WHAT IS A STROKE?

• It is a BRAIN ATTACK!  There is stoppage of blood flow and oxygen to the brain.

• During a stroke, two million brain cells die every minute.  Recognizing symptoms and calling 911 to get medical attention fast can save a life and limit disabilities.

• Stroke is the 3^rd leading cause of death in the United States and the leading cause of long-term disability.

• Stroke can happen to anyone – regardless of age, sex or race

• Men have a higher rate of stroke when they are younger, but approximately 55,000 more women than men will have a stroke each year.

• African Americans have nearly twice the risk of first time strokes compared to whites

WHAT IS A TIA?

• TIA stands for “transient ischemic attack”.  It is a warning sign that a stroke could be right around the corner; in fact, up to 40% of all people who experience a TIA can go on to suffer a stroke.  Recognizing and treating TIAs can reduce your risk of stroke. 

• A TIA produces stroke-like symptoms but does not cause lasting damage.  The symptoms of a TIA are the same as stroke (see below). 

• TIAs typically last a few seconds to a few minutes and are gone in an hour.

TYPES OF STROKE:

Ischemic stroke - Approximately 85% of all strokes are ischemic strokes.  This type of stroke takes place when the arteries in the brain or neck become blocked by plaque, fatty deposits or blood clots. 

Hemorrhagic stroke – This type of stroke accounts for 15% of all strokes; however, it is responsible for more than 30% of all stroke related deaths.  Hemorrhagic stroke is caused by leaking or ruptured blood vessels in the brain.  There are two types of hemorrhagic stroke:

• Intracerebral hemorrhage – this is most often due to high blood pressure where over time the vessels become weak and bleed. 
• Subarachnoid hemorrhage - this is usually due to a weakened blood vessel that has ruptured (aneurysm) or less commonly a tangle of blood vessels that has bled (vascular malformation or arteriovenous malformation/AVM).

SYMPTOMS OF STROKE:

Ischemic stroke

• Sudden numbness or weakness of the face, arm or leg – especially on one side of the body.

• Sudden confusion, trouble speaking or understanding.

• Sudden trouble seeing in one or both eyes.

• Sudden trouble walking, dizziness, loss of balance or coordination.

• Sudden severe headache with no known cause.                                                            

Hemorrhagic stroke – these symptoms may be similar to the above, yet symptoms typically come on very quickly.  Common symptoms of bleeding into the brain may include:

• Partial or total loss of consciousness.

• Severe nausea or vomiting in conjunction with any other stroke symptom.

• Severe headache - the patient may say it is the  “the worst headache of their life” or call it a “thunderclap” headache.

• Stiff neck.

• Sensitivity to light.

Know the “F.A.S.T.” test for recognizing and responding to stroke symptoms:

F = FACE                    Ask the person to smile.  Does one side of the face droop?

A = ARMS                  Ask the person to raise both arms.  Does one arm drift downward?

S = SPEECH               Ask the person to repeat a simple sentence.  Does the speech sound slurred or strange?

T = TIME                    If you observe any of these signs, it’s time to call 9-1-1 or get to the nearest stroke center.

WHAT INCREASES YOUR RISK FOR STROKE?

•  Age over 55

• African-American, Pacific/Islander or Hispanic

•  High blood pressure (Hypertension)

• High blood pressure is a leading cause of stroke. If you have high blood pressure or a family history of high blood pressure or are on blood pressure medication, keep a “blood pressure diary” weekly or monthly to monitor your pressures and share them with your doctor. 

• High blood pressure puts stress on blood vessel walls, causing them to thicken and deteriorate, and this can eventually lead to a stroke and heart disease.

• When blood vessel walls thicken with increased pressure, cholesterol or other fat-like substances can break off of artery walls and block the brain artery.  It can also cause stress to the wall of the vessel, weakening it and cause bleeding into the brain.

• Atrial fibrillation (A-fib)A-fib is a type of irregular or fast heartbeat, (an arrhythmia), that can cause blood to collect in the heart, form a clot, which can then travel to your brain and cause a stroke.  Uncontrolled A-fib can significantly increase the risk of stroke.

• Heart disease, coronary artery disease and previous heart attack

• High cholesterol

• Diabetes

• Smoking can double the risk for stroke. When you stop smoking, you greatly reduce your chances of having a stroke

• Previous stroke or TIA

• Family history of stroke

• Clotting disorders

• Obesity and lack of exercise

• Too much alcohol

• Cocaine

WHAT TO DO IF SOMEONE IS HAVING A STROKE OR TIA:

•Always call 9-1-1!  Every minute counts! 

•Studies show that when the EMS (ambulance) system is used patients get worked up and treated faster. 

HOW IS STROKE DIAGNOSED?

• A neurological physical exam.

• Cat Scan (CT) of the brain.

TREATMENT OPTIONS FOR STROKE:

• Depending on the severity of the stroke, the patient may require Intensive Care.

• Much of the damage caused by a stroke occurs in the first few hours.

• Ischemic stroke:

• If the patient meets criteria, a clot busting drug may be given intravenously.  This medication is time sensitive.

• Some hospitals  also offer interventions such as clot retrieval and intra-arterial medications.

• After a stroke, the doctor may prescribe blood thinners, (Anticoagulant or Antiplatelet) to reduce the ability of the blood to clot.  This may help to keep blood vessels open.

• Hemorrhagic stroke:

• A variety of medical and surgical techniques may be used and depends on the exact cause and size of the hemorrhage.  If the bleeding is due to high blood pressure, doctors try to reduce the blood pressure carefully.  If there is high pressure or swelling in the brain then this is addressed.

• If the hemorrhage is due to an aneurysm or AVM, a procedure called embolization may be done where a catheter is guided through a sheath in a groin artery up to the arteries in the brain with the help of a special X-ray machine.  Metal coils are then inserted into the aneurysm or AVM to help to secure it and prevent it from bleeding.  Other times the patient may need surgery to clip the aneurysm.

TAKE THIS QUIZ TO ASSESS YOUR STROKE RISK:

http://www.stroke.org/site/DocServer/Scorecard.Q._08.pdf?docID=601

IMPORTANT RESOURCES:

National Stroke Association

• http://www.stroke.org

American Stroke Association

• http://www.strokeassociation.org

Atrial Fibrillation

• http://www.afibstroke.com

The National Coalition for Stroke and Heart Disease Prevention

• http://www.strokeheartcoalition.org

The National Heart, Lung, and Blood Institute

• http://www.nhlbi.nih.gov