INTRODUCTION

The brain is arguably the most complex of all the organs in your body.
These three pounds of tissue compose the major nerve center of the body,
which coordinates all of our bodily functions, including behavior, thought and
emotions. Because your brain is a very hard-working organ, it requires
constant supplies of oxygen and nutrients from the blood to function
effectively. The heart pumps blood throughout the cerebral arteries
(cerebral means related to the brain), delivering blood to the brain. Any
significant interruption to this supply of nutrients and oxygen will start killing
brain cells. Damage to brain cells occurs almost immediately upon cessation
or even significant restriction of blood flow to the brain. Minor damage to any
part of the brain can have a serious adverse effect on the rest of the body.
Significant damage to the brain can even result in death.
One relatively common cause of brain damage and death is referred to
as a stroke. A stroke is similar to a heart attack, only in this case, blood flow
to brain, rather than the heart, is blocked. The term stroke comes from the
once popular idea that someone had received a stroke of Gods hand and
was therefore damaged. Strokes are also called cerebrovascular accidents
(CVAs; cerebrum is Latin for brain, while vascular refers to the blood
vessels) or brain attacks to emphasize the need to call 911 and get
immediate medical attention when they occur.
Arterial blood vessels feeding the brain can become blocked on a
permanent or temporary basis. The term stroke is generally reserved for
more permanent blockages that do not rapidly and spontaneously resolve
themselves. These blockages result in permanent brain damage and leave
lasting physical or mental deficits. Transient and temporary blockages are
called Transient Ischemic Attacks (or TIAs for short). TIAs temporarily alter
behavior and thinking (for less than 24 hours), but do not end up creating
lasting brain damage. Because the damage is temporary, a TIA is sometimes
referred to as a mini or warning stroke. Individuals who experience TIAs
are at greater risk for having serious strokes in the future.

There are two major ways that strokes generally occur:

Ischemic strokes occur when a blood clot (called a thrombi) or a

fatty plaque (composed of fat deposits, cholesterol, and waste products)
blocks blood flow to an area of the brain, causing death of the associated
neurons (brain cells). Fatty plaques often line the interior artery walls of
people with a cardiovascular disease called arteriosclerosis (hardening of
the arteries). These plaques narrow the arterial space, and serve as points
around which blood begins to clot. Resulting thrombi start to block the
artery, which reduces the amount of blood able to pass through, and
therefore the amount of oxygen getting to the cells is reduced. The clots can
also detach and float downstream (they are then referred to as emboli),
block blood flow to brain areas, and cause subsequent brain damage.
Approximately 88% of strokes are ischemic events.
Hemorrhagic stroke, occurs when a cerebral (brain) artery ruptures
and spills blood over the brain tissue. This spilled blood ends up pooling
inside the skull, exerting pressure on and causing damage to delicate brain
tissue. In addition, the ruptured vessels fail to do their typical job of feeding
blood to specific areas of the brain. Between being starved for oxygen and
nutrients, and being squeezed by the pressure of spilled blood, the brain
ends up being severely injured or destroyed. Approximately 12% of strokes
are hemorrhagic.
Approximately 700,000 Americans suffer a stroke each year. It is the third
major cause of death in the United States each year after heart disease and
cancer. In 2002, 162,672 individuals died of stroke in the United States.
Though strokes can be lethal, there are many people who survive
them. However, these stroke survivors typically experience a range of
limitations. For example, people might lose the ability to comprehend
language, to speak, to walk, or to control parts of their body. As a general
rule, the right side of the brain controls the left side of the body and the left
side of the brain controls the right side of the body. So, individuals who had a
stroke affecting the right side of their brain will probably have some difficulty
controlling some portion of the left side of their bodies, and vice versa.
Due to concept called neuroplasticity, healthy areas of the brain are
sometimes able to compensate for abilities lost to stroke. Therefore, many
people experience partial recovery of pre-stroke abilities.

STATISTICS

According to the World Health Organization, 15 million people suffer

stroke worldwide each year. Of these, 5 million die and another 5 million
are permanently disabled.

