Stroke Information

Learn About Stroke

What is a Stroke?

Stroke is a sudden interruption in the blood supply of the brain.  Most strokes are caused by an abrupt blockage of arteries leading to the brain ( ischemic stroke).  Other strokes are caused by bleeding into brain tissue when a blood vessel bursts ( hemorrhagic stroke).   

Because stroke occurs rapidly and requires immediate treatment, stroke is also called a brain attack.  When the symptoms of a stroke last only a short time (less than 24 hourS), this is called a transient ischemic attack (TIA) or mini-stroke.

  • Stroke affects more than 600,000 Americans each year - including 150,000 deaths.

  • World wide stroke incidence is around 25 millions.

  • World wide stroke mortality is 1 million per year.

  • Stroke is the leading cause of adult disability and the third leading cause of death in the United States.

  • Stroke has many consequences.  Including motor disability, seizures, depression, dementia, incontinence and many others.

Signs of Stroke

Stroke is a medical emergency and can be treated if recognized in time (Brain is Time).  Even if the symptoms pass quickly, they represent an important warning phenomenon, indicating an on going brain threat, which  requires immediate and prompt medical attention.

The most common sign of stroke is sudden weakness of the face, arm or leg, most often on one side of the body. 

To recognize stroke quickly, look for a tilted smile, inability to speak or weak arm raising ..

The most common sign of stroke is sudden weakness of the face, arm or leg, most often on one side of the body. 

Other signs:

  • Sudden numbness of the face, arm, or leg, especially on one side of the body 

  • Sudden confusion, trouble speaking or understanding speech 

  • Sudden trouble seeing in one or both eyes 

  • Sudden trouble walking, dizziness, loss of balance or coordination 

  • Sudden severe headache with no known cause

Risk Factors

The following risk factors will increase the chances to develop stroke, and all modifyable:

  • Asymptomatic carotid artery stenosis (stroke chance increases by 10.5%)  

  • TIA (stroke chance increases by 10-15%)  

  • H/O Stroke (stroke chance increases by 30-40%)  

  • Hypertension:   (stroke increases by 2-4 times) : More ...

  • Diabetes:  (stroke increases by 2-4 times): More ...

  • Cigarette smoking:   (stroke increases by 2- 3 times)

  • Alcohol: Heavy drinking  

  • Obesity

  • Abnormalities of serum lipids  

  • Cardiac lesion: More ...

  • Hematological disorders


Stroke register: 

Experience from the eastern province of Saudi Arabia

  • Population of 750,000 inhabitants   (545,000 Saudi citizens)

  • The crude incidence rate for first-ever strokes was 29.8/100,000/year. When standardized to the 1976 US population, it rose up to 125.8/100,000/year.

  • Ischemic strokes (69%)

  • Systemic hypertension (38%)

  • Diabetes mellitus (37%)

  • Heart disease (27%)

  • Smoking (19 %)

  • Family history of stroke (14%)

  • Previous transient ischemic attacks (3%)

  • Carotid bruits (1%)

  • SAH was extremely rare (1.4%)

  • The 30-day case fatality rate is 15%

al-Rajeh S.  King Saud University, Riyadh, Saudi Arabia


Reducing Your Risk of Stroke

As a leading cause of heart disease which can lead to stroke, high cholesterol is a controllable condition through diet, exercise and, in some cases, medications.

Certain medical conditions greatly increase your likelihood of having a stroke (or another stroke).  Working  with your doctor, you may need to begin specific medical treatment to control these risks:

  • Previous stroke or "mini-stroke" (transient ischemic attack, TIA).
    Depending on the most likely cause of your stroke, your doctor may prescribe specific medication or consider surgery to remove fatty deposits in your carotid artery.

  • High blood pressure.
    Hypertension is one of the leading risks for heart disease and stroke.  Your physician may advise dietary or lifestyle changes, or specific medications to lower your blood pressure.

  • Diabetes.

  • High blood sugar can increase your risk, so you should work closely with your doctor to manage it.

  • Heart disease: Particularly heart beat irregularities (atrial fibrillation), disease of the heart valves, congestive heart failure, or recent heart attack.  If you have one of these conditions, your physician may prescribe medications to thin your blood and/or reduce your cholesterol level.   

Other risk factors for stroke can be controlled by life style choices you make:

  • Smoking: Tobacco use is a major preventable risk factor for stroke and heart disease.  Even if you have smoked for years, you can still reduce your risk by quitting now.

  • Obesity, elevated cholesterol, and elevated lipids: Reduce your dietary intake of saturated fats and cholesterol .

  • Physical inactivity.

  • Excessive alcohol intake.

  • Illegal drug use.

There are some risk factors you can't control:

  • Increasing age: Stroke is more common in people over 60 years of age.

  • Male sex: Men and women both have strokes, although stroke is more common at younger ages in men.

  • Heredity and Race: Stroke is more common in people whose close relatives have had stroke at an early age.  African-Americans and Hispanic Americans are at higher risk than white Americans.  This may be due in part to high blood pressure and dietary differences.

The ischemic cascade

Numbers of factors have an important role in the final destination of ischemia, that is cell death. Full understanding of this ischemic cascade would enlighten the path for potentially effective treatment for acute ischemic stroke.          


The autoregulation curve

The brain has an autoregularity  mechanism that would protect it when there is a fall in the oxygen supply. These mechanisms involve blood flow, intracranial pressure, systemic blood pressure, heart rate, intracerebral blood vessel wall compliance and vasomotor reserve. This mechanism would fail if exhausted.        

                         


Atherosclerosis

Atherosclerosis carries high risk for stroke, particularly if there is stenosis of the internal carotid artery (higher risk with stenosis more than 70%). The studies showed that endarterectomy is effective against stroke occurrence and recurrence. 

Cholesterol deposits on the inner wall of the vessels, particularly at bifurcation site, then ulcerations occur on these cholesterol deposits


At later stages, platelet aggregants form on top of the ulcerated site of the cholesterol deposits, enlarging in size and causing stenosis of the vessel lumen


When the platelet aggregant grow in size, it becomes fragile and easily can brake and dislodge distally in the vessel causing obstruction in smaller branches. Also if the stenosis increases progressively, it eventually might cause complete obstruction of the vessel.

               


Facts about Stroke

  • 3 rd   most common cause of mortality

  • Affect 700,000 people in USA yearly  

  • 5% of   victims are less than age of 45 years  

  • Rate in young   is around 11-70 per 100,000 population

  • Ischemic stroke accounts for 80-85 % of all stroke

  • Intracerebral hemorrhage accounts for 15 % of all stroke

  • Subarachnoid hemorrhage is rare among Saudi population

  • 15 – 20 % ICU admissions are related to a vascular event