By AMERICAN HEART ASSOCIATION NEWS
A finger-to-nose test could help emergency medical workers better recognize a kind of stroke that affects the back of the brain, according to preliminary research released Thursday.
Training paramedics in this simple assessment during a small pilot project in southwestern Michigan nearly doubled the number of posterior strokes they were able to recognize. The coordination test asks patients to touch their own nose and then extend their finger to touch the examiner’s finger, going back and forth without difficulty or missing.
“It is potentially a fairly elegant solution to one aspect of the stroke recognition problem,” said Dr. John Adam Oostema, who led the project. He is associate professor of emergency medicine and director of neurological emergency medicine research at Michigan State University’s College of Human Medicine. “The findings are preliminary and with a pretty small sample size. But we were impressed with the degree of improvement we saw.”
The research, funded by the American Heart Association, was presented at the American Stroke Association’s International Stroke Conference. The meeting dedicated to the science of brain health gathers researchers and doctors from around the world.
Stroke is the No. 2 cause of death in the world and a leading cause of serious disability. Typically, most clot-caused ischemic strokes occur in the front, or anterior, part of the brain where most of the blood flow is provided by a pair of carotid arteries.
About one in five strokes, closer to about 15 percent in Oostema’s research, occur in the back, or posterior, an area that gets most of its blood from two vertebral arteries in the back of the neck.
Many of the symptoms for strokes in both regions are similar, such as face drooping, arm weakness and speech difficulty. The popular acronym F.A.S.T. encompasses each of those symptoms, with the “t” representing “time to call 911.”
But those symptoms can be milder in back-of-the-brain strokes – and accompanied by vertigo; nausea and vomiting; balance and coordination difficulty; and partial loss of vision or double vision.
These less-recognized symptoms can sometimes cloud the picture for paramedics and doctors. Oostema said research shows patients with posterior strokes are less often given the clot-busting drug called alteplase, or wait longer to receive it. Doctors give it intravenously, and if delivered quickly enough after a stroke, it can reduce death and disability.
“Posterior strokes have been shown in a few studies to get care slower,” he said. More training “could reduce the disparity in treatment times.”
Oostema and fellow researchers compared the recognition of posterior strokes between paramedics who received a 30-minute online standard training in stroke screening with those who received standard training plus in-person training in the “finger-to-nose test.”
–Paramedics trained in the test recognized 12 out of 16 posterior strokes, 75 percent. In the 12 months before training, they identified 9 out of 26, or 36 percent.
–Paramedics without the finger-to-nose training recognized 13 of 28 posterior strokes, or 46 percent. In the 12 months before, they identified 10 of 36, or 28 percent.
Oostema is working on the scope and funding for a larger-scale study. If the results stand, he hopes to eventually have the test be part of standard training for paramedics across the country.
Emergency medical service workers are a critical part of the front lines of identifying this under-recognized kind of stroke, he said. “They are a valuable part of the stroke system.”
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