Stroke: A Speaker’s Outline Developed by: The American Stroke Association Developed by: The American Stroke Association Updated

What Is a Stroke? A brain injury caused when a blood vessel to the brain becomes blocked our bursts, cutting off blood flow

What Is Stroke’s Impact? Stroke is the third leading cause of death in the United States Stroke is the third leading cause of death in the United States About 795,000 Americans suffer a stroke each year (that’s a stroke every 40 seconds)About 795,000 Americans suffer a stroke each year (that’s a stroke every 40 seconds) 77% are new strokes and 23% are recurrent strokes77% are new strokes and 23% are recurrent strokes Stroke kills more than 137,000 people in a year. ( that’s a death every 4 minutes)Stroke kills more than 137,000 people in a year. ( that’s a death every 4 minutes) Stroke is the third leading cause of death in the United States Stroke is the third leading cause of death in the United States About 795,000 Americans suffer a stroke each year (that’s a stroke every 40 seconds)About 795,000 Americans suffer a stroke each year (that’s a stroke every 40 seconds) 77% are new strokes and 23% are recurrent strokes77% are new strokes and 23% are recurrent strokes Stroke kills more than 137,000 people in a year. ( that’s a death every 4 minutes)Stroke kills more than 137,000 people in a year. ( that’s a death every 4 minutes)

What Is Stroke’s Impact? (cont’d) Stroke is a leading cause of serious, long-term disability Stroke is a leading cause of serious, long-term disability 40% of Stroke deaths occur in males, and 60% in females. 40% of Stroke deaths occur in males, and 60% in females. Americans paid about $73.7 billion for stroke-related medical costs in 2010 Americans paid about $73.7 billion for stroke-related medical costs in 2010 Stroke is a leading cause of serious, long-term disability Stroke is a leading cause of serious, long-term disability 40% of Stroke deaths occur in males, and 60% in females. 40% of Stroke deaths occur in males, and 60% in females. Americans paid about $73.7 billion for stroke-related medical costs in 2010 Americans paid about $73.7 billion for stroke-related medical costs in 2010

What Are the Types of Stroke? Ischemic (Blockage) 87% Caused by a blockage in the blood vessels to the brain Hemorrhagic (Bleeding) 13% Caused by burst or leaking blood vessels in the brain Ischemic (Blockage) 87% Caused by a blockage in the blood vessels to the brain Hemorrhagic (Bleeding) 13% Caused by burst or leaking blood vessels in the brain

What Causes Ischemic Stroke ? Fatty deposits line the blood vessel wall Thrombus: A blood clot forms at the fatty deposit Embolus: A traveling particle gets stuck in a small vessel Fatty deposits line the blood vessel wall Thrombus: A blood clot forms at the fatty deposit Embolus: A traveling particle gets stuck in a small vessel

Clot-caused Stroke by Age, Sex and Race Annual rate of first cerebral infarction by age, sex and race (Greater Cincinnati/Northern Kentucky Stroke Study: ). Source: Unpublished data from the GC/NKSS; Kissela et al., Stroke. 2004;35:

What Causes Hemorrhagic Strokes? A weakened blood vessel ruptures  Aneurysms: Ballooning of a weakened spot of a blood vessel  Arteriovenous Malformations (AVMs): Cluster of abnormal blood vessels A weakened blood vessel ruptures  Aneurysms: Ballooning of a weakened spot of a blood vessel  Arteriovenous Malformations (AVMs): Cluster of abnormal blood vessels

Hemorrhagic Stroke by Age, Sex and Race Annual rate of first intracerebral hemorrhage by age, sex and race (Greater Cincinnati/Northern Kentucky Stroke Study: ). Source: Kissela et al., Stroke. 2004;35:

What Parts of the Brain Can Stroke Affect?

What Are the Effects of Stroke? Right Brain

What Are the Effects of Stroke? Left Brain

Stroke Warning Signs Sudden weakness or numbness 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 headaches with no known cause Sudden weakness or numbness 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 headaches with no known cause

Learn to recognize a stroke. Time lost is brain lost. If you notice one or more of the stroke warning signs, GET HELP IMMEDIATELY! Stroke is an emergency – CALL If you notice one or more of the stroke warning signs, GET HELP IMMEDIATELY! Stroke is an emergency – CALL

Transient Ischemic Attacks (TIAs) TIAs are “warning strokes” that can happen before a major stroke They occur when blood flow through a brain artery is briefly blocked or reduced TIAs are “warning strokes” that can happen before a major stroke They occur when blood flow through a brain artery is briefly blocked or reduced

