STROKE STATISTICS

Each year there are many people who become casualties and fall to strokes
Stroke killed 158,448 people in 1998. It's the third largest cause of death, ranking behind "diseases of the heart" and all forms of cancer. Stroke is a leading cause of serious, long-term disability in the United States.
About 4,500,000 stroke survivors are alive today. 2,200,000 are males and 2,300,000 are females.
Data from the NHLBI's Framingham Heart Study show that about 600,000 people suffer a new or recurrent stroke each year. About 500,000 of these are first attacks and 100,000 are recurrent attacks.
In 1998 females accounted for 61.4 percent of stroke deaths.
Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke.

The 1998 death rates per 100,000 population for stroke were 57.6 (24.5) for white males and 86.4 (46.8) for black males, and 56.6 (22.0) for white females and 75.3 (37.2) for black females.


What causes a stroke?

Stroke is a cardiovascular disease that affects the blood vessels supplying blood to the brain. A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot or some other particle. Because of this rupture or blockage, part of the brain doesn't get the blood flow it needs. Deprived of oxygen, nerve cells in the affected area of the brain can't function and die within minutes. And when nerve cells can't function, the part of the body controlled by these cells can't function either. The devastating effects of stroke are often permanent because dead brain cells aren't replaced. There are four main types of stroke: two caused by blood clots or other particles, and two by bleeding or hemorrhage . *Cerebral thrombosis and cerebral embolism are by far the most common, accounting for about 70-80 percent of all strokes. They're caused by clots or particles that plug an artery. *Cerebral and subarachnoid hemorrhages are caused by ruptured blood vessels. They have a much higher fatality rate than strokes caused by clots.

What is a cerebral thrombosis?

Cerebral thrombosis is the most common type of stroke. It occurs when a blood clot (thrombus) forms and blocks blood flow in an artery bringing blood to part of the brain. Blood clots usually form in arteries damaged by atherosclerosis . One identifying feature of cerebral thrombotic strokes is that they often occur at night or first thing in the morning, when blood pressure is low. Another is that very often they're preceded by a transient ischemic attack, also called a T.I.A. or "mini-stroke."

What is a cerebral embolism?

Cerebral embolism occurs when a wandering clot (an embolus) or some other particle forms in a blood vessel away from the brain, usually in the heart. The clot is carried by the bloodstream until it lodges in an artery leading to or in the brain, blocking the flow of blood. The most common cause of these emboli is blood clots that form during arterial fibrillation , a disorder found in some 2-3 million Americans. In atria fibrillation the two small upper chambers of the heart, the atria, quiver instead of beating effectively. Blood isn't pumped completely out of them when the heart beats, so it pools and clots. Stroke occurs when the blood clot enters the circulation and becomes lodged in a narrowed artery of the brain.

What is a hemorrhage?

A subarachnoid hemorrhage occurs when a blood vessel on the brain's surface ruptures and bleeds into the space between the brain and the skull (but not into the brain itself). Another type of stroke occurs when a defective artery in the brain bursts, flooding the surrounding tissue with blood. This is a cerebral hemorrhage . Hemorrhage (or bleeding) from an artery in the brain can be caused by a head injury or a burst aneurysm . Aneurysms are blood-filled pouches that balloon out from weak spots in the artery wall. They're often caused or made worse by high blood pressure. Aneurysms aren't always dangerous, but if one bursts in the brain, a hemorrhagic stroke results. When a cerebral or subarachnoid hemorrhage occurs, the loss of a constant blood supply means some brain cells no longer can work. Another problem is that accumulated blood from the burst artery may put pressure on surrounding brain tissue and interfere with how the brain functions. Severe or mild symptoms can result, depending on the amount of pressure. The amount of bleeding determines the severity of cerebral hemorrhages. In many cases, people with cerebral hemorrhages die of increased pressure on their brains. Those who live, however, tend to recover much more than those who've had strokes caused by a clot. The reason is that when a blood vessel is blocked, part of the brain dies - and the brain doesn't regenerate. But when a blood vessel in the brain bursts, pressure from the blood compresses part of the brain. If the person survives, gradually the pressure goes away and the brain may regain some of its former function.


STROKE EFFECTS

Stroke affects different people in different ways, depending on the type of stroke, the area of the brain affected and the extent of the brain injury. Brain injury from a stroke can affect the senses, motor activity, speech and the ability to understand speech, behavioral patterns, thought patterns, memory and emotions. Paralysis or weakness on one side of the body is common.






Can a stroke affect emotions?

A stroke survivor may cry easily or experience sudden mood swings, often for no apparent reason. This is called emotional liability . Laughing uncontrollably also may occur but isn't as common as crying. Depression is common, as stroke survivors may feel less than "whole.
"
How can a stroke cause loss of awareness?

