Introduction
If you’re like most Americans, you plan for your future. When you take a job,
you examine its benefit plan. When you buy a home, you consider its location and
condition so that your investment is safe. Today, more and more Americans are
protecting their most important asset–their health. Are you?
Stroke ranks as the third leading killer in the United
States. A stroke can be devastating to individuals and their families, robbing
them of their independence. It is the most common cause of adult disability.
Each year more than 700,000 Americans have a stroke, with about 160,000 dying
from stroke-related causes. Officials at the National Institute of Neurological
Disorders and Stroke (NINDS) are committed to reducing that burden through
biomedical research.
Stroke Treatment
What is the treatment for stroke?
A stroke is a medical emergency and there is now ability to intervene and restore blood supply to the brain of some stroke patients if they present for medical care early enough.
As in many emergencies, the first consideration is the ABCs (Airway, Breathing, and Circulation) to make certain that the patient can breathe and has adequate blood pressure. In severe strokes, especially those that involve the brainstem, the brains ability to control breathing, blood pressure, and heart rate may be lost.
Read more about stroke symptoms and treatment »
What is a Stroke?
A stroke, or “brain attack,” occurs when blood circulation
to the brain fails. Brain cells can die from decreased blood flow and the
resulting lack of oxygen. There are two broad categories of stroke:
- those caused
by a blockage of blood flow and - those caused by bleeding.
Blockage of Blood Flow
While not usually
fatal, a blockage of a blood vessel in the brain or neck, called an ischemic stroke, is the most
frequent cause of stroke and is responsible for about 80 percent of strokes.
These blockages stem from three conditions:
- the formation of a clot within a
blood vessel of the brain or neck, called
thrombosis; - the
movement of a clot from another part of the body such as the heart to the neck or brain, called
embolism; or - a severe narrowing of an artery in or leading to the brain, called
stenosis.
Bleeding
Bleeding into
the brain or the spaces surrounding the brain causes the second type of stroke,
called hemorrhagic stroke.
Two key steps you can take will lower your risk of death or disability from
stroke: know stroke’s warning signs and control stroke’s risk factors.
Scientific research conducted by the NINDS has identified warning signs and a
large number of risk factors.
What are Warning Signs of a Stroke?
Warning signs are clues your body sends that your brain is not receiving
enough oxygen. If you observe one or more of these signs of a stroke or “brain
attack,” don’t wait, call a doctor or 911 right away!
- Sudden numbness or weakness of 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
Other danger signs that may occur include double vision,
drowsiness, and nausea or
vomiting. Sometimes the warning signs may last only a few moments and
then disappear. These brief episodes, known as
transient ischemic attacks or TIAs, are sometimes called “mini-strokes.” Although brief, they identify an
underlying serious condition that isn’t going away without medical help.
Unfortunately, since they clear up, many people ignore them. Don’t. Heeding them
can save your life.
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What are Risk Factors for a Stroke?
A risk factor is a condition or behavior that occurs more frequently in those
who have, or are at greater risk of getting, a disease than in those who don’t.
Having a risk factor for stroke doesn’t mean you’ll have a stroke. On the other
hand, not having a risk factor doesn’t mean you’ll avoid a stroke. But your risk
of stroke grows as the number and severity of risk factors increases.
Stroke occurs in all age groups, in both sexes, and in all races in every
country. It can even occur before birth, when the fetus is still in the womb. In
African-Americans, stroke is more common and more deadly–even in young and
middle-aged adults–than for any ethnic or other racial group in the United
States. Scientists have found more and more severe risk factors in some minority
groups and continue to look for patterns of stroke in these groups.
QUESTION
What is a stroke?
See Answer
What Are the Treatable Risk Factors?
Some of the most important treatable risk factors for stroke are:
- High blood pressure. Also called
hypertension, this is
by far the most potent risk factor for stroke. If your blood pressure is high, you and your
doctor need to work out an individual strategy to bring it down to the normal
range. Some ways that work: Maintain proper weight. Avoid drugs known to raise
blood pressure. Cut down on salt. Eat fruits and vegetables to increase
potassium in your diet.
Exercise more. Your doctor may prescribe medicines that help lower blood
pressure. Controlling blood pressure will also help you avoid
heart disease,
diabetes, and
kidney failure. - Cigarette smoking.
