1. American Heart Association Greater Southeast Affiliate
Understanding
Stroke
American Heart Association
Greater Southeast Affiliate
Welcome participants and introduce yourself.
If applicable and comfortable, share your personal connection to heart disease and stroke and why you are passionate about educating the community.
Encourage participants to share their personal stories when applicable.
Today I wanted to share with you some information developed by the American Stroke Association, a division of the American Heart Association. This presentation should give you a better understanding of stroke including risk factors, treatments and community resources available.

2. What is Stroke? A stroke occurs when blood flow to the
brain is interrupted by a blocked or burst
blood vessel.
If the human brain is to function at peak levels, blood must flow through its many vessels. If blood flow is obstructed at any point within the vessels, the brain loses its energy supply and becomes injured. If blood is obstructed for more than several minutes, the injury sustained by the brain cells becomes permanent and results in tissue death of the affected region. The loss or alteration of bodily function that results from an insufficient supply of blood to part of the brain is a stroke.

3. There are 2 types of stroke
Ischemic Stroke (Blockage)
Caused when there is a blockage in the blood vessels to the brain
Hemorrhagic Stroke (Bleeding)
Caused by burst or leaking blood vessels in the brain
If we consider an isolated blood vessel, blood flow to the brain tissue is hampered in two ways:
1. the vessel clogs within;
2. the vessel ruptures, causing blood to leak into the brain.
Ischemic stroke accounts for about 83 percent of all stroke cases. It results from an obstruction, typically a blood clot. These clots are called a cerebral thrombus or cerebral embolism.
Hemorrhagic stroke accounts for about 17 percent of stroke cases. It results from a weakened vessel that ruptures and bleeds into the surrounding brain. As the blood seeps out, the surrounding brain tissue becomes compressed by the accumulating blood.

4. What are the causes of Ischemic Stroke?
Begins with the development of fatty deposits lining the blood vessel wall
Thrombus: Development of blood clot at the fatty deposit
Embolus: Traveling particle too large to pass through a small vessel
Ischemic stroke occurs 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. The presence of these fatty deposits can cause two types of obstruction:
Cerebral thrombosis refers to a thrombus or blood clot that develops at the site of clogged portion of the vessel.
Cerebral embolism refers generally to a blood clot that forms at another location in the circulatory system, usually the large arteries of the upper chest and neck. A portion of the blood clot dislodges, enters the bloodstream and travels through the blood vessels of the brain until it encounters vessels that are smaller than the clot. A second important cause of clots is an irregular heartbeat, known as atrial fibrillation. Then clots can form in the heart and dislodge to travel to the brain.

5. What are the causes od Hemorrhagic Stroke?
Occurs when a weakened blood vessel ruptures
Aneurysms: Ballooning of a weakened region of a blood vessel
Arteriovenous Malformations (AVMs): Cluster of abnormal blood vessels
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 further 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.

6. What parts of the brain are affected by stroke?
The brain is an extremely complex organ that controls various body functions. If a stroke occurs such that blood flow is restricted from reaching the region that controls a particular body function, for example, the leg, then the result will be muscle weakness causing a limp or some related motor disability.
If the stroke occurs toward the back of the brain, it is likely that some disability involving vision will result.
However, because the brain is structured such that one side controls the opposite side of the body, a stroke affecting one side will result in neurological complications on the opposite side of the body as well.
Left Brain Injury:
If the stroke occurs in the left side of the brain, the right side of the body (and the left side of the face) will be affected, producing any or all of the following:
Paralysis on the right side of the body
Speech/language problems
Slow, cautious behavioral style
Memory loss
Right Brain Injury:
For example, if the stroke occurs in the right side of the brain, the left side of the body (and the right side of the face) will be affected, which could produce any or all of the following:
• Paralysis on the left side of the body
• Vision problems
• Quick, inquisitive behavioral style
• Memory loss

7. Risk Factors that CANNOT be changed
Age
Sex
Race
Prior stroke
Family history
Risk factors for stroke can be classified into two general types: modifiable and non-modifiable risk factors.
The stroke risk factors that cannot be treated are:
• Age (getting older)
• Sex (being male)
• Race (African American are at higher risk)
• Prior stroke
• Family history

