# "stuttering stroke"



## Wingnut (Apr 15, 2005)

Anyone ever hear of this? My husband's grandfather was admitted yesterday for a stroke and they couldn't find the clot, they diagnosed this today. I'm getting all this info second hand, so nothing is very clear. I know I'm new to EMS but not to medicine altogether, I've never heard of this kind of stroke. A pinhole in a blood vessel deep in the brain that is bleeding and all they can hope for is that it clogs...

I'm googling it...


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## MMiz (Apr 15, 2005)

[Topic moved to right / more correct forum]

I've never heard of it and even google doesn't have a ton of clinical information on it.

How is he doing?  Keep us updated, and hopefully someone may be able to provide more insight.


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## emt3225 (Apr 16, 2005)

> _Originally posted by Wingnut_@Apr 15 2005, 09:40 PM
> * Anyone ever hear of this? My husband's grandfather was admitted yesterday for a stroke and they couldn't find the clot, they diagnosed this today. I'm getting all this info second hand, so nothing is very clear. I know I'm new to EMS but not to medicine altogether, I've never heard of this kind of stroke. A pinhole in a blood vessel deep in the brain that is bleeding and all they can hope for is that it clogs...
> 
> I'm googling it... *


 there is a hemorrhagic stroke which causes intracranial hemorrhage which is when a small vessel deep within the brain tissues ruptures..this usually occurs in hypertensive people..i'm sill looking for you and if i come across anything else i will post it for you..good luck


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## Wingnut (Apr 16, 2005)

Thanks all. (sorry for putting it in the wrong spot) They're taking him for a MRI today (our hospitals don't have thier own) so I hope we'll know more after that. He usually runs hypotensive and apparently has 50-70% blockage in his carotid arteries. The right side of his face is still numb and he has limited use of his right hand, but he says he's feeling better. So I'm assuming it still must be bleeding, or there's still some ICP that's affecting him. I looked through google, webcrawler and a few others last night, didn't find much other than it can happen with hypotension in rare circumstances. I talked to a medic in my class about it today and he never heard of it either.

With all our training on strokes, even as -B's I'm suprised this one is never mentioned.


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## MMiz (Apr 17, 2005)

Usually I can depend on google to pull up lots of information on something, but even google has limitied clinical information on a stuttering stroke.  What they have is limited to "It happens" and "A stuttering stroke is..."

Keep us updated, and if you could, if you find out anything more about what it is, let us know   Thanks


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## Wingnut (Apr 17, 2005)

I'm working on it, MRI results should be today, and we're visiting him tomorrow so I can hound the doc with questions about this


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## CodeSurfer (Apr 17, 2005)

> _Originally posted by Wingnut_@Apr 17 2005, 07:58 AM
> * I'm working on it, MRI results should be today, and we're visiting him tomorrow so I can hound the doc with questions about this   *


 We probably dont learn anything about it because even as paramedics (correct me if I'm wrong) you wouldnt treat this type of stroke any different.  

Keep us posted.


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## Wingnut (Apr 18, 2005)

I'll definitely keep you posted. Now you're right, as paramedics/EMT's, this is going to present as a common stroke, which is basically transport and O2 via NC @4-6lpm, but firstly as medics, not EMT's do you treat differently? Give any drugs? And secondly, any blood thinner on a hemmoragic stroke/stuttering stroke would produce negative affects...or am I totally off my kilter and not nearly as smart as I think I am???


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## CodeSurfer (Apr 18, 2005)

> _Originally posted by Wingnut_@Apr 17 2005, 11:45 PM
> * I'll definitely keep you posted. Now you're right, as paramedics/EMT's, this is going to present as a common stroke, which is basically transport and O2 via NC @4-6lpm, but firstly as medics, not EMT's do you treat differently? Give any drugs? And secondly, any blood thinner on a hemmoragic stroke/stuttering stroke would produce negative affects...or am I totally off my kilter and not nearly as smart as I think I am???  *


 Logically it makes sense... the only problem with that is in the field there would be no way to know if it was hemmorhagic vs. embolic, you can only tell that with a CT scan or MRI.  Based on that the doctors diagnose which part of the brain the bleed is in and how to treat it from there. 