Cigarette smoking has been linked to the buildup of
fatty substances in the carotid artery, the
main neck artery supplying blood to the brain. Blockage of this artery is the
leading cause of stroke in Americans. Also,
nicotine raises blood pressure;
carbon monoxide reduces the amount of oxygen your blood can carry to the brain;
and cigarette smoke makes your blood thicker and more likely to clot. Your
doctor can recommend programs and medications that may help you quit smoking. By
quitting, at any age, you also reduce your risk of lung disease, heart disease,
and a number of cancers including lung cancer. - Heart disease. Common heart disorders such as coronary
artery disease, valve defects, irregular heart beat, and enlargement of one of
the heart’s chambers can result in
blood clots that may break loose and block vessels in or
leading to the brain. The most common blood vessel disease, caused by the
buildup of fatty deposits in the arteries, is called
atherosclerosis. Your
doctor will treat your heart disease and may also prescribe medication, such as
aspirin, to help
prevent the formation of clots. Your doctor may recommend surgery to clean out a
clogged neck artery if you match a particular risk profile. If you are over 50,
NINDS scientists believe you and your doctor should make a decision about
aspirin therapy. A doctor can evaluate your risk factors
and help you decide if you will benefit from aspirin or other blood-thinning
therapy. - Warning signs or history of stroke. If you experience a
TIA, get help at
once. Many communities encourage those with stroke’s warning signs to dial 911
for emergency medical assistance. If you have had a stroke in the past, it’s
important to reduce your risk of a second stroke. Your brain helps you recover
from a stroke by drawing on body systems that now do double duty. That means a
second stroke can be twice as bad. - Diabetes. You may think this disorder affects only the
body’s ability to use sugar, or glucose. But it also causes destructive changes in the blood
vessels throughout the body, including the brain. Also, if
blood glucose levels
are high at the time of a stroke, then brain damage is usually more severe and
extensive than when blood glucose is well-controlled. Treating
diabetes can
delay the onset of complications that increase the risk of stroke.
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Do You Know Your Stroke Risk?
Some of the most important risk factors for stroke can be determined during a
physical exam at your doctor’s office. If you are over 55 years old, the
worksheet below can help you estimate your risk of stroke and show the benefit
of risk-factor control.
The worksheet was developed from NINDS-supported work in the well-known
Framingham Study. Working with your doctor, you can develop a strategy to lower
your risk to average or even below average for your age.
Score your stroke risk for the next 10 years-MEN
Key:
- SBP = systolic blood pressure (score one line only, untreated or
treated); - Diabetes = history of diabetes;
- Cigarettes = smokes cigarettes;
- CVD
(cardiovascular disease) = history of heart disease; - AF = history of atrial fibrillation;
- LVH = diagnosis of left ventricular hypertrophy
Age
55-56
57-59
60-62
63-65
66-68
69-72
73-75
76-78
79-81
83-84
85
SBD-untrd
97-105
106-115
116-125
126-135
136-145
146-155
156-165
166-175
176-185
186-195
196-205
or SBP-trtd
97-105
106-115
113-117
118-123
124-129
130-135
136-142
143-150
151-161
162-176
177-205
Diabetes
No
Yes
Cigarettes
No
Yes
CVD
No
Yes
AF
No
Yes
LV
No
Yes
Your Risk/Probability of Stroke
1
3%
2
3%
3
4%
4
4%
5
5%
6
5%
7
6%
8
7%
9
8%
10
10%
11
11%
12
13%
13
15%
14
17%
15
20%
16
22%
17
26%
18
29%
19
33%
20
37%
21
42%
22
47%
23
52%
24
57%
25
63%
26
68%
27
74%
28
79%
29
84%
30
88%
Group
Probability of Stroke
55-59
5.9%
60-64
7.8%
65-69
11.0%
70-74
13.7%
75-79
18.0%
80-84
22.3%
Score your stroke risk for the next 10 years-WOMEN
Key:
- SBP = systolic blood pressure (score one line only, untreated or
treated); - Diabetes = history of diabetes;
- Cigarettes = smokes cigarettes;
- CVD
(cardiovascular disease) = history of heart disease; - AF = history of atrial fibrillation;
- LVH = diagnosis of left ventricular hypertrophy
Age
55-56
57-59
60-62
63-64
65-67
68-70
71-73
74-76
77-78
79-81
82-84
SBD-untrd
95-106
107-118
119-130
131-143
144-155
156-167
168-180
181-192
193-204
205-516
or SBP-trtd
95-106
107-113
114-119
120-125
126-131
132-139
140-148
149-160
161-204
205-216
Diabetes
No
Yes
Cigarettes
No
Yes
CVD
No
Yes
AF
No
Yes
LV
No
Yes
1
1%
2
1%
3
2%
4
2%
5
2%
6
3%
7
4%
8
4%
9
5%
10
6%
11
8%
12
9%
13
11%
14
13%
15
16%
16
19%
17
23%
18
27%
19
32%
20
37%
21
43%
22
50%
23
57%
24
64%
25
71%
26
78%
27
84%
55-59
3.0%
60-64
4.7%
65-69
7.2%
70-74
10.9%
75-79
15.5%
80-84
23.9%
Source: D’Agostino, R.B.; Wolf, P.A.; Belanger, A.J.; & Kannel, W.B. "Stroke
Risk Profile: The Framingham Study." Stroke, Vol. 25, No. 1, pp. 40-43, January
1994.
Many risk factors for stroke can be managed, some very
successfully. Although risk is never zero at any age, by starting early and
controlling your risk factors you can lower your risk of death or disability
from stroke. With good control, the risk of stroke in most age groups can be
kept below that for accidental injury or death.
Americans have shown that stroke is preventable and treatable. In recent
years, a better understanding of the causes of stroke has helped Americans make
lifestyle changes that have cut the stroke death rate nearly in half.
Scientists at the NINDS predict that, with continued attention to reducing
the risks of stroke and by using currently available therapies and developing
new ones, Americans should be able to prevent 80 percent of all strokes.
SOURCE: National Institute of Neurological Disorders and Stroke; “Brain
Basics: Preventing Stroke,” April 09, 2009