A Guide to Stroke and Emergency Stroke Care

Stroke as a global burden 

A stroke occurs when there is an obstructed blood flow in an area of the brain that results in brain cell atrophy (cell death) due to deprivation of oxygen. The oxygen supply is interrupted because the blood vessel that carries oxygen and nutrients to the brain either gets blocked by a clot or gets ruptured.¹ Stroke is the third leading cause of disability worldwide² and the second leading cause of death.³ In 2013, the number of stroke survivors was almost 25.7 million globally, deaths from stroke were 6.5 million, disability-adjusted life years (DALYs) due to stroke was 113 million, and cases of new strokes were 10.3 million.⁴ In 2016, there were 177,196 deaths due to stroke in the U.S., the number of stroke survivors reached 731,256 and the incidence of DALYs  was 3,162,485.⁵ Additionally, around 53.5% of the total stroke cases in the U.S. occur among women.⁶

Types of stroke

Ischemic stroke takes place when a blood supplying vessel is obstructed and blood doesn’t reach the brain cells.^7,8  Ischemic strokes are responsible for approximately 87 percent of all strokes. Atherosclerosis or fatty plaque within the blood vessel is the main cause of ischemic stroke. ¹

Silent stroke is a brain injury that is generally caused by a blood clot that interrupts blood flow in the brain. It is characterized by a lack of clinical stroke-like symptoms and an association with elusive deficits in physical and cognitive function which very often remain unnoticed. It’s a risk factor for future strokes and a vital sign of progressive brain damage.^1,9

• Hemorrhagic stroke happens when a weak blood vessel ruptures. It contributes to about 13 percent of stroke cases,^1,7 and carries a very high morbidity and mortality rate.¹⁰

• Transient Ischemic Attacks (TIA) or “mini-strokes” occur when there is a temporary blockage of blood flow to the brain. About 80% of strokes that occur after experiencing a TIA are preventable by seeking urgent medical treatment. Though it doesn’t cause permanent damage, it’s a major warning for prevention of future strokes.^7,11

• Cryptogenic stroke is the name for any stroke when the cause is unexplained despite testing. Such strokes are present in approximately 30%–40% of ischemic stroke patients.¹²
• Brain stem stroke occurs in the brain stem, affecting both sides of the body, often leaving someone in a paralyzed state. In such a condition, the patient is generally unable to speak or move below the neck.¹  They are attributable to approximately 10% of all ischemic brain strokes.¹³ 

Stroke impact as a global concern

• Factors such as the location of the obstruction, severity, and  the number of brain tissue affected will modulate the impact of stroke. If a stroke has occurred in the left side of the brain, the following impairments are most likely to occur in the right side of the body: paralysis on the right side of the body, speech/language problems, slow and cautious  movement, memory loss, etc. 
• If a stroke has occurred in the right side of the brain, the following impairments are most likely to occur in the left side of the body: paralysis on the left side of the body, vision problems,  inquisitive behavior, memory loss, etc.^1,14,15

Who is more likely to have a stroke?

• Conditions like hypertension (higher among men and older age groups), diabetes (among both genders), atrial fibrillation (higher among women), dyslipidemia (higher among men), migraine (higher among women), and cognitive impairment (higher among women), promote the occurrence of stroke.¹⁶ 

How to avoid a stroke?

Almost 80% of second clot-related strokes are preventable. You just need to take a little more effort to keep a record of your health status and be a little more cautious about your health care practices. Keep yourself healthy by monitoring your blood pressure at regular intervals, check  your cholesterol levels, keep your blood sugar under control, get active, quit smoking, eat a healthy diet and, of course, talk to your doctor about the medications you are currently taking.^17,18

Stroke care

You must seek immediate medical care if you experience any of the following: sudden numbness or weakness 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, or experiencing a sudden severe headache with an unknown cause.^1,17

• Recognizing the signs and symptoms of stroke and seeking immediate medical attention are the first and foremost steps to ensure recovery and minimize the effects of a stroke. Perform a quick FAST test to confirm the warning signs of a stroke: 

Primary and Comprehensive Stroke Centers

Based on the commitment and ability to treat stroke and to provide rehabilitation support, The Joint Commission has certified stroke centers as primary and comprehensive.^1,22

* Top stroke care centers in the U.S. include:

1. Catawba Valley Medical Center
   810 Fairgrove Church Road, Hickory, NC 28602
   Telephone: (828) 326-3000
   www.catawbavalleymedical.org/
   
   
2. Einstein Medical Center Montgomery
   559 West Germantown Pike, East Norriton, PA 19403
   Telephone: (484) 622-1000
   www.einstein.edu
   
   
3. Florida Hospital Carrollwood
   7171 N Dale Mabry Hwy, Tampa, FL 33614
   Telephone: (813) 932-2222
   www.floridahospital.com
   
   
4. Mayo Clinic Hospital, Methodist Campus
   201 W Center St, Rochester, MN 55902
   Telephone: (507) 266-7890
    https://www.mayoclinic.org
   
