Stroke: What you don’t know about risk, cost, treatment and prevention

By Michael Alday, MD, MPH
May 01, 2014
Each year in the United States, approximately 795,000 people experience a stroke. On average, someone will have a stroke every 40 seconds and every 4 minutes someone will die as a result. There are currently 4 million stroke survivors in the U.S. living with the repercussions of stroke.

Many people think of stroke as a disease of the elderly, and age is a risk factor. However, over a quarter of those who experience a stroke are under the age of 55. Stoke is the leading cause of adult disability. Only 10 percent of stroke survivors fully recover. Throw in the estimated $71.55 billion cost of treatment and the $33.65 billion in lost productivity in 2010 coupled with an aging workforce, and stroke becomes a major concern for any employer. Now consider that, according to the American Heart Association, 80 percent of strokes are preventable through risk factor management alone.

The best comparison for a stroke is a heart attack. During a stroke the same thing happens in the brain as happens to the heart in a heart attack. A stroke is the disruption of blood flow to the brain, depriving it of oxygen and causing brain cells to die. There are two different kinds of stroke:
· Ischemic stroke, where the arteries that supply blood to the brain are blocked either by a clot or buildup of plaque.
· Hemorrhagic stroke, where a blood vessel in the brain bursts, causing it to bleed into the brain, often the result of an aneurysm.

Of the two different types of stroke, ischemic stroke accounts for 87 percent of all strokes, while hemorrhagic stroke accounts for 30 percent of deaths caused by stroke.

“Mini-stroke” is a common term used to describe a transient ischemic attack (TIA). A TIA is an event where stroke-like symptoms last for less than a day before disappearing. TIAs normally don’t cause permanent damage to the brain but they are a precursor or warning sign of a more significant event to come. Forty percent of those who experience a TIA go on to have a stroke and half of those experience stroke within one to two days after having a TIA.

The symptoms for all three - Ischemic and Hemorrhagic stroke and TIA - are the same. Common symptoms, those affecting both men and women, include:
· Sudden numbness or weakness in the face, arm or leg, especially on one side of the body.
· Sudden confusion, trouble speaking, or difficulty understanding speech.
· Sudden trouble seeing in one or both eyes.
· Sudden trouble walking, dizziness, loss of balance or lack of coordination.
· Sudden severe headache with no known cause.

On top of these symptoms, women can experience additional symptoms such as hiccups, shortness of breath, chest pain, nausea, general weakness, palpitations, and pain in their face or limbs.

Two million brain cells die every minute the brain is deprived of oxygen during a stroke. The longer a stroke goes untreated, the higher the risk of permanent brain damage, disability, or death. The most important thing to remember if you think someone is having a stroke is to act F.A.S.T. This quick and simple test can help you determine if someone is having a stroke.
F—FACE: Ask the person to smile. Does one side of the face droop?
A—ARMS: Ask the person to raise both arms. Does one arm drift downward?
S—SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—TIME: If you observe any of these signs, call 9-1-1 immediately.

Time is of the utmost importance when you suspect someone is having a stroke. The most effective treatments can only be given if stroke is diagnosed and treatment started within the first three hours of the appearance of symptoms. After this window, stroke patients are not eligible for the most effective treatments. Never drive someone to the hospital or attempt to drive yourself. Call 9-1-1 immediately so paramedics can begin life saving treatments on the way to the hospital.

Risk factors for stroke include unalterable risks: family history, age, ethnicity, and gender. However, risk factors are cumulative. By eliminating or actively managing one or more of the following preventable risk factors, an individual’s risk for stroke can be significantly minimized.
· Obesity
· Lack of exercise
· Smoking
· High cholesterol
· Hypertension
· Diabetes
· Substance / alcohol abuse
· Arthrosclerosis
· Atrial Fibrillation
· Circulation

These risk factors are the same for men and women, yet women also have risk factors related to reproductive health, hormones, pregnancy, and childbirth including:
· Taking birth control pills
· A history of preeclampsia during pregnancy
· Being on Hormone Replacement Therapy (HRT)
· Suffering from migraines with aura.

May is National Stroke Awareness Month, for resources and materials to educate yourself and others on how to prevent stroke visit the American Stroke Association at

Comments (1)

Stroke Heroes Act FAST
Great reminder on stroke, particularly the use of "FAST," the proven method of helping people remember 1) The symptoms of stroke and, 2) ... Read more
5/1/2014 1:42 PM
Ted Clark