Approximately 700,000 individuals suffer a stroke each year. According to the American Stroke Association, every 45 seconds someone in America has a stroke, and every 3.1 minutes someone dies of one. Stroke is the third leading cause of death. Statistics show that African Americans have an increased risk of having a stroke compared to Caucasians, and they have a lower rate of surviving a stroke compared to Caucasians. Stroke is a debilitating, often deadly, disease that needs to be addressed by our nation, especially the African American population.

One of the most powerful ways to protect yourself against stroke is to educate yourself. Know the definition of stroke, warning signs for stroke, what to do if you or someone you love is suffering a stroke, risk factors for stroke, and some simple stroke prevention strategies.

Definition

A stroke is a sudden malfunction of the blood vessels of the brain. The blood vessels can malfunction in two main ways: either they get blocked or they rupture and bleed. When a blood vessel is blocked, it creates an infarct in the brain. When a blood vessel ruptures and bleeds, it creates a hemorrhage in the brain. Both of these scenarios cause a lack of blood flow to the brain cells. Blood feeds brain cells oxygen, glucose, and nutrients. Lack of blood flow to the brain cells causes them to fail in their functions. Some brain cells work to make our muscles move. Others help us talk. Some help us sense light touch on our skin. Still others help us to see. Failure in any of these areas is disturbing and can be devastating.

Symptoms of a Stroke

Drawing on the definition above, we can work to understand the varying symptoms a stroke can create. Different blood vessels feed different areas of the brain. The brain is set up in such a way that it has distinct areas which control specific functions such as producing speech, moving the face, moving the leg, feeling the arm, and seeing. Depending on which blood vessel has malfunctioned, the person suffering the stroke will experience different symptoms. For example, an artery called the anterior cerebral artery feeds an area of the brain that controls the movement of the foot and lower leg. If this artery is blocked, then the person will not be able to bear weight, walk or move that foot. However, if the artery that feeds the speech area is affected, then the person will have language difficulty.

The fact that the human brain is such a complex organ allows us to perform complex tasks. However, it also makes recognizing a stroke more challenging. Most people know that with a heart attack, individuals commonly experience pain on the left side of their chests, over the anatomical location of their hearts. They may be short of breath, sweaty, anxious, and even feel pain in their left arm. What is the common presentation of a stroke or brain attack, as it has been called? Unlike a heart attack, the answer is not well known, but it should be.

Knowing the symptoms of a stroke could help save your friend's life or even your own. Here is a mnemonic that I created to try to help people remember the warning signs of stroke. It is FALLEN. Has the person FALLEN from their normal level of functioning? If the answer is yes, they may be having a stroke.

F----(face)---Is the person's face drooping on one side? When they smile, does one side of his mouth hang down instead of curl up? Do they feel numb on one side of their face?
A----(arm)---Is the person's arm dropping on one side, weak, unable to lift objects or move? Does the arm feel numb?
L---(leg)---Is the person's leg dropping on one side, weak, unable to support the person's weight, unable to walk? Does the leg feel numb?
L---(language)---Is person's language off, are they having trouble producing speech or understanding speech?
E---(eyesight)---Is the person's eyesight affected? Is he having difficulty seeing out of the left eye, the right eye or both eyes?
N----(nasty headache)---Is the person experiencing the worst headache that he has ever had, like no other?

If the answer to any of these questions listed in FALLEN is yes, then the person may be having a stroke.

What to do if you or someone you know is having a Stroke

What do you do if you suspect that you or someone you love is having a stroke? First, call 911, immediately. Second stay calm. There is not much you can do until the ambulance arrives. Getting anxious will not help you or the person suffering the stroke. If you are calm and you keep your wits about you, then you can look at the clock. It is important to note the exact time that the symptoms started. Write down the time to be sure you remember it. When the paramedics arrive, be sure to tell them the time the symptoms started. You need this information, in case the person is experiencing a blockage type of stroke and could benefit from a medicine call tPA (tissue plasminogen activator) which is a clot buster. This medicine can only be used if it is administered within three hours of the onset of stroke symptoms. Do not give the person an aspirin because it could make the bleeding worse if the cause of the stroke is a burst blood vessel. Whatever the cause a blocked blood vessel or a ruptured blood vessel, it is of utmost importance to get the individual to the hospital as soon as possible.

Risk Factors for Stroke

What makes someone susceptible to stroke? Risk factors for stroke include: smoking, excessive alcohol use, illicit drug use, obesity, physical inactivity, high blood pressure, diabetes, high cholesterol, atrial fibrillation (an abnormal heart rhythm), being elderly, and being of African American descent. Some of these risk factors are modifiable; they are things that you have the power to change. Some of these risk factors can be controlled through medication and medical management in conjunction with your physician; they are things that you have the power to influence. Other risk factors are genetic or not modifiable.

You have the most control over the modifiable risk factors. If you smoke, quit. This will add years to your life. Smoking is associated with an increased rate of cholesterol build up in the arteries which can block blood flow and cause a stroke. If you drink in excess, get help and stop. Excessive drinking is linked to stroke. Using illicit drugs not only puts your job, your relationships, and your mental health in jeopardy but also it is connected to stroke. Being over-weight is a risk factor for a number of diseases, including stroke. There is a calculation to use in order to evaluate your weight. It is called the body mass index or BMI. Take your weight in pounds and divide it by your height in inches squared then multiply by 703. If the number is between 18.5 and 24.9, then your weight is within normal limits. If your BMI is over 25, then you are overweight. If it is over 30, you are considered obese. Carrying extra weight causes stress on your system which can lead to high blood pressure, diabetes, and stroke. If you do not exercise regularly, visit your physician and design an exercise program appropriate for you. Scientific studies have shown that exercise can improve your body's ability to handle sugar, lower your blood pressure, lower your cholesterol, and improve your mood.