High blood pressure contributes to more than 12.7 million strokes

worldwide.

Europe averages approximately 650,000 stroke deaths each year.

In developed countries, the incidence of stroke is declining, largely due

to efforts to lower blood pressure and reduce smoking. However, the
overall rate of stroke remains high due to the aging of the population.

SIGNS & SYMPTOMS

Trouble with speaking and understanding. You may experience

confusion. You may slur your words or have difficulty understanding
speech.

Paralysis or numbness of the face, arm or leg. You may develop

sudden numbness, weakness or paralysis in your face, arm or leg,
especially on one side of your body. Try to raise both your arms over
your head at the same time. If one arm begins to fall, you may be
having a stroke. Similarly, one side of your mouth may droop when you
try to smile.

Trouble with seeing in one or both eyes. You may suddenly have
blurred or blackened vision in one or both eyes, or you may see double.

Headache. A sudden, severe headache, which may be accompanied

by vomiting, dizziness or altered consciousness, may indicate you're
having a stroke.

Trouble with walking. You may stumble or experience sudden

dizziness, loss of balance or loss of coordination.

COMPLICATIONS

Paralysis or loss of muscle movement. You may become paralyzed

on one side of your body, or lose control of certain muscles, such as
those on one side of your face or one arm. Physical therapy may help
you return to activities hampered by paralysis, such as walking, eating
and dressing.

Difficulty talking or swallowing. A stroke may cause you to have

less control over the way the muscles in your mouth and throat move,
making it difficult for you to talk clearly (dysarthria), swallow or eat

(dysphagia). You also may have difficulty with language (aphasia),

including speaking or understanding speech, reading or writing.
Therapy with a speech and language pathologist may help.

Memory loss or thinking difficulties. Many people who have had

strokes experience some memory loss. Others may have difficulty
thinking, making judgments, reasoning and understanding concepts.

Emotional problems. People who have had strokes may have more
difficulty controlling their emotions, or they may develop depression.

Pain. People who have had strokes may have pain, numbness or other
strange sensations in parts of their bodies affected by stroke. For
example, if a stroke causes you to lose feeling in your left arm, you
may develop an uncomfortable tingling sensation in that arm.
People also may be sensitive to temperature changes, especially
extreme cold after a stroke. This complication is known as central
stroke pain or central pain syndrome. This condition generally develops
several weeks after a stroke, and it may improve over time. But
because the pain is caused by a problem in your brain, rather than a
physical injury, there are few treatments.

Changes in behavior and self-care ability. People who have had

strokes may become more withdrawn and less social or more impulsive.
They may need help with grooming and daily chores.

RISK FACTORS
Many factors can increase your risk of a stroke. Some factors can also
increase your chances of having a heart attack. Potentially treatable stroke
risk factors include:
Lifestyle risk factors

Being overweight or obese

Physical inactivity

Heavy or binge drinking

Use of illicit drugs such as cocaine and methamphetamines

Medical risk factors

High blood pressure the risk of stroke begins to increase at blood

pressure readings higher than 120/80 millimeters of mercury (mm Hg).
Your doctor will help you decide on a target blood pressure based on
your age, whether you have diabetes and other factors.

Cigarette smoking or exposure to secondhand smoke.

High cholesterol.

Diabetes.

Obstructive sleep apnea a sleep disorder in which the oxygen level

intermittently drops during the night.

Cardiovascular disease, including heart failure, heart defects, heart

infection or abnormal heart rhythm.

Other factors associated with a higher risk of stroke include:

Personal or family history of stroke, heart attack or transient ischemic

attack.

Being age 55 or older.

Race African-Americans have a higher risk of stroke than do people

of other races.

Gender Men have a higher risk of stroke than women. Women are
usually older when they have strokes, and they're more likely to die of
strokes than are men. Also, they may have some risk from some birth
control pills or hormone therapies that include estrogen, as well as from
pregnancy and childbirth.