, raise both arms, and speak a simple sentence.
“The Smile Test” was originally presented at a conference hosted by the American Stroke Association (ASA) in 2003. The ASA makes a point of not endorsing this test as a way to identify stroke. The research that came up with these three signs was based on a very small study.

Stick out your tongue

Since 2006 there’s been an additional sign of stroke circulating in emails: Ask the person to stick out their tongue and see if comes out straight or if it’s “crooked,” that is, if it deviates to one side. This is a less reliable indicator of stroke simply because “crooked” is open to interpretation.

True deviation of the tongue is an indication that something is wrong, though it’s not necessarily a sign of stroke. Bell’s Palsy, for example, can present with tongue deviation. For thousands of years deviation of the tongue has been recognized as a symptom of what’s called “Wind Stroke” in traditional Chinese medicine.
Rather than ask a patient to stick out their tongue, a doctor will tell a patient to push into each cheek with the tongue. By pressing on the tongue through the cheek — “push back and resist my fingers” — the doctor can tell whether one side is stronger. You want both sides to be the same.

The signs of stroke

The actual warning signs of stroke, according to the ASA, are:
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause
There’s another email about stroke that you should definitely ignore. It advises drawing blood from all ten fingertips and suggests that this is all you need for recovery. You should always call 911 if you suspect a stroke.
Another circulating email says that if you get treatment for stroke within three hours, the damage can be completely reversed. The actual recommended time is sixty minutes, and although rapid treatment is extremely important, this doesn’t guarantee there won’t be permanent damage.

It’s a good thing

On the whole, I think emails about “The smile test” — even the tongue deviation email — are valuable. An email with the ASA warning signs would be even better.
Most strokes are preceded by a transient ischemic attack (TIA) or mini-stroke. The symptoms are identical, but of short duration. Since TIAs are “transient” – they happen quickly and then disappear – they’re easily dismissed. But TIAs are extremely important predictors of stroke and shouldn’t be ignored. An email reminder about TIAs might motivate someone to see a doctor, and that would be good.
For more on healthy and unhealthy tongue characteristics, from the perspective of traditional Chinese medicine, I recommend Beyond Well Being: Tongue Diagnosis.
Related Posts:
Is the Internet bad for your health?
Are you a supertaster: Look at your tongue