CVA (stroke) is an interesting 911 call an requires a mindset much different than most others. We need to hurry to beat the clock, but remember to acquire the information necessary to make the patient's outcome as optimal as possible. We have to constantly watch for changes that may present in the most shuttle fashions.
Strokes present in basically 5 presentations, but remember as with ECGs, strokes can be as different as fingerprints and may not be as classic as the good ole text told you they would.
Our eyes are great places to looks for clues, they will often gaze in the direction of the injury during stroke, but will be opposite during events of seizures. This clue is often the first thing that helps us rule out a mimic vs a true stroke presentation. The other is the combination of focal deficits matched with the suspected area of infarction.
Left dominant presents with right sided paralysis and aphasia (either receptive or expressive unless you are left handed)
Right non dominant presents with left sided deficits and commonly left side neglect ( the pt reacts as if the side moved and has no deficits ). This is often a frustrating event for EMS due to the neglect.
Cerebellum strokes affect fine motor movement and often present with one sided ataxia ( left/right shaking. This is often a missed CVA due to the presentation of the patient. We often confuse this patient with the typical weakness times a few days due to decreased intake. We should still advise the receiving facility of the findings due to the need of preventative measures that should be taken to avoid another CVA which could include significant/debilitating symptoms.
Brainstem strokes are very significant in an EMS setting most patients don't present conscious with the ability to relay symptoms to EMS crews. Brainstem strokes can present with unusual symptoms which may include for full body paralysis (neck down) or contralateral presentations. This is to include facial droop on one side and paralysis/weakness on the other as well as vertigo weak oropharyngeal muscles, tennitis and also nausea and vomiting. Special precautions should be taken to avoid allowing patient to aspirate. Watch for watering of the eyes which may be the only symptom remaining since gag reflexes are often diminished during brainstem strokes.
Subarachnoid and intracerebral hemorrhages become a category of themselves considering that both are bleeds within the cranium, however they are different in presentation. Subarachnoid often presents as the worst headache the patient has ever had before but never presents with focal deficits. Intracerebral hemorrhage can and will often present with focal deficits that don't match typical CVA symptoms of any other sort. It is truly dependent upon how much bleeding has occurred and how much brain has shifted during the bleed.
Hopefully this information has been somewhat helpful to you, however this is only tipping the iceberg when it comes to treatment of the CVA this is merely naming stroke syndromes that could occur. I strongly encourage participation in local stroke assessment class that may better suit you when it comes to the treatments of CVA. Each of them are very different and do require a paramedic assessment that may be much different than what you were used to before. You can make a difference in the treatment of CVA. Your assessment and treatment of the CVA patient may make the difference of the individual being able to spend time walking and playing with grandchildren versus sitting in an nursing home enjoying only an occasional visit from the occasional family member.
Remember to stay safe, enjoy what you do, and keep Assesing!
