NY Times Misinformation on Strokes

A NY Times article on strokes that was very misleading:

Until two months ago, Todd McGee, 34, was a healthy man in top physical condition — a builder, surfer and devoted father of a 15-month-old. The last person anyone would expect to have a stroke.

Yet a stroke has left him nearly unable to speak, with months, maybe years, of therapy ahead. Partly because of his age and partly because of the lack of a hospital with an M.R.I. machine where he lives, no one recognized the symptoms of a stroke until it was too late to administer a treatment that could have limited the damage and speeded his recovery.

This treatment, with a drug called t-PA (for tissue plasminogen activator), can help dissolve a brain-damaging clot in the 80 percent of victims who have strokes caused by them. But it must be administered within three hours of a stroke to be effective, and the sooner the better.

About only one stroke victim in five who could benefit from t-PA receives it, primarily because people don’t realize a stroke is happening and wait too long to get to the hospital.

* * *

Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati Medical Center, said that in people under 50, trauma — often relatively minor trauma — to the carotid artery that feeds the brain is the main cause of stroke. Such trauma can occur as a result of a whiplash injury in a car accident, for example, or leaning back over the sink in the beauty salon or getting chiropractic manipulation of the neck, he said.

* * *

In reviewing Mr. McGee’s symptoms, it is easy to see why he, his partner and hospital personnel missed the cause of the problems. His first symptom was severe vomiting, which he thought was from the same “bug” that had afflicted his partner, Sue, and their daughter two days earlier. Then he got a headache, and not just any headache — “by far the very worst headache in my life,” he told Sue, who said he yelped at every bump in the road on the way to the hospital, where he was given an unrevealing CT scan and a potent painkiller and sent home.

Next, during a phone conversation, Mr. McGee began slurring his words, which he thought was a reaction to the medication. But soon after, the right side of his body went numb and he could not hold up his right arm. He went back to the hospital, where medical staff suggested that the numbness might be related to the headache, but considered it serious enough to transfer him to a major medical center.

Two days after the first signs of trouble, Mr. McGee’s problem was finally diagnosed as a major stroke, resulting from two clots caused by damage to the carotid artery, most likely from repeated trauma during surfing.

I sent the following letter to the NY Times in response:


To the Editor:

A recent article ("With Strokes, Knowledge is a Lifesaver," Dec. 12, 2006) claimed that people often fail to recognize the symptoms of a stroke, and thus fail to receive a certain clotbuster drug ("tissue plasminogen activator," or TPA) that potentially can break up blood clots in the brain if administered within a few hours of a stroke. In fact, TPA can be helpful in some circumstances, but in others it can be deadly.

For instance, the article's chief example of a stroke victim was a 34-year-old man who had an injury to the carotid artery. As it happens, I had the exact same type of stroke 3 years ago at age 29, but when I asked a stroke specialist (the late Hal Unwin) whether I should have received TPA, he emphatically said, "No. TPA is absolutely contraindicated in cases of dissection." This is because a dissection is an injury to an arterial wall, and there is a risk of hemorrhaging if the injury worsens. In the event of a hemorrhage, the last thing you want in your system is a drug that prevents blood clotting.

Sincerely,
Stuart Buck



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