1. Burcu Ormeci, MD Assistant Professor Department of Neurology CEREBRO-VASCULAR DISEASES «S TROKE »

2. D EFINITION OF S TROKE Sudden brain damage Lack of blood flow to the brain caused by a clot or rupture of a blood vessel Ischemic (emboli, thrombosis) Makes up approximately 87% of all strokes Hemorrhagic Bleeding around brain Bleeding into brain EmbolicThrombotic

3. TIA Transient ischemic attack (TIA) is a warning sign of a future stroke up to 40% of TIA patients will have a future stroke Symptoms of TIAs are the same as stroke TIA symptoms can resolve within minutes or hours (max 24 hours) It is important to seek immediate medical attention if you suspect that you are having or have had a TIA

4. STROKE «B RAIN A TTACK !» The term “Brain Attack” is the most descriptive and realistic description of a stroke 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 Treatment is available and some options are most effective if administered within the first three hours after experiencing symptoms

5. S TROKE F ACTS The third leading cause of death in the world behind heart disease and all forms of cancer combined A leading cause of serious, long-term adult disability in the world 795,000 Americans suffer strokes each year On average, someone suffers a stroke every 40 seconds in America 134,000 deaths each year

6. S TROKE F ACTS W OMEN & S TROKE 6,400,000 stroke survivors Men make up about 2,500,000 and women make up 3,900,000 Stroke kills more than twice as many women every year as breast cancer More women than men die from stroke and risk is higher for women due to higher life expectancy

7. T HE C OST OF S TROKE The mean lifetime cost of ischemic stroke is about $140,048 in America The estimated direct and indirect cost of stroke is 73,7 billion in 2010

8. S TROKE S YMPTOMS It depends on which brain region affected Sudden confusion Trouble speaking or understanding Motor or sensoriel afasia Sudden numbness or weakness of face, arm or leg especially on one side of the body Trouble seeing in one or both eyes Sudden severe headache with no known cause Sudden dizziness, loss of balanca or coordination Trouble walking

9. RISK FACTORS OF S TROKE Hypertension; increases stroke risk four to six times Atrial fibrillation; AF can increase stroke risk four to six times Smoking; doubles stroke risk

10. RISK FACTORS OF S TROKE Alcohol; Recent studies have suggested that modest alcohol consumption (up to two glasses of wine) may reduce stroke risk If you don’t drink, don’t start High cholesterol level; Can indirectly increase stroke risk by putting people at greater risk of heart disease Diabet; This may be related to circulation problems that diabetes can cause

11. RISK FACTORS OF S TROKE Inactive lifestyle; Active people tend to have lower cholesterol levels Regular exercise also seems to slow down or stop clogging of blood vessels High-sodium (salt) and high-fat diet; Too much salt may contribute to high blood pressure Circulation problems; Previously experience any stroke symptoms

12. T REATMENT OF STROKE Primary treatment Acut stroke treatment Secondary treatment Prevention of stroke Control of risk factors Antiagregan and/or anticoagulan drugs Rehabilitation

13. A CUTE S TROKE T REATMENTS Ischemic stroke Clot busting medication: t-PA (Tissue Plasminogen Activator) can only be given within the first three hours of symptom onset Clot-removing devices: Merci Retriever, Penumbra Hemorrhagic Stroke Clipping; İnvolves making an opening in the skull bone Coiling; involves inserting a catheter through an artery

14. S ECONDARY TREATMENT Many strokes are preventable; if you pay attention to pre-existing medical conditions to control lifestyle factors such as diet and exercise …etc

15. Up to 80% of all strokes are preventable through risk factor management Recognize: stroke symptoms Reduce: stroke risk Respond : at the first sign of stroke The 3 R’s of stroke

16. S TROKE R ECOVERY Some brain cells may be only “ temporarily ” damaged and may resume functioning In some cases, the brain can “re-learn” what was lost Sometimes, a region of the brain “takes over” for a region damaged by the stroke

17. S TROKE R ECOVERY 10% of stroke survivors recover almost completely 25% recover with minor impairments 40% experience moderate to severe impairments requiring special care 10% require care within either a skilled-care or other long-term care facility 15% die shortly after the stroke

18. T HE P ERCEPTIONS OF S TROKE Myth Stroke is not preventable Stroke cannot be treated Stroke only strikes the elderly Stroke happens in the heart Stroke recovery ends after 6 months Reality Up to 80% percent of strokes are preventable Stroke requires emergency treatment Anyone can have a stroke Stroke is a “Brain Attack” Stroke recovery can last a lifetime

19. T YPES OF S TROKE R EHABILITATION Physical Therapy Walking, range of movement Occupational Therapy Taking care of one’s self Speech Language Therapy Communication skills, swallowing, cognition Recreational Therapy Cooking, gardening

20. L IFESTYLE C HANGES FOR S URVIVORS AND C AREGIVERS Behavior abnormalities Depression & anger Emotional lability One-sided neglect Memory loss Communication problems o Lost of daily living skills o Dressing and grooming problems o Diet, nutrition and eating difficulties o Skin care problems o Pain o Sexuality/Intimacy

21. R EFERENCES : American Heart Association. Heart Disease and Stroke Statistics 2010 Update At-a-Glance. At: http://www.americanheart.org/presenter.jhtml?identifier=1200 026. http://www.americanheart.org/presenter.jhtml?identifier=1200 026 Perry HM, Roccella EJ. Conference report on stroke mortality in the southeastern United States. Hypertension. 1998;6:1206- 15. 1-800-STROKES (787-6537) www.stroke.org