As far as I know paramedics in san diego county treat a stroke the same way basics would.  Our protocol is to expedite transport, apply appropriate O2 therapy, use the prehospital stroke scale (facial droop, arm drift, speech abnormalities) and most importantly find out when was the last time they appreared normal.  Medics in addition to that would start a line and use the heart monitor, but not give any drugs.

Stroke (Hemmorhagic)


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## TheLocalMedic (Jan 6, 2013)

*OKAY...  I know this is a super old thread but...*

Alright, I had a patient today that had what the doc was calling a stuttering stroke.  We picked him up from home, was found GCS 13 (E4 V3 M6) and only stating "I'm fine" or stating "the casino".  Just the way he looked and acted I thought it was a diabetic issue, but his BG was normal and besides mild HTN I couldn't find anything wrong with him.  I began suspecting CVA, but apart from the inappropriate verbal responses there were no other symptoms.  The RP who called it in couldn't provide a timeline for onset of symptoms, but it must have been at least a day since he was seen acting normally and his normally tidy house was in shambles.  (oh, BTW no hx, meds or allergies)

Anyhow, we transported him in, ER did labs and a CT which all came back clean and the doc didn't feel as though simply being altered gave him license to give the guy tPA, especially with no known onset time.  

5 hour later we get sent to transfer the same guy to a hospital with neuro.  When we pick him up, it seems as though he's almost 100% normal, although he's still a little fuzzy as to where he is or what exactly was going on.  His only complaint was a diffuse frontal headache.  About 30 mins en route he suddenly sits bolt upright and stares ahead vacantly, then lays back and closes his eyes.  Now he is GCS 8 (E3 V1 M4) and cannot speak and is drooling.  Just to cover my bases I did a BG check, which was fine, rechecked vitals, which were stable, and then did a base consult.  

The doctor said that he suspected the pt was having a "stuttering stroke"  where his symptoms will gradually diminish and then suddenly recur.  Sure enough, over the next hour he gradually became more alert, until when we dropped him off he was acting almost as he had before.  

I did a little online searching, but the only vague reference I found was on a UK site that mentioned stuttering stroke being caused by a narrowing in the Circle of Willis.  It described a similar symptoms progression and recession and mentioned that the pt may complain of diffuse frontal headache.  

Anyhow, thought this was interesting and decided to drag out an old thread to give it a bump!


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## mycrofft (Jan 6, 2013)

This ought to be in the Pimp Questions thread now that it isn't asking for medical advice (OP gone).


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## TheLocalMedic (Jan 7, 2013)

Indeed...  I was just trying to do a little research and this thread popped up on Google when I was searching for stuttering strokes.


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## VFlutter (Jan 7, 2013)

TheLocalMedic said:


> Indeed...  I was just trying to do a little research and this thread popped up on Google when I was searching for stuttering strokes.



EMTLife always pops up on google. I guess I should watch what I say h34r:


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## TheLocalMedic (Jan 7, 2013)

Right?  Especially since the EMS world is an exceedingly small one.


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## mycrofft (Jan 7, 2013)

TheLocalMedic said:


> Right?  Especially since the EMS world is an exceedingly small one.



Yeah, I made a blind date through the chat room and it was myself!


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## TheLocalMedic (Jan 7, 2013)

Hahaha!!!


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## msjellybean (Jan 10, 2013)

I'm a neuro & stroke RN and I've never encountered this phrase before. After a little searching, it appears to have the same meaning as an evolving CVA. Sometimes presents as a TIA and then as the ischemia worsens turns into an infarct.

Will have to ask our neurologists if this is a commonly used term.


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## FLdoc2011 (Jan 10, 2013)

I've never heard that term used.


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## TheLocalMedic (Jan 11, 2013)

I'd never heard the term used before either.  Although I did a little thinking about it, and I raised the question as to whether it was similar to an MI in which a ruptured plaque was forming a clot which was the broken down repeatedly as is seen in some coronary patients.  I've seen a few cardiac complaints where the pain "comes and goes" during the course of a day which is attributed to the clot being broken down by plasminogen only to reform.  I wasn't able to find a good answer, but maybe you see if there's some correlation?


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## mycrofft (Jan 11, 2013)

Cerebral arterial spasm?


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