Stroke often causes people to lose mobility and/or feeling in an arm and/or leg, or suffer dimness of sight on one side. The loss of feeling or visual field results in a loss of awareness, so stroke survivors may forget or ignore their weaker side. This problem is called "neglect." As a result, they may ignore items on their affected side, have trouble reading, or dress only one side of their bodies and think they're fully dressed. Bumping into furniture or door jambs is also common. One-side neglect is most common in those with injury to the brain's right hemisphere.

How can a stroke affect perception?

A stroke can also affect seeing, touching, moving and thinking, so a person's perception of everyday objects may be changed. Stroke survivors may not be able to recognize and understand familiar objects the way they did before. When vision is affected, objects may look closer or farther away than they really are, causing survivors to have spills at the table or collisions when walking.

How can a stroke affect hearing and speech?

Stroke usually doesn't cause hearing loss, but people may have problems understanding speech. They also may have trouble saying what they're thinking. This is called aphasia . Aphasia affects the ability to talk, listen, read and write. It's most common when a stroke weakens the body's right side. A related problem is that a stroke can affect muscles used in talking (those in the tongue, palate and lips). Speech can be slowed, slurred or distorted, so stroke survivors can be hard to understand. This is called dysarthria and may require the help of a speech expert. How can a stroke affect chewing and swallowing food? This problem, called dysphagia , can occur when one side of the mouth is weak. One or both sides of the mouth can lack feeling, increasing the risk of choking.

How can a stroke can affect the ability to think clearly?

Planning and carrying out even simple activities may be hard. Stroke survivors may not know how to start a task, confuse the sequence of logical steps in tasks, or forget how to do tasks they've done many times before.For stroke information, call the American Stroke Association at 1-888-4STROKE.


STROKE RISK FACTORS

The American Heart Association has identified several factors that increase your risk of stroke. The more risk factors you have, the greater your chance for a stroke. You can’t control some of these, such as increasing age, family health history, prior stroke, race and gender. But you can modify, treat or control most risk factors to lower your risk of stroke. A healthcare provider can help you change factors that result from lifestyle or environment.

What are the risk factors for stroke you cannot change?

*Increasing age -- Stroke happens to people of all ages, including children. But the older you are, the greater your risk for stroke.
*Sex (gender) -- Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.
*Heredity (family history) and race -- Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians do. In part this is because blacks have higher risks of high blood pressure, diabetes and obesity.
*Prior stroke or heart attack -- Someone who has had a stroke is at much higher risk of having another one. If you’ve had a heart attack, you’re at higher risk of having a stroke, too.

What are the risk factors you and your healthcare provider can change, treat or control?

*High blood pressure -- High blood pressure is defined in an adult as a systolic pressure of 140 mm Hg or higher and/or a diastolic pressure of 90 mm Hg or higher for an extended time. It’s the most important risk factor for stroke.
*Diabetes mellitus (di"ah-BE'teez or di"ah-BE'tis meh-LI'tis) -- While diabetes is treatable, having it still increases a person’s risk of stroke. People with diabetes often also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. If you have diabetes, work closely with your doctor to manage it.
*Carotid or other artery disease -- The carotid (kah-ROT'id) arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (ath"er-o-skleh-RO'sis) may become blocked by a blood clot. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It’s caused by atherosclerosis.
*Arterial fibrillation -- This heart rhythm disorder raises the risk for stroke, because the heart’s upper chambers quiver instead of beating effectively. This lets the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.
*Other heart disease -- People with coronary heart disease or heart failure have more than twice the risk of stroke as those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
*Transient ischemic (TRANZ'e-ent is-KEM'ik) attacks (TIAs) -- TIAs are "mini-strokes" that produce stroke-like symptoms but no lasting damage. Recognizing and treating TIAs can reduce your risk of a major stroke. It’s very important to recognize the warning signs of a TIA or stroke. Call 9-1-1 to get medical help immediately if they occur!
*Certain blood disorders -- A high red blood cell count thickens the blood and makes clots more likely. This raises the risk of stroke. Doctors may treat this problem by removing blood cells or prescribing "blood thinners."
*Sickle cell anemia is a genetic disorder that mainly affects African Americans. "Sickled" red blood cells are less able to carry oxygen to the body’s tissues and organs. They also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
*High blood cholesterol -- A high level of total cholesterol in the blood (240 mg/dL or higher) is a major risk factor for heart disease, which raises your risk of stroke. Recent studies show that high levels of LDL ("bad") cholesterol (greater than 100 mg/dL) and triglycerides (blood fats) directly increase the risk of stroke in people with previous coronary heart disease, ischemic stroke or transient ischemic attack (TIA). Low levels of HDL ("good") cholesterol (less than 35 mg/dL) also may raise stroke risk.

What risk factors require a lifestyle change?

