Strokes

What are strokes? A stroke occurs when the blood supply to your brain is interrupted or reduced, preventing brain tissue from getting sufficient oxygen and nutrients. This causes brain cells to die in minutes. What causes stroke disease? A stroke also known as a brain attack occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptured. When this happens blood that carries oxygen is unable to reach the brain, causing brain cells to die. How common are strokes? Stroke and cerebrovascular diseases are the top five leading causes of death in America, resulting in around 150,000 deaths per year. Every year, more than 795,000 people in the United States have a stroke. To put it into perspective, someone in the U.S. has a stroke every 40 seconds and someone dies of a stroke every 4 minutes. Who is most at risk for stroke? ​Stroke disease can affect anyone at any age, however people over the age of 55 are at a higher risk. In addition, these factors can increase the risk of stroke:

• Being overweight or obese

• Physical inactivity

• Heavy drinking

• Use of drugs

• High blood pressure

• Smoking

• High cholesterol

• Diabetes

• Sleep apnea

• Cardiovascular disease

• Genetic history of stroke or heart disease

• COVID-19

Here are some facts about stroke risk by race, age, and sex:

• African-Americans have a higher risk of death from strokes and have twice a higher risk of getting a stroke than Caucasians.

• The risk of getting a stroke increases by age, but people of any age can get a stroke.

• Men have a higher chance of getting a stroke than women, but women are more likely to die of a stroke.

​ What are the types of stroke disease? There are numerous types of strokes, but two main types of stroke disease are Ischemic and Hemorrhagic strokes. Ischemic strokes occur 87% of the time when the artery which supplies oxygen-rich blood to the brain becomes blocked. Fatty deposits lining the artery walls also known as atherosclerosis, create blood clots which is the main cause of Ischemic stroke. Hemorrhagic strokes occur the other 13% of the time when weakened arteries either leak blood or rupture. As the blood accumulates, it places pressure on the surrounding brain tissue, damaging the cells. The two types of hemorrhagic strokes are Intracerebral (within the brain) hemorrhage and Subarachnoid hemorrhage. Intracerebral hemorrhage occurs when an artery in the brain bursts, flooding surrounding tissue. Subarachnoid hemorrhage is less common and occurs when the artery bursts and bleeds in the area between the brain and the membranes which cover it. How does this affect people/symptoms? The human brain is vastly complex as it controls our movements, stores our memories, sources emotion, and thoughts, and controls many body functions including breathing. Even though the brain only accounts for 2% of our body weight, it needs 20% of the oxygen we breathe to function normally. The lack of oxygen for a mere number of minutes can kill brain cells vital for a specific function or ability. Symptoms of stroke include:

• Trouble speaking and understanding what others are saying - confusion, slurring of words, difficulty understanding words

• Paralysis or numbness of the face, arm, or leg - often just affects on side of your body

• Problems seeing in one or both eyes - may have blurred, blackened, or double vision

• Headaches - sudden, severe, may be accompanied by vomiting, dizziness, or altered consciousness

• Trouble walking - stumbling, loss of balance, sudden dizziness, or loss of coordination

The acronym FAST can be used to determine whether to call a doctor: F - Facial drooping A - Arm weakening S - Speech difficulties T - Time to call 911 What additional complications arise from strokes? Because strokes affect your brain, many functions in your body controlled by your brain may become temporarily or permanently damaged. Some additional problems that may arise from a stroke include:

• Paralysis or loss of muscle movement

• Difficulty talking or swallowing

• Memory loss or thinking difficulties

• Emotional problems

• Pain

• Changes in behavior and self-care ability ​

​ How are strokes diagnosed? To diagnose a stroke, doctors perform a series of tests to determine the type of stroke (ischemic or hemorrhagic) and rule out other causes such as brain tumors or drug reactions. These tests include blood tests to determine the number of blood clots, a computerized tomography (CT) scan to monitor bleeding in the brain and determine the type of stroke, magnetic resonance imaging (MRI) scan to detect brain tissue damage, and carotid ultrasound test which uses sound waves to create detailed images of arteries and fat deposits. In addition, doctors will likely check one's speech, alertness, and overall health with a physical exam. How is stroke disease treated? Treatments vary depending on the type of stroke. To treat an ischemic stroke, doctors must quickly restore blood flow to the brain. Doctors may use IV medication during the first 4.5 hours of symptoms. IV medication contains drugs which restore blood flow by dissolving the clot. tPA is a clot-busting drug which is inserted into your arm. If tPA can't be used because it's too powerful, aspirin or similar medicine can be used as a substitute. Another treatment is a stent retriever, a device used to directly remove the clot from the blocked vessel. This procedure is typically used for larger clots. To treat a hemorrhagic stroke, doctors focus on controlling the bleeding and reducing the pressure in the brain tissue. There are two ways, depending on its cause. If the cause is high blood pressure, a doctor might clamp a broken vessel or thread a tiny coil at the base of the aneurysm to stop blood flow and bursting of the blood vessel. If the cause is tangled blood vessels, a doctor may take them out with surgery, use radiation to shrink them or use a special substance to block the flow of blood to them. ​

How to prevent strokes? To prevent the likelihood of getting a stroke, you should

• Lead a healthy lifestyle

• Lower blood pressure

• Lose weight

• Eat nutritious foods

• Exercise more

• Drink alcohol in moderation or avoid it

• Avoid drugs

• Treat atrial fibrillation (irregular heartbeat)

• Treat diabetes

• Quit smoking

Sources: “Effects of Stroke.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/effects-of-stroke. “Hemorrhagic Strokes (Bleeds).” Www.stroke.org, www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds. “Stroke.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Feb. 2021, www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119. “Stroke.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Feb. 2021, www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113#:~:text=Age%20%E2%80%94%20People%20age%2055%20or,risk%20of%20stroke%20than%20women. “Types of Stroke.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 31 Jan. 2020, www.cdc.gov/stroke/types_of_stroke.htm. https://www.webmd.com/stroke/guide/understanding-stroke-treatment#1 https://www.health.harvard.edu/womens-health/8-things-you-can-do-to-prevent-a-stroke