Risk factors that you may not be able to change but you will be able to influence include:

1) a history of diabetes
2) a history of high cholesterol
3) a history of high blood pressure
4) a history of irregular heart rhythm called atrial fibrillation
5) a history of narrowing of the arteries in the neck called carotid artery stenosis
6) a history of sickle cell anemia

Most strokes are caused by blockages in the blood vessels. The most common reason for a blockage in an artery is cholesterol build up or plaque. High cholesterol levels in the blood stream allow for an increased rate of this cholesterol build up. Diabetes and high blood pressure put an extra strain on the blood vessel walls altering their physical make up and allowing cholesterol to build up more quickly. Thus, high cholesterol, diabetes and high blood pressure all put you at increased risk for a blockage of blood flow in the arteries that supply the brain. High blood pressure also puts you at increased risk for a rupture of the arteries in the brain.

Apart from cholesterol build up, the arteries can be blocked by clots that travel through the circulation into small arteries in the brain where the clot gets caught and creates a blockage. A person with atrial fibrillation has a heart that pumps irregularly and at times inefficiently. This allows blood to pool in the heart and form a clot. Pieces of this clot can break off from the heart and travel to the brain. The arteries in the neck can also be the source for a traveling clot. When there is cholesterol build up in these arteries, a piece of the cholesterol plaque can break off and travel to the brain where it can block a small artery.

In sickle cell anemia, the sickled red blood cells themselves can clump together and clog an artery. If this happens in the brain, a stroke can result. If you have sickle cell anemia, it is very important to discuss your disease with your physician and work together to avoid the rare but possible complication of a stroke.

There are risk factors that we are simply unable to control or influence such as age, sex and race. The older we are the more likely we are to have a stroke. Men are more susceptible to this disease. African Americans have a higher rate of stroke compared to Caucasians. We can simply be aware of these statistics and do our best to address the modifiable and controllable risk factors discussed previously.

Simple Strategies to Prevent a Stroke

Understanding stroke and knowing the risk factors is the first step in prevention. Identifying your own risk factors is the next step. One of the most important steps is addressing all the risk factors you have. Changing the ones you can change (such as smoking, excessive alcohol use, illicit drug use, obesity, and physical inactivity) is often hard to do as many of these require life style modifications and a great deal of will power. Working with groups, friends, family, and your physician can really help you make the changes you need to make and also help you to stick with these important changes. Leading a nicotine free, drug free, alcohol only in moderation life can add many productive and joyful years to your life. Exercising regularly and addressing any weight issues you may have is critical to your well being.

Working with your physician, you can address the risk factors that you may not be able
to change but you can influence and get under control. High blood pressure, diabetes, and high cholesterol levels all fall into this category. Diet and exercise can make a significant impact on these diseases. For high blood pressure, a diet low in salt and rich in fruits and vegetables has been shown to help lower blood pressure. For diabetes, sugar is the main factor to watch in the diet. Simple carbohydrates are readily broken down into sugar and need to be carefully monitored as well. White bread, white rice, pastries, and cookies are examples of simple carbohydrates. For high cholesterol, saturated fat (such as palm oil, palm kernel oil and coconut oil) and partially hydrogenated fat (also known as trans fats) should be avoided. Stick to polyunsaturated fats (such as corn oil, safflower oil, sunflower oil, and soybean oil), or monounsaturated fats (such as olive oil and canola oil)

Many people with these diagnoses require medication to get their disease under control. However, diet and exercise can improve your blood pressure, your blood sugars, and your cholesterol levels which might allow a reduction in the amount of medication you require to control these diseases. If you have high blood pressure, diabetes, or high cholesterol, it is important for you to work closely with your physician to get your disease under control. Take all the medication your physician prescribes just as it has been prescribed. You may have high blood pressure, diabetes or high cholesterol and feel just fine. These diseases are often "silent killers" because they do damage to your body without you noticing them. You may not feel as if you need medicine, but if you have high blood pressure, diabetes or high cholesterol and your physician has prescribed medicine for you, it is imperative that you take the medicine. Stay in close touch with your physician and make sure to keep your scheduled appointments. The best way to handle these problems is to be proactive and get them under control as soon as possible.

Simple tips for individuals with sickle cell anemia include staying well hydrated, making sure your folic acid levels are normal, eating a healthy diet, addressing fevers when you experience them, and treating any infections especially pneumonia which can lower the level of oxygen in your blood and trigger sickling of the red blood cells. Your physician can help you to develop a plan to help manage the sickle cell anemia and keep it in control.

Stroke is a common disease that is not well understood. Taking the time to learn about it and making changes to help reduce your risk can save your life. The American Stroke Association and the National Stroke Association are two excellent sources of information. You can start collecting more information on stroke by talking with your own primary care physician.

Elizabeth Pegg Frates, M.D. is a physiatrist and Clinical Instructor in the Harvard Department of Physical Medicine and Rehabilitation, teaching at Harvard Medical School in the central nervous system and musculoskeletal systems courses. Her research focuses on stroke education, life style medicine and risk factor modification. Dr. Frates felt compelled to write "Life After Stroke: The Guide to Recovering Your Health & Preventing Another Stoke" (Johns Hopkins University Press, 2006) for the layperson after her Dad suffered his second stroke and did not recognize the warning signs. Life After Stroke: The Guide to Recovering Your Health & Preventing Another Stoke is available at local bookstores and through Amazon.com.