Perceptions of stroke in the general public and patients with stroke: a qualitative study
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7345.1065 (Published 04 May 2002) Cite this as: BMJ 2002;324:1065
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The paper about the public understanding of symptoms of stroke has an
interesting design in contrasting the views of a group of the general
public with people who have had a stroke.
The article would be more interesting to read (and pass around) if it
had included a list of the main symptoms of stroke. For the non-clinical
readership, please could you publish a list of the main symptoms?
In appreciation,
Chloe Mason
Competing interests: No competing interests
Sirs,
S.S.Yoon and J.Byles’s article conclusion (1) is interesting, in my
opinion, not only as far as facing stroke early diagnosis in general
public is concerned, but, more remarkable, as regards perceptions in the
same people of serious disease and patients involved by a large variety of
grave disorders. For example, I mean thoracic and/or arm pain, appearently
trivial, in patients with initial myocardial infarction.
This paper
intriguingly underscores the need and utility of “simple” tools and
manoeuvres, reliable, at the beach as well as in the mountains, in
clinical and prompt recognising serious diseases, unavoidable in order to
prevent future morbidity or mortality. A 45-year long clinical experience
allows me to state that general public “could” recognise, e. g., a stroke,
a part from its clinical symptomatology, by the simple following manouvre:
digital pressure, applied “gently” on an eye-ball (after the subject’s
eyes are closed in some way,of course), homolateral to stroke site, brings
about face muscles slight contractions, absent, by contrast, when digital
pressure stimulates controlateral “trigger-points”.
Obviously, doctors,
using a stethoscope, are able to assesse a lot of biophysical-semeiotics
signs during the same maneouvre, I have illustrated previously (2,3,4)(See
in the site HONCode 233736, http://digilander.iol.it/semeioticabiofisica,
Cerebral Tumour, and Bibliography).
1) Yoon S.S., Byles J. Perceptions of stroke in the general public and
patients with stroke: a qualitative study. BMJ 2002;324:1065 ( 4 May ).
2) Stagnaro S., Auscultatory percussion of the cerebral tumour: Diagnostic
importance of the evoked potentials, Biol. Med., 7, 171-175, 1985.
3) Stagnaro S., Auscultatory percussion of the cerebral tumour: Diagnostic
importance of the evoked potentials, Biol. Med., 7, 171-175,1989.
4) Stagnaro S., Valutazione percusso-ascoltatoria della microcircolazione
cerebrale globale e regionale. Atti, XII Congr. Naz. Soc. It. di
Microangiologia e Microcircolazione. 13-15 Ottobre, Salerno, e Acta Medit.
145, 163, 1986.
Competing interests: No competing interests
stroke knowledge
We read with interest the article by Yoon and Byles (1) in 4th May
issue of the BMJ. The authors found their subjects had poor recognition of
stroke symptoms and risk factors. Lack of knowledge results in delays in
seeking medical care (2). As a result, patients with stroke may fail to
gain the benefits of acute treatments eg acute thrombolysis due to the
narrow therapeutic window (3).
We conducted a large prospective questionnaire study amongst elderly
patients attending a United Kingdom hospital clinic (4). Patients with
established stroke risk factors (atrial fibrillation, diabetes,
hypertension, previous stroke, TIA) were interviewed. 410 patients (mean
age 78 years) gave their responses to a semi-structured questionnaire. 82%
patients could identify the stroke symptoms correctly and the remainder
were not sure/incorrect. 10% thought that stroke is caused by damage to
the heart while 86% correctly correlated stroke with brain damage. On free
recall, 65% correctly identified at least one established stroke risk
factor and 35% did not know a single risk factor for stroke. The commonest
perceived risk factor was ‘stress’ (reported by 52%) and the second
commonest was hypertension (48%). When subjects were asked to choose
stroke risk factors (on closed ended questionnaire containing both correct
and incorrect responses) stress was again identified as the commonest
factor (62%). A large number of subjects reported other incorrect stroke
risk factors eg liver disease, cold, no rest. Only 15% patients considered
themselves to be at higher risk of stroke because of underlying disease.
Very few subjects (22%) had been informed by a health professional that
their underlying condition predisposed them to stroke.
Our results show that there is incomplete understanding about stroke
symptoms, risk factors, perceived risk and organ affected amongst at risk
population in a civilized world. We agree with the authors that
educational strategies are urgently needed to remove misconceptions and to
enable patients in seeking medical help and therefore the benefits of
early stroke treatments (5). Effective educational programs could also
increase public awareness of stroke in the population.
References :
1. Yoon SS, Byles J. Perception of stroke in the general public and
patients with stroke : a questionnaire study. BMJ 2002; 324: 1065.
2. Williams LS, Bruno A, Rouch D et al. Stroke patients knowledge of
stroke : influence on time to presentation. Stroke 1997; 28:912-15.
3. National Institute of Neurological Disorders and Stroke recombinant
tissue plasminogen activator Study group: TPA for acute ischaemic stroke.
N Eng J Med. 1995; 333: 1581-87.
4. Gupta A, Thomas P. Knowledge of stroke among elderly patients at
increased risk of stroke. Abstract. JAGS 2000; 48: S76.
5. Panicoli AM, Broderick J, Kothari R et al. Public perception of stroke
warning signs and knowledge of potential risk factors. JAMA. 1998;
279(16): 1288-92.
Competing interests: No competing interests