Amanda Ferguson (45) suspected drugs in the accident and amergency department. Jesse North (25) was diagnosed initially with vertigo in the emergency room but too was suffering with an early onset brainstem stroke.
Steven Cassidy said ‘my mum was 49 and was diagnosed as having an alcoholic seizure.’
Model Kati (20) was clinically assessed to be on drugs or having epilepsy. For twenty years, she has lived with the long term locked in syndrome. Our pre-judgements can be catastrophic.
Rachel Capps was a bit of an enigma when she presented with her symptoms to A & E staff, so they gave her a shot of adrenalin and by doing so inadvertently sped up her full blown devastating stroke!
Brin Helliwell (47) had a bike accident so his shoulder was treated and stitched before he being discharged fit and healthy. Just eight hours later Brin survived a massive right hemispshere aschaemic stroke.
Linda Jones said her son (37) ‘made several trips to his doctor and the emergency room but no one suggested his were early onset stroke symptoms until after he had the stroke.’
My story started with a catastrophic misdiagnosis by a junior doctor in A & E on 7 February 2010. I presented with slurring and the most piercing headache. I had a severe pain in the base of my head and was unable to look at light. I was 39, an obsessive fell runner, business owner, mother of three dependent children, married with almost no family support.
Clearly, my stress diagnosis seemed reasonable didn’t it? I wasn’t offered a CT or MRI scan.
My blood pressure was in normal range, though very high indeed for a very fit runner. The doctor told me to ‘go home to rest and take some cocodamol!’ By the way, I’d never had migraine in my life. Five hours later I collapsed at home half an hour away from hospital with a right vertebral artery dissection, occlusion and infarction and required months of hospital rehabilitation, let alone years of my private convalescence.
I could go on for days with case studies from stroke survivors including; complex migraine, vertigo, dizziness, double vision, stress, being drunk/drugs, food poisoning, epilepsy, pinched nerves to meningitis. But what are my solutions?
Well stroke campaigner Brin suggested getting a second opinion in A&E within 4 hours of attending A & E. I wonder, is this routine?
I have my own personal and professional opinions on how to reduce early onset young stroke misdiagnosis in emergency departments too.
Firstly, have an independent systematic review of younger stroke survivors case studies. We feel fobbed off that our anecdotal stories are not admissible, yet we don’t have any evidence-based research of cases studies as people leave specialist stroke units.
Secondly, MRI testing/results must be available 24/7, seven days a week in A & E for patients who present there first with persistent headaches which haven’t abated with paracetamol but have lasted 72 hours plus. Thirdly, A & E doctors should perform intra-arterial thrombolysis (t-PA) treatments within the first three hours of stroke symptoms in the emergency room or ambulance.
Fourthly, there still appears to be a clinical stroke age-bias which discriminates against young people in A & E. Anyone with a brain can have a stroke! The stroke F.A.S.T awareness works well for the public I think, but it’s far too simple as a clinical diagnostic tool in A & E.
ROSIER was age-biased too, so I came up with my own acronym which I think would be a more accurate in a clinical setting.
B.Y.E.F.A.S.T or Balance, eYesight, hEadache, Face, Arm, Slurring and Time to call 999 would be more thorough I think. I wouldn’t use hospital posters to raise awareness with hospital staff, but exploit social media channels – where clinicians actually hang out – to spread this message to frontline medical professionals.
Tweetchats, forums, Facebook groups, Linkedin professional networks, could all be used to raise clinical awareness. In fact, I think we are quite poor at exploiting social media generally to reduce our health costs and improve health outcomes, though that’s a different blog!