Nurses Need to Consider Youths' Risks for Stroke
Monday, August 23, 2010
By: Marylisa Kinsley, RN

Nurse.com

There is an old saying about diagnostics: “When you hear thundering hooves, think horses, not zebras.” When Julia*, a 28-year-old event organizer, arrived in the ED complaining of a severe headache on the left side of her head, the staff heard she had attended a wedding the night before and diagnosed dehydration. As she was signing her discharge form, she told them it was hard to write, but the staff dismissed it. Two days later, she returned to the ED and an MRI revealed an ischemic stroke. Everyone was thinking horses — Julia was riding a zebra.

Not Your Typical Stroke

Strokes are much more common among the elderly, but the American Stroke Association reports annually about 15,000 people have their first cerebral infarctions by the age of 45. A study presented at the ASA 2009 International Stroke Conference indicated that the problem in younger people often is initially misdiagnosed, costing valuable time.

Sandra Goodman, RN, CPNP, clinical coordinator of the division of pediatric neurology at Maimonides Medical Center in Brooklyn, N.Y., says any symptoms that appear suddenly should be taken seriously. “If you’re thinking complex migraine, you should think stroke,” she says. Goodman says the availability of MRIs, the gold standard for differentiating between hemorrhagic and ischemic strokes, aids in making the diagnosis.

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