TIA symptoms are temporary but similar to those of a full-fledged stroke A person who has a TIA is 9.5 times more likely to have a stroke A TIA is a medical emergency TIA symptoms are temporary but similar to those of a full-fledged stroke A person who has a TIA is 9.5 times more likely to have a stroke A TIA is a medical emergency Transient Ischemic Attacks (TIAs)

Stroke Risk Factors That Cannot Be Treated Age Heredity (family history) and race Sex (gender) Prior stroke, TIA or heart attack Age Heredity (family history) and race Sex (gender) Prior stroke, TIA or heart attack

Stroke Prevalence by Age & Sex Prevalence of stroke by age and sex (NHANES: ). Source: NCHS and NHLBI.

Stroke Risk Factors That Can Be Treated High blood pressure Tobacco use Diabetes Carotid or other artery disease Atrial fibrillation Other heart disease High blood pressure Tobacco use Diabetes Carotid or other artery disease Atrial fibrillation Other heart disease

Stroke Risk Factors That Can Be Treated (cont’d) Sickle Cell Disease (Sickle Cell Anemia) High blood cholesterol Poor diet Physical inactivity Obesity

Stroke Risk by Levels of Risk Factors ABCDEF Systolic BP* DiabetesNoNoYesYesYes Yes CigarettesNoNoNoYesYes Yes Prior Atrial Fib.NoNoNoNoYes Yes Prior CVDNoNoNoNoNo Yes Estimated 10-year stroke risk in 55-year-old adults according to levels of various risk factors (FHS). Source: Wolf et al., Stroke.1991;22:

Less Well-Documented Stroke Risk Factors Geographical location Socioeconomic factors Excessive alcohol intake Certain kinds of drug abuse Geographical location Socioeconomic factors Excessive alcohol intake Certain kinds of drug abuse

How Can You Reduce Your Risk of Stroke? Control high blood pressure Don’t smoke Consume less sodium Lower cholesterol Lose excess weight Be physically active Control high blood pressure Don’t smoke Consume less sodium Lower cholesterol Lose excess weight Be physically active

Other Actions That Will Probably Reduce Stroke Risk Limit alcohol intake Don’t use illicit drugs Women who smoke or have a history of blood clots should not take oral contraceptives Look for signs of sleep-disordered breathing Limit alcohol intake Don’t use illicit drugs Women who smoke or have a history of blood clots should not take oral contraceptives Look for signs of sleep-disordered breathing

How Are Strokes Treated? Ischemic Stroke Ischemic Stroke Acute treatmentAcute treatment  Clot-buster, e.g., t-PA  Interventional procedures Preventive treatmentPreventive treatment  Anticoagulants (warfarin)  Antiplatelet agents (aspirin)  Carotid endarterectomy  Angioplasty/stents Hemorrhagic Stroke Hemorrhagic Stroke SurgerySurgery Endovascular procedures, e.g., “coils”Endovascular procedures, e.g., “coils” Ischemic Stroke Ischemic Stroke Acute treatmentAcute treatment  Clot-buster, e.g., t-PA  Interventional procedures Preventive treatmentPreventive treatment  Anticoagulants (warfarin)  Antiplatelet agents (aspirin)  Carotid endarterectomy  Angioplasty/stents Hemorrhagic Stroke Hemorrhagic Stroke SurgerySurgery Endovascular procedures, e.g., “coils”Endovascular procedures, e.g., “coils”

Rehabilitation If you have a stroke, start a rehabilitation program as soon as you can Rehabilitation may focus on: Self-care Mobility Communication Cognitive skills Social skills If you have a stroke, start a rehabilitation program as soon as you can Rehabilitation may focus on: Self-care Mobility Communication Cognitive skills Social skills

Types of Rehabilitation Programs Acute care and rehabilitation hospitals Long-term nursing care facilities At home, through home health agencies Outpatient facilities Acute care and rehabilitation hospitals Long-term nursing care facilities At home, through home health agencies Outpatient facilities

Rehabilitation Specialists Physicians Rehabilitation nurses Physical therapists Speech/language therapists Physicians Rehabilitation nurses Physical therapists Speech/language therapists

Rehabilitation Specialists (cont’d) Audiologists Audiologists Occupational therapists Occupational therapists Physiatrists Physiatrists Psychologists / psychiatrists Psychologists / psychiatrists Audiologists Audiologists Occupational therapists Occupational therapists Physiatrists Physiatrists Psychologists / psychiatrists Psychologists / psychiatrists

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