When Is It Critical To Say “Stick Out Your Tongue”?

Why did a 28 year friend of mine survive a stroke when a stroke destined another to spend the rest of his life disabled? The reason is that some people are “stroke smart”. They know that speed often determines the difference between walking again, or being confined to a wheelchair. And it’s easy to be “stroke smart”. You only need to remember the first three letters of stroke, STR.

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Stroke is the third leading cause of death in Canada and the U.S. But it’s the # One cause of adult disability. Dying is not a good thing, but being severely disabled from stroke may be a worse fate. Unfortunately, only three percent of stroke victims are treated within the first crucial three hours of attack. There are two kinds of stroke. “Blockage strokes” are most common, in which a blood clot forms in an artery and prevents oxygenated blood from reaching the brain. The other type happens when an artery, like a flat tire, suffers a blowout and its leakage destroys brain tissue. Whether or not a stroke occurs usually depends on the condition of the arteries. Sir William Osler, one of the world’s most famous doctors, said patients were lucky if they were born with “good rubber”. He meant it was good to have soft, pliable, arteries rather than ones hardened by atherosclerosis, a cause of hypertension. Sometimes an impending stroke can be diagnosed before it happens. When dark clouds appear before a major storm, we know it’s wise to seek cover to avoid getting soaked or struck by lightning. Fortunately, some patients, before a major stroke happens, recognize danger when they suffer loss of vision or numbness that lasts only a few seconds. This signal is called a transient ischemic attack (TIA), and is due to decreased blood supply to the brain. So never take the attitude, “I’ll wait and see if it happens again.” These symptoms provide an opportunity for treatment to prevent paralysis or death. But these smaller strokes are less noticeable and precious moments may be lost in getting medical attention. I recall many years ago meeting my Father at the airport on his return from a business trip. He was a proud Scot who never liked to bother anyone and said he felt good. But I could see there was a problem. A corner of his mouth was sagging. He had had a small stroke and unfortunately had not seen a doctor for speedy treatment. The first three hours following a stroke are of vital importance in order to prevent permanent brain damage. Patients who have a blocked artery need to receive a drug called TPA to dissolve the clot. But administering TPA to a patient who has a ruptured artery will cause more brain damage. And some hospitals do not have the staff or equipment to make this crucial diagnosis. Unfortunately, where you live and what hospital is involved may determine the outcome. So what can everyone do to prevent a disastrous delay in treatment? How a stroke affects patients depends on where the stroke occurs in the brain and how much the brain is injured. In some cases the diagnosis is obvious. For instance, when a large stroke causes immediate paralysis on one side of the body or when the patient is suddenly unable to speak, few need to be told to call 911. But in less dramatic situations when you’re unsure what is happening, remember the first three letters of the word stroke, “STR” and ask the person these three questions. S - Stick out your tongue. See if it’s crooked or flops to one side. If so, it’s a sign of stroke. T- Ask the patient to talk. If he or she can’t say a simple sentence, it’s another clue that a stroke has occurred. R- Can the patient respond to a simple request such as lifting an arm. If not, or if one or more of these tests is failed, immediately call 911. The message is that sticking out the tongue isn’t just for diagnosing a sore throat. And remembering three letters can help people walk again.