A Needle Can Save A Stroke Patient?

Answer 1

The information contained in this e-mail, credulously spread around the internet, is both wrong and dangerous. Anyone believing and following its advice would almost certainly cause harm.

First let me dispense with the claims that are made - primarily that minute bleeding through finger or earlobe pricks will prevent permanent damage from a stroke.

There are actually several kinds of stroke. The term refers to the presentation of symptoms - stroke-like or sudden in appearance. The two main types of stroke are hemmorhagic and ischemic. Hemmorhagic strokes are caused by bleeding into the brain. Ischemic strokes are caused by lack of blood flow to a portion of the brain, and are further divided by the cause of the blockage. Ischemic strokes can also secondarily bleed from the damage to the brain tissue and its blood vessels.

There is no situation in which all of the capillaries in the brain burst - this is not part of a stroke. The closest thing to this that actually occurs is that an ischemic stroke may subsequently bleed, but there is no evidence or any plausible reason to think that any of the things mentioned in this e-mail would lead to or prevent secondary bleeding.

Further, pricking the fingers or earlobes would cause (thankfully) a negligible amount of bleeding and would not in any way affect the stroke victim's hemodynamics. And if it did,that would just worsen the stroke by decreasing brain perfusion and oxygen delivery.

Next, let's take a look at the specific recommendations of this e-mail to see how harmful they are. The recommendations begin with statement "when a stroke occurs," but it is not possible to say by observation alone when a stroke has occurred. All that you can tell from symptoms and examination is that a "stroke-like event" has occurred. Stroke-like symptoms can be caused by a seizure, a bleed, or a true ischemic stroke. There is no way to tell the difference without imaging. The management will depend upon an urgent X-ray - usually a CT scan.

The e-mailer then advises not to move the patient, but there is no reason not to move a stroke victim. Then is says to sit the patient up. If the patient has a bleed sitting up (to a degree) may be helpful. But if they have an ischemic stroke then sitting up with further impair blood flow and make the stroke worse. Again, there is no way to tell without a picture which kind of stroke a patient has, but most are ischemic so this advice is likely to cause harm by worsening the stroke.

The bleeding, as I mentioned above, is worthless but it does serve to delay getting the stroke victim to proper care. We have a saying in neurology, time = brain. There is a public health campaign to treat stroke like a "brain attack" and to get patients to emergency medical care as soon as possible. This kind of nonsensical misinformation works directly against these efforts by telling people to waste a considerable amount of time before doing anything useful.

The next statement is even worse - wait for the patient to regain consciousness (most stroke victims actually don't lose consciousness) and for the symptoms to resolve. Wow - that is exactly the opposite of what you should do. Do Not wait for the symptoms to resolve (which may not occur or may take hours), get the patient as quickly as possible to the nearest emergency room. A bumpy ride will not burst the capillaries, delaying emergency care will cost brain tissue.

Delaying treatment is even more of a bad idea these days because of the use of TPA - a clot-busting drug that can reverse some strokes. In order to use TPA a stroke victim must come to medical attention very quickly. The drug can only be given within three hours, so arrival at the ER within two is usually necessary. But any delay could lose the opportunity to treat with TPA.

What about the anecdotal evidence of success? Well, there is no compelling reason to believe anything contained in this e-mail. It has all the markings of urban legend SPAM. However, many strokes are actually what we call transient ischemic attacks, or TIA's. TIA's, by definition, completely resolve on their own within 24 hours, but most will resolve within 10-15 minutes. Therefore treating a TIA with any method will often correlate with a complete resolution of symptoms. This, of course, proves nothing.

Conclusion

The claims made in this e-mail are absurd from a physiological/medical point of view and the recommendations based upon them are actually dangerous and almost certain to cause harm, mainly by delaying appropriate diagnosis and care in the setting of a genuine medical emergency.