8. Risk Factors that CAN be changed
Hypertension/High Blood Pressure
Heart Disease
Cigarette Smoking
Transient Ischemic Attacks
Diabetes
Elevated Blood Cholesterol/Lipids
Asymptomatic Carotid Bruits
Stroke risk factors that can be treated through diet, medication and/or intervention are:
• Hypertension/High Blood Pressure
• Heart Disease
• Cigarette Smoking
• Transient Ischemic Attacks (TIAs)
• Diabetes
• Elevated Blood Cholesterol/Lipids
• Asymptomatic Carotid Bruits (Broo-ee) – An irregular sound that a doctor can detect by listening

9. Stroke Warning Signs
Sudden weakness or numbness 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
Sudden, severe headaches with no known cause
These are the five most common warning signs/symptoms of stroke:
The key word in each of the warning signs is sudden.

10. How are strokes treated?
Ischemic Stroke
Clot-busters e.g., t-PA
Anticoagulants – warfarin, aspirin
Carotid Endarterectomy
Angioplasty/Stents
Hemorrhagic Stroke
Surgical Intervention
Endovascular Procedures, e.g., “coils”
Because their mechanisms are different, the treatment for the types of stroke are different. Ischemic stroke is treated by removing obstruction and restoring blood flow to the brain. In hemorrhagic stroke, doctors introduce an obstruction to prevent rupture and bleeding of aneurysms and arteriovenous malformations.
The most promising treatment for ischemic stroke is the FDA-approved clot-busting drug t-PA, which must be administered within a three-hour window from the onset of symptoms to work best. Generally, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to receive treatment.
Anticoagulants such as warfarin and aspirin interfere with the blood’s ability to clot and can play an important role in preventing stroke. Carotid endarterectomy is a procedure in which blood vessel blockage is surgically removed from the carotid artery. Doctors use balloon angioplasty and implantable steel screens called stents to treat cardiovascular disease in which mechanical devices are used to remedy fatty buildup clogging the vessel.
For hemorrhagic stroke, surgical treatment is often recommended to either place a metal clip at the base, called the neck, of the aneurysm or to remove the abnormal vessels comprising an AVM. Endovascular procedures are less invasive and involve the use of a catheter introduced through a major artery in the leg or arm, guided to the aneurysm or AVM where it deposits a mechanical agent, such as a coil, to prevent rupture.

11. Prevention of stroke Control high blood pressure Prevent heart disease
Stop cigarette smoking
Recognize signs of TIA and tell physician about them
Reduce blood cholesterol levels

12. Learn to recognize a stroke Time lost is brain lost.
Stroke is a medical emergency – call
If you notice one or more of the warning signs for stroke,
GET HELP IMMEDIATELY!
The sudden occurrence of any of these symptoms could possibly indicate a stroke and should prompt the individual to seek immediate medical attention.
Remember,
Stroke is a medical emergency — call 911.
Rapid recognition and reaction to stroke warning signs. Recognize the warning signs and note the time when they first occur. Call immediately. Tell the operator you or the person you are with is having stroke warning signs.
Rapid start of prehospital care. Receive early assessments and pre-hospital care by Emergency Medical Personnel.
Rapid Emergency Medical Services (EMS) system transport and hospital pre-notification. Get to an appropriate hospital quickly via EMS – ambulance personnel will notify the emergency room.
Rapid diagnosis and treatment at the hospital. Receive prompt evaluation of medical data and treatment to restore blood flow to the brain or other treatments as appropriate by a properly staffed and equipped hospital.

13. To learn more about stroke:
Call the Stroke Connection hotline at
888-4-STROKE
Get a subscription to Stroke Connection Magazine
Join the Power To End Stroke movement and take the pledge
Sign up online at:
You can take action by calling
STROKE.
The Stroke Connection “Warmline” is a toll-free information and referral telephone service offering free stroke support information to stroke survivors, family members, caregivers, and healthcare professionals. Information specialists answering the calls are also stroke survivors or caregivers themselves.
You can subscribe to Stroke Connection Magazine
And join the American Stroke Association’s Power To End Stroke campaign, which is a movement to help educated African Americans of their increased risk of stroke.