*Tobacco use -- Cigarette smoking is the No. 1 preventable risk factor for stroke. The nicotine and carbon monoxide in tobacco smoke reduce the amount of oxygen in your blood. They also damage the walls of blood vessels, making clots more likely to form. Using some kinds of birth control pills combined with smoking cigarettes greatly increases stroke risk.
*Physical inactivity and obesity -- Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active at least 30 minutes total on most days.
*Excessive alcohol -- An average of more than one alcoholic drink a day for women or more than two drinks a day for men raises blood pressure and can lead to stroke.
*Illegal drug abuse -- Intravenous drug abuse carries a high risk of stroke. Cocaine use has been linked to strokes and heart attacks. Some have been fatal even in first-time users.

STROKE TREATMENT--- What are accepted ways to treat stroke?

Surgery, drugs, acute hospital care and rehabilitation are all accepted treatments for stroke. When a neck artery has become partially blocked, surgery might be used to remove the buildup of atherosclerotic plaque. This is called carotid endarterectomy. Cerebral angioplasty is a new, experimental technique. Balloons, stents and coils are used to treat some types of cerebral vascular problems. Its widespread use will require more study of its safety and effectiveness.

What about tissue plasminogen activator (TPA)?

The Food and Drug Administration approved the clot-dissolving drug tissue plasminogen activator (tPA) to treat stroke in 1996. This was a major advance because physicians can use this approved treatment for ischemic strokes caused by blood clots, which constitute 80 percent of all strokes. It is the only FDA-approved drug proven to be effective in treating ischemic stroke. Studies have shown that tPA can significantly reduce the debilitating effects of stroke and minimize permanent disability, if administered promptly. For maximum benefit, the therapy must be started within three hours of the onset of stroke symptoms. Therefore, it's critical that caregivers, medical professionals and the public recognize stroke as a medical emergency and respond immediately by calling 9-1-1.tPA carries a risk of bleeding in the brain, but its benefits outweigh the risks when an experienced doctor uses it properly. Therefore, not every stroke patient, particularly those experiencing a hemorrhagic stroke, should receive tPA treatment.

What about treating heart disease?

Sometimes treating a stroke means treating the heart, because various forms of heart disease can contribute to the risk of stroke. For example, damaged heart valves may need to be surgically treated or treated with anti-clotting drugs to reduce the chance of clots forming around them. Blood clots can also form in patients with atrial fibrillation, a type of arrhythmia (abnormal heart rhythm). If clots form, there's a chance they could travel to the brain and cause a stroke.

STROKE REHABILITATION

Besides being the third leading cause of death in the United States, stroke is a leading cause of serious, long-term disability. Many stroke survivors are left with mental and physical disabilities

.Does a person need rehabilitation to recover from a stroke?

Most gains in a person's ability to function in the first 30 days after a stroke are due to spontaneous recovery. Still, rehabilitation is important. For the most part, successful rehabilitation depends on
*the extent of the brain injury
*the survivor's attitude
*the rehabilitation team's skill
*the cooperation of family and friends People with the least impairment are likely to benefit the most. But even when improvement is slight, rehabilitation may still mean the person can return home rather than stay in an institution.

What is the goal of rehabilitation?

The goal is to reduce dependence and improve physical abilities. Often old skills have been lost and new ones are needed. It's also important to maintain and improve a person's physical condition when possible. Rehabilitation begins early as nurses and other hospital personnel work to prevent such secondary complications as stiff joints, bedsores and pneumonia. These can result from being confined to bed for a long time.

How can a stroke survivor's family help?

A person's family has a significant role in rehabilitation. A caring and able spouse or partner can be one of the most important positive factors in rehabilitation. The knowledge of family members also matters a great deal. Family members need to understand what the stroke survivor has been through and how disabilities can affect the person. The situation will be easier to handle if the family knows what to expect and how to handle problems that arise after the person leaves the hospital. For a stroke survivor, the goal of rehabilitation is to be as independent and productive as possible, given the limitations resulting from the stroke.



Links

stroke forum 
Brain Stem Stroke/Joe&Jackie
Tobacco Control -- Abstracts: Bonita et al. 8 (2): 156
 The Stroke Network

New Hope for Speech Problems After Stroke
A drug related to speed, called dextroamphetamine, may
bring new hope to stroke victims, according to a study
reported in the September issue of the journal Stroke.

     Scientists are building evidence in study after study that indicate eating whole fruits and vegetables may protect you against heart disease and cancer. Although the recommended number of daily servings for adults is five, the average American is only eating three servings.                      If more people realized how beneficial fruits and vegetables are for their health, they'd surely beat a path down the produce aisle. A Harvard study revealed that adults who ate 9.2 servings of fruits and vegetables each day had a 30-percent lower risk of stroke. Another study linked the consumption of fruits and vegetables with lowered blood pressure. These foods may also help prevent obesity. Plus, many fruits and vegetables are portable and make handy snacks and healthy additions to the lunch bag.