Stroke

Stroke (also known as cerebrovascular disease) occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so it starts to die. The extent and location of the brain cell damage determines the severity of the stroke, which can range from minimal to catastrophic. Because different areas of the brain control different functions, the specific effects of a particular stroke depend on which area of the brain is injured. A small stroke in a critical area of the brain can be permanently disabling. Because brain cells do not regenerate, damage to the nerve cells is permanent. Millions of brain cells die each minute a stroke is untreated. Ruptured blood vessels cause hemorrhagic or bleeding strokes.

The theme of the campaign is "1 in 6". The reason behind this is to emphasize how widespread stroke is. Not many people are aware of this fact. One in six people in the world will suffer a stroke in their lifetime; on this page, you will find the data and references behind that statistic and others.

• 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

If you notice one or more of these signs, don't wait. Stroke is a medical emergency.
Call your emergency medical services and get to a hospital right away!

Types of Stroke 
There are two types of stroke caused by an isolated blood vessel that hampers blood flow to the brain:

• That where the vessel clogs within - ischemic stroke
• Where the vessel ruptures, causing blood to leak into the brain - hemorrhagic stroke

Ischemic
Ischemic stroke accounts for about 87 percent of all cases. 
Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls. This condition is called atherosclerosis. These fatty deposits can cause two types of obstruction:

Cerebral thrombosis refers to a thrombus (blood clot) that develops at the clogged part of the vessel.
Cerebral embolism refers generally to a blood clot that forms at another location in the circulatory system, usually the heart and large arteries of the upper chest and neck. A portion of the blood clot breaks loose, enters the bloodstream and travels through the brain's blood vessels until it reaches vessels too small to let it pass. A second important cause of embolism is an irregular heartbeat, known as atrial fibrillation. It creates conditions where clots can form in the heart, dislodge and travel to the brain.

Hemorrhagic
Hemorrhagic stroke accounts for about 13 percent of stroke cases. It results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. The two types of hemorrhagic strokes are intracerebral hemorrhage or subarachnoid hemorrhage.

Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations (AVMs).

An aneurysm is a ballooning of a weakened region of a blood vessel. If left untreated, the aneurysm continues to weaken until it ruptures and bleeds into the brain.  An arteriovenous malformation (AVM) is a cluster of abnormally formed blood vessels. Any one of these vessels can rupture, also causing bleeding into the brain. 

Treatment
Thrombolytics
Thrombolytic (fibrinolytic) drugs help reestablish blood flow to the brain by dissolving  the clots, which are blocking the flow. In June, 1996, the “clot-buster” Activase® (Alteplase recombinant) became the first acute ischemic stroke treatment to be approved by the Federal Food and Drug Administration (FDA). Activase is also known as tissue plasminogen activator (tPA). To be effective, thrombolytic therapy should be given as quickly as possible.

tPA
tPA is an enzyme found naturally in the body that converts, or activates, plasminogen into another enzyme to dissolve a blood clot. It may also be used in an IV by doctors to speed up the dissolving of a clot. tPA should be given within three hours of symptom onset. It is important for people to understand stroke warning signs and get to a hospital FAST in case they are eligible to receive tPA. Time is an important factor associated with determining whether a patient can receive it or not.

The results of a five-year trial, conducted by the National Institute of Neurological Disorders and Stroke (NINDS) found that carefully selected stroke patients who received Activase within three hours of the beginning of stroke symptoms were at least 33 percent more likely than patients given a placebo to recover from their stroke with little or no disability after three months. The most common complication associated with Activase is brain hemorrhage. However, studies have shown that tPA does not increase the death rate of stroke patients when compared with placebo.

MERCI Retrieval System
In 2004 the FDA cleared Concentric Medical's innovative Merci® Retriever for patients who are ineligible for IV-tPA or fail to respond to IV-tPA. The system can be used for patients who are beyond the 3-hour time window for IV-tPA and it does not have a time limit for its intended use. This device offers physicians and patients long-awaited options for stroke intervention and creates a departure from the historic method of caring for stroke patients. The Merci Retriever has repeatedly been proven to restore blood flow in the larger vessels of the brain by removing blood clots. Over 8,000 patients world-wide have undergone this procedure and it has been performed at over 300 US hospitals. The system is a tiny cork-screw shaped device that works by wrapping around the clot and trapping it. The clot is then retrieved and removed from the body.

Penumbra System
At the beginning of 2008 it was announced that the Penumbra System is now available for use. The system allows for safe revascularization of occluded vessels after an ischemic stroke. The system also helps restore brain blood flow by using suction to grab blood clots in the brain for treatment of acute ischemic stroke. For doctors and patients alike, this system is revolutionary. Previously doctors had limited treatment options with acute ischemic stroke if patients were beyond the three-hour window for intravenous thrombolysis. The Penumbra System is a device that is effective if used within eight hours of symptom onset.

Although stroke can happen to anyone, certain risk factors can increase chances of a stroke. However, studies show that up to 80 percent of strokes can be prevented by working with a healthcare professional to reduce personal risk. It is important to manage personal risk and know how to recognize and respond to stroke
signs and symptoms.

Know blood pressure (hypertension) 
High blood pressure is a major stroke risk factor if left untreated. Have blood pressure checked yearly by a doctor or at health fairs, a local pharmacy or supermarket or with an automatic blood pressure machine.

Identify atrial fibrillation (Afib) 
Afib is an abnormal heartbeat that can increase stroke risk by 500%. Afib can cause blood to pool in the heart and may form a clot and cause a stroke. A doctor must diagnose and treat Afib.

Stop smoking  
Smoking doubles the risk of stroke. It damages blood vessel walls, speeds up artery clogging, raises blood pressure and makes the heart work harder.

Control alcohol use  
Alcohol use has been linked to stroke in many studies. Most doctors recommend not drinking or drinking only in moderation - no more than two drinks each day.

Know cholesterol levels  
Cholesterol is a fatty substance in blood that is made by the body. It also comes in food. High cholesterol levels can clog arteries and cause a stroke. See a doctor if your total cholesterol level is more than 200.

Control diabetes
Many people with diabetes have health problems that are also stroke risk factors. A doctor and dietician can help manage diabetes.

Manage exercise/diet 
Excess weight strains the circulatory system. Exercise five times a week. Maintain a diet low in calories, salt, saturated and trans fats and cholesterol. Eat five servings of fruits and vegetables daily.

Treat circulation problems  
Fatty deposits can block arteries carrying blood to the brain and lead to a stroke. Other problems such as sickle cell disease or severe anemia should be treated.

Transient Ischemic Attack (TIA)
A TIA is a temporary episode of stroke-like symptoms that can last a few minutes to 24 hours but usually causes no permanent damage or disability. TIA and stroke symptoms are the same. Recognizing and treating a TIA can reduce stroke risk. Up to 40 percent of people who experience a TIA may have a stroke.