A stroke, or "brain attack," occurs when blood circulation to the brain fails. Brain cells can die from decreased blood flow and the resulting lack of oxygen. There are two broad categories of stroke: those caused by a blockage of blood flow and those caused by bleeding into the brain. A blockage of a blood vessel in the brain or neck, called an ischemic stroke, is the most frequent cause of stroke and is responsible for about 80 percent of strokes. These blockages stem from three conditions: the formation of a clot within a blood vessel of the brain or neck, called thrombosis; the movement of a clot from another part of the body such as the heart to the brain, called embolism; or a severe narrowing of an artery in or leading to the brain, called stenosis. Bleeding into the brain or the spaces surrounding the brain causes the second type of stroke, called hemorrhagic stroke.

Two key steps you can take will lower your risk of death or disability from stroke: control stroke's risk factors and know stroke's warning signs.

Warning signs are clues your body sends that your brain is not receiving enough oxygen. If you observe one or more of these signs of a stroke or "brain attack," don't wait, call a doctor or 911 right away!

• Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
• Sudden confusion, or trouble talking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, or loss of balance or coordination
• Sudden severe headache with no known cause

Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called "mini-strokes." Although brief, they identify an underlying serious condition that isn't going away without medical help. Unfortunately, since they clear up, many people ignore them. Don't. Paying attention to them can save your life.

A risk factor is a condition or behavior that occurs more frequently in those who have, or are at greater risk of getting, a disease than in those who don't. Having a risk factor for stroke doesn't mean you'll have a stroke. On the other hand, not having a risk factor doesn't mean you'll avoid a stroke. But your risk of stroke grows as the number and severity of risk factors increases.

Some factors for stroke can’t be modified by medical treatment or lifestyle changes.

• Age. Stroke occurs in all age groups. Studies show the risk of stroke doubles for each decade between the ages of 55 and 85. But strokes also can occur in childhood or adolescence. Although stroke is often considered a disease of aging, the risk of stroke in childhood is actually highest during the perinatal period, which encompasses the last few months of fetal life and the first few weeks after birth.
• