1. Explaining Stroke 101 __________________
This presentation will help you understand more about stroke – its prevention, treatment and recovery. It will cover stroke risk factors, prevention measures, how to recognize the symptoms of stroke and how to respond.
© 2015 National Stroke Association

2. May Is National Stroke Awareness Month
Partner with National Stroke Association and help us spread awareness about stroke in May:
ADVOCATE – Influence public policy and legislature on stroke survivor issues.
EDUCATE – Spread the word about stroke awareness.
PARTICIPATE – Get involved and make a difference in the world of stroke.
National Stroke Awareness Month takes place in May every year. In honor of this special time, National Stroke Association strives to provide everyone with the tools and inspiration to raise public awareness about stroke. 
Stroke is the fifth leading cause of death and a leading cause of disability, but many people do not realize how educating themselves and others will help reduce the incidence of stroke. National Stroke Association encourages everyone to take time during May to spread awareness about how to:
ADVOCATE – Influence public policy and legislature on stroke survivor issues.
EDUCATE – Spread the word about stroke awareness.
PARTICIPATE – Get involved and make a difference in the world of stroke.
© 2015 National Stroke Association

3. We want you to know and understand the three R’s of stroke:
Be Stroke Smart
Recognize—Stroke symptoms
Reduce—Stroke risk
Respond—At the first sign of stroke,
Call 911 immediately
We hope your participation in today’s presentation will support you in becoming more stroke smart.
We want you to know and understand the three R’s of stroke:
– Reduce risk
– Recognize stroke symptoms
– Respond by calling 9-1-1
© 2015 National Stroke Association

4. Stroke by the Numbers
Stroke is the fifth leading cause of death in the United States
Each year nearly 800,000 people experience a new or recurrent stroke
Nearly 130,000 deaths each year (every 4 minutes someone dies from stroke)
7,000,000 stroke survivors
Stroke is a leading cause of death in the United States behind heart disease and all forms of cancer combined.
Nearly 800,000 people in the U.S. have a new or recurrent stroke each year.
Stroke kills nearly 130,000 Americans each year.
7 million stroke survivors living in the United States. About one-third have mild impairments, another third are moderately impaired and the remainder are severely impaired.
© 2015 National Stroke Association

5. Stroke by the Numbers A stroke happens every 40 seconds
A leading cause of adult disability
Up to 80 percent of all strokes are preventable through risk factor management
Stroke is a leading cause of serious, long-term adult disability. Over the course of a lifetime, four out of every five families in the United States will be touched by stroke.
Up to 80 percent of all strokes are preventable.
Every 40 seconds someone experiences a stroke, every four minutes someone dies from a stroke.
© 2015 National Stroke Association

6. Women & Stroke
Stroke kills more than twice as many American women every year as breast cancer
More women than men die from stroke and risk is higher for women due to higher life expectancy
Women suffer greater disability after stroke then men
Women ages 45 to 54 are experiencing a stroke surge, mainly due to increased risk factors and lack of prevention knowledge
Stroke kills more than twice as many American women every year as breast cancer.
Each year, about 55,000 more women than men experience a stroke.
More women than men die from stroke - accounting for more than 67 percent of all stroke deaths.
Overall lifetime risk of stroke is higher in women then men because life expectancy is higher. Also, women who have already suffered a stroke are significantly more at risk for a second stroke than men after two years.
Women suffer greater disability and functional outcomes because they are more likely to require institutionalized care than men, which adds to the economic burden of stroke.
Women ages 45 to 54 are experiencing a stroke surge, mainly due to increased risk factors and lack of prevention knowledge.
© 2015 National Stroke Association

7. African-Americans & Stroke
Incidence is nearly double that of Caucasians
African Americans suffer more extensive physical impairments
Twice as likely to die from stroke than Caucasians
High incidence of risk factors for stroke
Includes hypertension, diabetes, obesity, smoking and sickle cell anemia
Incidence rate of stroke in African-Americans is almost double that of Caucasians.
African Americans suffer more extensive physical impairments.
African Americans are twice as likely to die from stroke than Caucasians.
Unfortunately, African-Americans have disproportionately high incidence of risk factors for stroke, including:
> Hypertension
> Diabetes
> Obesity
> Smoking
> Sickle cell anemia
© 2015 National Stroke Association

8. Hispanics & Stroke
Higher incidence among Mexican Americans than Caucasians
Mexican Americans are at increased risk for all types of stroke and TIA at younger ages than Caucasians
Spanish-speaking Hispanics are less likely to know stroke symptoms than English-speaking Hispanics, African Americans and Caucasians
Higher incidence among Mexican Americans than Caucasians.
Mexican Americans are at increased risk for all types of stroke and TIA at younger ages than Caucasians.
Spanish-speaking Hispanics are less likely to know stroke symptoms than English-speaking Hispanics, African Americans and Caucasians.
© 2015 National Stroke Association

9. Well-known Stroke Survivors
President Gerald Ford
Teddy Bruschi
Sharon Stone
Della Reese
Kirk Douglas
Roy Horn of Siegfried & Roy
Mary Kay Ash
Charles Schultz
Harry Caray
Charles Dickens
Ed Koch
Ted Williams
“Seeing” a disease in the news always brings greater attention to it. Prominent people who have experienced strokes include:
U.S. Presidents Gerald Ford, Thomas Jefferson, Woodrow Wilson, Warren G. Harding, Franklin Delano Roosevelt, Dwight Eisenhower, Richard Nixon
Super Bowl player Teddy Bruschi
Actors Sharon Stone, Della Reese, Kirk Douglas and Robert Guillaume
Entertainers Luther Vandross and Roy Horn of Siegfried & Roy
Cosmetics entrepreneur Mary Kay Ash
Comics artist Charles Schultz
Sports commentator Harry Caray
Novelist Charles Dickens
Former New York City Mayor Ed Koch
Major league baseball player Ted Williams
© 2015 National Stroke Association

10. Definition of Stroke Sudden brain damage
Lack of blood flow to the brain caused by a clot or rupture of a blood vessel
Ischemic = Clot
(makes up approximately
87 percent of all strokes)
Hemorrhagic = Bleed
- Bleeding around brain
- Bleeding into brain
Thrombotic
A stroke occurs when a blood clot blocks a blood vessel or artery, or when a blood vessel breaks, interrupting blood flow to an area of the brain. When a stroke occurs, it kills brain cells in the area surrounding where the clot or breakage occurrs.
There are 2 types of stroke:
1. Ischemic Strokes can occur two ways and are the most common, accounting for approximately 87 percent of strokes.
Embolic: Clot travels to the brain from another part of the body
Thrombotic: Clot develops in an artery
2. Hemorrhagic Stroke is a second type of stroke which occurs when a blood vessel in the brain breaks or ruptures. While hemorrhagic stroke is less common, it’s more deadly.
© 2015 National Stroke Association

11. The term “Brain Attack” is the most descriptive and realistic description of a stroke. It also provides a powerful call to action.
A brain attack should warrant the same degree of emergency care as a heart attack. After all, your brain is your mind and your body’s most vital and delicate organ.
Immediate response is crucial because every minute matters – from the time symptoms first become noticeable to the time treatment is received, more brain cells die. In other words TIME IS BRAIN. The best thing to do is to call for immediate assistance.
Treatment is available and some options are most effective if administered within the first three hours after experiencing symptoms.
Your chances of walking out of the hospital with little to no disability are greatly improved if you receive appropriate treatments early.
Unfortunately, it takes the average person in the U.S. 12 to 24 hours to get to the hospital after experiencing the first stroke symptom. This is why it’s important that everyone learns how to RECOGNIZE stroke symptoms and how to RESPOND.

12. Stroke Symptoms So how do you know if someone is having a stroke?
The most common stroke symptoms are:
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
If you see someone having these symptoms or experience any of these symptoms yourself, call immediately.
Appropriate treatment can be more effective if given quickly. Every minute matters!
© 2015 National Stroke Association

13. Stroke Strikes FAST
One way to help remember the symptoms of stroke and what to do, is to learn the Face, Arms, Speech Test, otherwise knows as FAST:
F = FACE: ask the person to smile – do both sides of the face move equally? (Normal) Or does one side of the face not move at all? (Abnormal)
A = ARM: ask the person to raise both arms – do both arms move equally? (Normal) Or does one arm drift downward compared to the other? (Abnormal)
S = SPEECH: ask the person to speak a simple sentence – Does the person use correct words with no slurring? (Normal) Or do they slur their speech, use inappropriate words or is unable to speak at all? (Abnormal)
T = TIME: to call 911 – if you observe any of these symptoms, call 911 immediately. Every minute matters!
© 2015 National Stroke Association

14. Transient Ischemic Attack (TIA)
Transient ischemic attack (TIA) is a warning sign of a future stroke – up to 40 percent of TIA patients will have a future stroke
Symptoms of TIAs are the same as stroke
TIA symptoms can resolve within minutes or hours
It is important to seek immediate medical attention if you suspect that you are having or have had a TIA
TIAs  transient ischemic attacks are a serious warning of an impending stroke.
TIA symptoms are the same as for stroke.
TIAs are brief episodes of stroke symptoms that resolve within minutes or hours, unlike stroke symptoms which can last longer.
Up to 40 percent of all persons who experience a TIA will go on to have a full stroke.
- Within two days of a TIA, 5 percent of patients will have a stroke
- Within 90 days of a TIA, 10 percent to 15 percent will have a stroke
Management of TIAs focuses on preventing a future stroke.
© 2015 National Stroke Association

15. Stroke Facts There are many misconceptions about stroke….
Myths vs. Realities:
Stroke is not preventable – up to 80 percent of strokes are preventable. We’ll discuss steps you can take to reduce stroke risk in a minute.
Stroke cannot be treated – Stroke can be treated, but requires emergency treatment. Call immediately if you experience or see someone with stroke symptoms.
Stroke only strikes the elderly – Anyone of any age can have a stroke.
Stroke is like a heart attack – Stroke is a “Brain Attack.”
Stroke recovery ends after 6 months – Stroke recovery can continue throughout a survivor’s life.
© 2015 National Stroke Association

16. The Cost of Stroke
The estimated direct and indirect cost of stroke is 73.7 billion in 2010
The mean lifetime cost of ischemic stroke is about $140,048 in the U.S.
The cost of stroke: Direct and Indirect costs are estimated at more than $73 billion a year. The estimated direct and indirect cost of stroke is 73.7billion in 2010.
Direct costs make up over 60 percent of this total and include things like hospital, nursing home, physicians/other professionals, drugs/medical, home health care
Indirect costs make up nearly 40 percent of the total and include things like lost roductivity and mortality
© 2015 National Stroke Association

17. Preventing Stroke National Stroke Association
recommends that you follow
these guidelines to help people
reduce their risk for stroke.
Many strokes are preventable if you pay attention to pre-existing medical conditions and control lifestyle factors such as diet and exercise.
National Stroke Association recommends the following public stroke prevention guidelines.
© 2015 National Stroke Association

18. Prevention Guidelines
Know your blood pressure.
Have it checked at least annually.
If it is elevated, work with your
healthcare professional to control it.
Find out if you have atrial fibrillation
(Afib) – a type of irregular heartbeat.
If you have it, work with your
healthcare professional to manage it.
1. Know your blood pressure. Have it checked at least annually. If it’s elevated, work with your healthcare professional to keep it under control. Having high blood pressure, or hypertension, increases stroke risk four to six times.
2. Find out if you have atrial fibrillation – a type of irregular heartbeat. If left untreated, Afib can increase stroke risk four to six times.
© 2015 National Stroke Association

19. Prevention Guidelines
If you smoke, stop.
If you drink alcohol, do so in moderation.
Know your cholesterol number.
If it is high, work with your doctor
to control it.
If you are diabetic, follow your doctor’s recommendations carefully.
3. If you smoke, stop. Smoking doubles stroke risk.
4. If you drink alcohol, do so in moderation. Recent studies have suggested that modest alcohol consumption (up to two glasses of wine or the alcohol equivalent) may reduce stroke risk. If you don’t drink, don’t start.
5. Find out if you have high cholesterol. High cholesterol can indirectly increase stroke risk by putting people at greater risk of heart disease. Talk to your doctor if your total cholesterol is higher than 200 mg/dL or if you LDL cholesterol is higher than 100 mg/dL.
6. If you are diabetic, follow you doctor’s recommendation carefully to control your diabetes. People with diabetes have a significantly higher stroke risk. This may be related to circulation problems that diabetes can cause.
© 2015 National Stroke Association

20. Prevention Guidelines
Include exercise in your daily routine
Enjoy a lower sodium (salt) and lower fat diet
If you have circulation problems, work with your healthcare professional to improve your circulation.
7. Incorporate physical activity that you enjoy into your daily routine. Active people tend to have lower cholesterol levels. Regular exercise also seems to slow down or stop clogging of blood vessels.
8. Enjoy a low-sodium (salt) and low-fat diet. Too much salt may contribute to high blood pressure and make it more difficult to control. A diet that is low in fat will likely include vegetables, lean meats such as chicken and fish, low-fat dairy products and a limited number of eggs.
9. Ask your healthcare professional if you have circulation problems which increase your risk for stroke. If you do, work with your healthcare professional to control this condition.
© 2015 National Stroke Association

21. Stroke Awareness National Stroke Association
recommends that you learn stroke
symptoms and how to respond
by calling
© 2015 National Stroke Association

22. People Don’t Respond to Symptoms
Don’t recognize symptoms
Denial
Think nothing can be done
Worry about cost
Think symptoms will go away
Fear or don’t trust hospitals
Many people don’t recognize stroke symptoms. A 2001 National Stroke Association survey reported that many older Americans could not identify stroke symptoms. A 2009 study revealed that despite numerous national stroke public awareness campaigns, public knowledge of stroke symptoms and risk factors has not improved over the last 5 years.
People don’t want their fear of stroke to be confirmed. Stroke is one of the most terrifying medical emergencies because many people would rather die than be disabled. Yet quick confirmation of stroke is the best way to receive the treatments that are proven to greatly reduce disability after stroke.
Of those surveyed, only 40 percent would call immediately if they were having a stroke.
Many people worried about the cost of stroke treatment, especially if they do not have health insurance. Studies show that acute treatment is significantly less expensive than the costs of extensive rehabilitation and long-term care.
The survey also showed that two-thirds of respondents were unaware of the short time frame in which a person must seek treatment. Waiting to see if symptoms disappear can mean the difference between complete recovery and disability.
Fear of hospitals may keep some individuals from calling to get help when they experience stroke symptoms. Those who call immediately when experiencing stroke symptoms are likely to have a much shorter stay in the hospital than those who wait.
© 2015 National Stroke Association

23. Acute Stroke Treatments
Ischemic stroke (brain clot)
– Clot busting medication: tPA (tissue plasminogen activator)
– Clot-removing devices: Merci Retriever, Penumbra
Hemorrhagic stroke (brain bleed)
– Clipping
– Coiling
There are two types of treatment for ischemic stroke (caused by clots):
The Clot Buster – or tPA works by dissolving blood clots that are blocking arteries. tPA is an enzyme found naturally in the body. The drug was approved by the Food and Drug Administration in June 1996 for treatment of stroke and can improve outcomes but can only be given within the first three hours of symptom onset.
In 2004 the Merci Retriever was FDA approved. This corkscrew-like device is an option for patients ineligible for t-PA treatment. The device is threaded through a catheter up through the body to the clot in the brain. The clot is then removed, restoring the blood flow to the affected area of the brain.
The Penumbra System is a new embolectomy device specifically designed to remove the thrombus in acute ischemic stroke secondary to large vessel thromboembolism. The device removes the thrombus through two mechanisms: aspiration and extraction.
There are also FDA-approved treatments available for hemorrhagic stroke: surgical clipping and coiling.
Clipping, currently the most common treatment, involves making an opening in the skull bone and placing a metal clip across the neck of the aneurysm to stop blood from flowing into the brain.
Coiling, performed since the early 1990s, involves inserting a catheter through an artery in the leg, running it through the body into the brain, and filling in the aneurysm with tiny platinum coils.
© 2015 National Stroke Association

24. Stroke Recovery
10 percent of stroke survivors recover almost completely
25 percent recover with minor impairments
40 percent experience moderate to severe impairments requiring special care
10 percent require care within either a skilled-care or other long-term care facility
15 percent die shortly after the stroke
There’s still so much we don’t know about how the brain can seemingly repair itself from the functional damage caused by stroke. Some brain cells may be only temporarily damaged and may resume functioning. In some cases, the brain can “relearn” what was lost. Sometimes, a region of the brain “takes over” for a region damaged by the stroke. People who have had a stroke sometimes experience remarkable and unanticipated recoveries that can’t be explained. General recovery guidelines show:
10 percent of stroke survivors recover almost completely.
25 percent recover with minor disabilities.
40 percent experience moderate to severe disabilities requiring special care.
10 percent require care within either a skilled-care or other long-term care facility.
15 percent die shortly after the stroke.
Stroke survivors and their families can find workable solutions to most difficult situations by approaching every problem with patience, creativity and tenacity.
© 2015 National Stroke Association

25. Post-Stroke Rehabilitation
Physical therapy (PT)
Walking, range of movement
Occupational therapy (OT)
Taking care of one’s self
Speech language therapy
Communication skills, swallowing, cognition
Recreational therapy
Cooking, gardening
There are different types of Stroke Rehabilitation
Physical Therapy helps restore skills like walking and range of movement. Physical therapy works on improving partial or one-sided paralysis, faulty balance and foot drop.
Occupational Therapy involves relearning skills needed for everyday living such as eating, using the bathroom, dressing and taking care of oneself.
Speech Language Therapy helps stroke survivors that have problems with aphasia – which is when stroke survivors are able to think clearly but cannot put those thoughts into words. Speech language pathologists can teach the aphasic stroke survivor and caregiver methods for coping with this frustrating condition. Speech therapy also helps stroke survivors cope with memory loss and other “thought” problems caused by stroke. Additionally, speech therapy treats stroke survivors with dysphasia, or swallowing problems, that could result in pneumonia if not appropriately managed.
Recreational Therapy involves regaining enjoyable skills and pastimes such as cooking, gardening, sewing and playing cards. These activities also may help stroke survivors regain some lost thinking abilities and physical capabilities.
© 2015 National Stroke Association

26. Lifestyle Changes for Survivors and Caregivers
Daily living skills
Dressing and grooming
Diet, nutrition and eating difficulties
Skin care problems
Pain
Sexuality/Intimacy
Behavior
Communication Problems
Depression & Anger
Emotional Liability
One-sided Neglect
Memory Loss
After stroke, both the stroke survivor and his/her family are often concerned about being on their own at home. Among the common issues are:
Behavior: Stroke survivors’ needs vary depending on what area of the brain has been affected. Care-partners need to be aware of the reasons for the stroke survivor’s behavior, without overlooking the possibility that he or she may also be depressed.
Depression: Many survivors experience a form of depression after stroke. It can be overwhelming, affecting the spirit and confidence of everyone involved. Family can help by trying to stimulate interest in other people, encouraging leisure activities and providing opportunities to participate in spiritual activities. Chronic depression can be treated with individual counseling, group therapy or antidepressant drugs.
Emotional Liability: Sudden laughing or crying for no apparent reason and difficulty controlling emotional responses, known as emotional liability, or Pseudo Bulbar Syndrome, affects many stroke survivors. The “inappropriate” emotional behavior will occur randomly and end as quickly as it started.
Neglect: Some stroke survivors neglect the side of their world opposite the side of their stroke brain injury. This may impact their ability to complete some activities. Examples: eating only on one side of a dinner plate or recognizing only one side of a clock.
Memory Loss: Memory loss  also called vascular dementia  can be so subtle the family may not notice it at first. A stroke survivor may be anxious and cautious, needing a reminder to finish a sentence or follow-through with a behavior.
Communication Problems: If a stroke causes damage to the language center in the brain, there will be language difficulties or aphasia. Communication problems are among the most frightening after-effects of stroke for both the survivor and the family, often requiring professional help.
© 2015 National Stroke Association

27. Types of Recovery Services
Rehabilitation unit in the hospital
In-patient rehabilitation facility
Home-bound therapy
Home with outpatient therapy
Long-term care facility
Community-based programs
Rehabilitation Unit in Hospital: Many general hospitals now offer a variety of rehabilitation services. These may include acute rehabilitation (comparable to free-standing rehabilitation facilities) and sub-acute or transitional care units (usually a skilled nursing facility is a long-term care facility.)
In-Patient Rehabilitation Facility: Patients admitted to a rehabilitation hospital must be able to tolerate a minimum of three hours of intensive therapy per day. These hospitals may also offer less intensive programs known as sub-acute rehabilitation units similar to those in long-term skilled nursing facilities.
Home-Bound Therapy: This form of rehabilitation is for patients who cannot leave their homes after discharge from an inpatient setting. A variety of therapies, along with follow-up nursing and social services, may be available. Clinicians can focus on personalized needs and unanticipated concerns for patients in this setting.
© 2015 National Stroke Association

28. National Stroke Association
What we do…
Aim to reduce the incidence and impact of stroke
Advocate for prevention and public education
Provide professional education and training
Provide recovery resources for stroke survivors and caregivers
National Stroke Association is the only national nonprofit organization dedicating 100 percent of its resources to reducing the incidence and impact of stroke.
National Stroke Association has established itself as a leading resource on the topics of stroke prevention, treatment, rehabilitation research and support for stroke survivors and their families through its work in:
Advocating for stroke prevention and public education
Providing professional education and training
Providing and promoting resources for stroke survivors and caregivers
© 2015 National Stroke Association

29. National Stroke Association
For more information about stroke or National Stroke Association, call toll-free at STROKES ( ) or visit us at
© 2015 National Stroke Association