1. Stroke – Objectives Identify most common cause of stroke List risk factors for stroke Discuss warning signs and symptoms of stroke Identify complications of stroke Describe a method for determining if a person is having a stroke http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31828124ad

2. Stroke – Cerebrovascular Accident (CVA) Third leading cause of death in U.S. A stroke occurs every 40 seconds – more often between 6 am and 12 noon (Seminars in Neurology, 2009). Of every 5 deaths from stroke, 2 occur in men and 3 in women. Ischemic vs Hemorrhagic TIA – Transient Ischemic Attack “mini-stroke” –Stroke symptoms lasting less than 1 hr Circ.ahajournals.org (Sept 16, 2010)

3. Annual age-adjusted incidence of first-ever stroke by race. Go A S et al. Circulation. 2014;129:e28-e292 Copyright © American Heart Association, Inc. All rights reserved.

4. Stroke death rates, 2008 through 2010. Go A S et al. Circulation. 2014;129:e28-e292 Copyright © American Heart Association, Inc. All rights reserved.

5. Stroke Stats 6,400,000 strokes 2003-2006 795,000 new strokes / yr 55,000 more women than men Blacks have first-ever stroke 2-5 times that of white Only 50% of those who have TIA report it –Within 1 year, 1/4 of those will die of stroke Every 4 minutes someone dies of stroke Circ.ahajournals.org

6. Stroke Risk Factors Older age African American race Positive family history of stroke Low Birth Weight Hypertension Smoking (2x risk for stroke) Diabetes Prior stroke, TIA or MI Physical Inactivity – Active 25-30% lower risk Abdominal body fat (men > 40 in; women > 35 in) Sickle cell disease Alcohol Consumption Migraine Atrial Fibrillation (increases risk of thromboembolism) Drug Abuse: cocaine, amphetamine Oral Conctraceptive Agents

7. Stroke Warning Sign/Symptoms Sudden weakness, numbness, or paralysis of face, arm, or leg on one side of the body Sudden trouble seeing in one or both eyes Sudden confusion, difficulty speaking or trouble understanding speech Sudden severe headache with no known cause Sudden trouble walking, dizziness, unsteadiness, or sudden fall STR –Ask the person to SMILE –Ask the person to TALK –Ask to RAISE BOTH ARMS www.strokeassociation.org

8. Stroke Complications Sleep problems Confusion Depression ( JAMA 2011;306 1241-1249) Incontinence Pneumonia Swallowing dysfunction –Aspiration –Dehydration Female Physical inactivity –Thromboembolism –Sarcopenia (skeletal muscle loss) –Pressure ulcers www.strokeassociation.org

9. Effects of Diet Adherence to Mediterranean Diet Reduces Risk –10-18% reduced risk in total and ischemic stroke Emphasis: –Fruits and vegetables –Monounsaturated fats (olive Oil) –Whole grains –Legumes and nuts –Fish –Moderate alcoholSleep problems Limits: –Meat –Refined and simple carbohydrates –Dairy Ayesha Z Sherzai, Columbia University; Mediterranean Diet and Incidence of Stroke in the California Teachers Study. International Stroke Confernece 2015

10. Risk Factor Prevalence in Stroke Victims www.strokeassociation.org