   
5. Hugh Chatham Memorial Hospital
   180 Parkwood Drive, Elkin, NC 28621
   Telephone: (336) 527-7000
   www.hughchatham.org
   
   
6. Massachusetts General Hospital
   165 Cambridge St, Suite 810, Boston, MA 02114
   Telephone: (617) 726-2760
   www.massgeneral.org/trauma/
   
7. Kaiser Permanente Santa Rosa Medical Center
   401 Bicentennial Way, Santa Rosa, CA 95403
   Telephone: (707) 393-4000
   www.kaiserpermanente.org
   
   
8. Mission Hospital Mission Viejo
   27700 Medical Center Road, Mission Viejo, CA  92691
   Telephone: (949) 364-1400
   www.mission4health.com
   
   
9. Cleveland Clinic
   2049 East 100th Street, Cleveland, OH 44195
   Telephone: (216) 444-2222
   www.my.clevelandclinic.org
   
   
10. Saint Francis Hospital and Medical Center
    114 Woodland St, Hartford, CT 06105
    Telephone: (860) 714-4000
    www.stfranciscare.org
    
    
11. The Johns Hopkins Hospital
    1800 Orleans St, Baltimore, MD 21287
    Telephone: (410) 955-5000
    www.hopkinsmedicine.org
    
    
12. St. Joseph Hospital
    1100 West Stewart Drive, Orange, CA 92868
    Telephone: (714) 633-9111
    www.sjo.org
    
    
13. New York-Presbyterian/Columbia University Medical Center
    622 W 168th St, New York, NY 10032
    Telephone: (212) 305-2500
    www.nyp.org 
    
    
14. Saint Jude Medical Center
    101 E. Valencia Mesa Drive, Fullerton, CA  92835
    Telephone: (714) 871-3280
    www.stjudemedicalcenter.org
    
    
15. Ronald Reagan UCLA Medical Center
    757 Westwood Plaza, Los Angeles, CA 90095
    Telephone: (310) 825-9111
    www.uclahealth.org
    
    
16. Saint Luke’s Hospital
    232 South Woods Mill Road, Chesterfield, MO 63017
    Telephone: (314) 434-1500
    www.stlukes-stl.com
    
    
17. Stanford Hospital Stroke Center
    213 Quarry Road, Palo Alto, CA 94304
    Telephone: (650) 723-6469
    www.stanfordhealthcare.org
    
    
18. St. Tammany Parish Hospital
    1202 S Tyler St, Covington, LA 70433
    Telephone: (985) 898-4000
    www.stph.org
    
    
19. Northwestern Memorial Hospital
    251 E Huron St, Chicago, IL 60611
    Telephone: (312) 926-2000
    www.nm.org
    
    
20. Temecula Valley Hospital
    31700 Temecula Parkway, Temecula, CA 92592
    Telephone: (951) 331-2200
    www.temeculavalleyhospital.com
    
    
21. Hospital of the University of Pennsylvania
    3400 Spruce St, Philadelphia, PA 19104
    Telephone: (800) 789-7366
    www.pennmedicine.org
    
    
22. Duke University Hospital
    2301 Erwin Rd, Durham, NC 27710
    Telephone: (919) 684-8111
    www.dukehealth.org
    
    
23. The Valley Hospital
    223 N. Van Dien Avenue, Ridgewood, NJ 07450
    Telephone: (201) 447-8000
    www.valleyhealth.com

*Rejuvenation Therapeutics is not affiliated with any of the above-mentioned institutions. No specific criteria were used to compile this list.

____________________________________

References

1. American Stroke Association, a division of American Heart Association, 2019.
2. Lancet. 2012; 380:2197–223.
3. Lancet. 2012; 380:2095–128.
4. Neuroepidemiology. 2015; 45:161-176.
5. Lancet Neurol. 2019 May; 18(5):439-458.
6. Stroke. 2014; 45:1545–1588.
7. Information for Health Professionals, National Heart, Lung and Blood Institute, NIH, 2019.
8. Ischemic Stroke - StatPearls - NCBI Bookshelf, 2019.
9. Lancet Neurol. 2007;6(7):611-9.
10. Mo Med. 2011 Jan-Feb; 108(1): 50–54.
11. Continuum (Minneap Minn). 2017 Feb 3; 23(1): 82–92.
12. Neurol Clin Pract. 2014 Oct; 4(5): 386–393.
13. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41.
14. Effects of Stroke, Johns Hopkins Medicine, 2019.
15. Stroke. 2002;33:1840–1844.
16. Stroke. 2018; 49:536–542.
17. Stroke - National Institute on Aging - NIH, 2019.
18. International Journal of Stroke. 2018; 13(4), 420-443.
19. The rapid recognition of symptoms and diagnosis, Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA), 2011.
20. Pract Neurol. 2017 Aug; 17(4): 252–265.
21. Age Ageing. 2008 Jan;37(1):32-8.
22. Certification for Primary Stroke Centers, Joint Commission, 2019.

---

Also in Wellness Blog