“Whispering stroke” symptoms may damage health, lower quality of life
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People who have stroke-like symptoms but no stroke diagnosis incur physical and mental damage that significantly lowers their quality of life, according to a report in Stroke: Journal of the American Heart Association.
In a study reviewing data from more than 21,000 people, those reporting stroke-like symptoms had functional impairment similar to that of people who had a history of transient ischemic attack (TIA), which is sometimes called “mini-stroke.” Because almost 20 percent of people older than age 45 may have vague or “whispering stroke” symptoms, the condition poses a major public health problem, said study author George Howard, Dr.P.H.
“Silent” strokes are diagnosed with brain imaging that detects damage in people who did not have any apparent stroke symptoms. However, some silent strokes may be better described as “whispering” because there are symptoms, but they are so minor that they don’t alarm the patient or raise concern to physicians.
“Many clinicians argue that there is no need to do an extensive workup for vague symptoms, but these vague symptoms substantially lower a person’s quality of life and cause cognitive impairment and possibly other harmful effects that potentially indicate a silent stroke,” said Howard, chair of biostatistics at the University of Alabama at Birmingham School of Public Health.
The warning signs of stroke 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.
“People need to take these symptoms more seriously and see a doctor about them,” Howard said. “Physicians also should take the symptoms more seriously when patients have them.”
The findings came from the ongoing study called REGARDS (REasons for Geographic And Racial Differences in Stroke), which is investigating why stroke risk varies by geography and race.
Half the study population comes from the so-called Stroke Belt comprising North Carolina, South
Carolina, Georgia, Alabama, Mississippi, Louisiana, Tennessee and Arkansas. About 40 percent of the study participants are black and about half are women.
Previous reports showed that 18 percent of this population had a history of stroke-like symptoms but no stroke diagnosis and that these “silent strokes” caused a decline in mental functioning.
In this study, researchers reported data on 21,803 participants who answered standardized questionnaires on their mental and physical status. A separate questionnaire assessed stroke symptoms. Overall, 3,404 REGARDS participants said they had experienced stroke-like symptoms but had no stroke or TIA diagnosis; 818 had a history of TIA; and 1,491 had a history of stroke.
Compared to people with no symptoms or history of stroke or TIA, people with stroke-like symptoms had a 5.5-point decrease on a scale of physical functioning. Participants who reported a history of weakness or numbness had larger current deficits in physical functioning.
People with symptoms had a 2.7-point lower score in mental functioning compared to those with no symptoms. That difference was greater than the decline observed in the TIA group (0.5) or the stroke group (1.6). People who reported a history of inability to express themselves or understand language had larger current deficits in mental functioning.
Analysis of individual symptoms showed that a sudden loss of ability to understand or to express verbally or in writing had the greatest impact on function. Those symptoms were associated with a four- to five-point reduction in scores on the measures of physical and mental functioning.
REGARDS participants did not have brain scans that could detect evidence of silent strokes, which affect mental functioning and increase the risk of a clinical stroke. Even so, the researchers said “it would be reasonable to assume that there is considerable overlap” in the effects of whispering stroke symptoms and silent stroke.
Howard said the report strengthens the evidence that subtle deficits that could represent whispering strokes are associated with a large public health burden.
“These results show a need for a greater awareness of stroke symptoms and a need to take these symptoms seriously,” he said. “These symptoms could indicate that a person already has had a small stroke, which greatly increases the risk of major stroke.”
Co-authors are Monika M. Safford, M.D.; James F. Meschia, M.D.; Claudia S. Moy, Ph.D.; Virginia J. Howard, M.S.P.H.; LeaVonne Pulley, Ph.D.; Camilo R. Gomez, M.D. and Martha Crowther, Ph.D.
The National Institute of Neurological Disorders and Stroke funded the study.
Editor’s note: For more information on stroke, visit the American Stroke Association Web site: strokeassociation.org.
Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
NR07– 1169 (Stroke/Howard)
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