Should sudden visual impairments be included in the test that detects strokes?
Paralysis and speech difficulties are signs of a stroke in seven out of ten victims. Vision problems are the only symptom in some people. The Norwegian Directorate of Health is now considering including disturbances in vision in new campaigns.
"Facial weakness, arm weakness, speech problems" has become a rule of thumb for strokes in information campaigns in recent years. If you suddenly experience problems talking, smiling, or raising your arms, it could be a sign that you have had a stroke.
Recently, forskning.no wrote that many people may have other symptoms of stroke than paralysis (link in Norwegian). This particularly applies to women, several new research studies show.
A number of female neurologists advocate in the Journal of Norwegian Medical Association (Tidsskriftet.no) that the guidelines for EMTs must be changed (link in Norwegian).
Considering including vision
Sciencenorway.no has asked the Norwegian Directorate of Health about what they are going to do with the new research that shows women can have other symptoms than men.
They say they are now considering whether vision problems should be included in the campaigns in Norway.
“We are closely following developments in the field, and earlier this year sent a request to our collaborating professional communities for an assessment of whether vision problems should be included as a symptom of stroke in our campaigns,” Department Director Liv Heidi Brattås Remo at the Norwegian Directorate of Health writes in an e-mail to sciencenorway.no.
- In 2020, sciencenorway.no wrote about the topic: Problems with vision after a stroke often overlooked
Sudden vision problems can be an acute stroke
A sudden and noticeable change in vision, such as double vision, loss of vision in one eye or loss of peripheral vision in both eyes can be a sign of a stroke.
Six per cent of the patients reported that they experienced problems with their vision in an early phase, and no other symptoms, according to figures from the Norwegian Stroke Registry (link in Norwegian).
“The problem is that many people don’t know that such sudden vision problems can be signs of an acute stroke that requires rapid admission to hospital for optimal treatment,” five researchers point out in this article from last year (link in Norwegian).
Risk factors for strokes:
- High blood pressure
- High cholesterol
- Atrial fibrillation
- Have suffered a previous stroke
(Source: Norwegian Stroke Registry)
Needs to be included in the test
The five researchers believe that "Se" (see) must be included in the test, so that it becomes: “If you have problems talking, smiling, lifting or seeing, it’s time to call emergency services!”
Paralysis and speech problems apply to 70 per cent of those affected by stroke.
However, it is problematic that the informational campaign does not include the rest of the symptoms, so that more people affected by stroke are detected, they point out.
“In other countries, symptoms from vision and balance have been included, which has led to more strokes being detected,” the researchers write.
Many wait and see – don’t get treatment fast enough
The researchers have discovered that many stroke patients choose to wait and see what happens with their vision problems before they contact the healthcare system.
This leads to delayed treatment, which is crucial to saving visual function, they write.
Studies have shown that over 60 per cent of those who have a stroke develop a problem with their vision. Last year, 9,158 strokes were registered in Norway.
This means that over 5,500 people have to learn to live with a visual impairment every year.
Afraid of complicating the message
Nevertheless, Liv Heidi Brattås Remo conveys that there is a risk of complicating the message if they add more symptoms.
“We believe that part of the success behind the "talk, smile, lift" campaign we have in Norway has been the very simple and short message,” she points out.
The question becomes whether it is right to expand this test with one more element, when it affects a relatively small proportion of patients, with the risk of complicating the message so that some may miss the other larger symptom groups, Brattås Remo writes.
The Norwegian Directorate of Health will continue to work with the professional communities in this area to evaluate possible changes to any subsequent campaigns.
Translated by Alette Bjordal Gjellesvik.
Norwegian Stroke Registry: Annual Report 2021 (link in Norwegian)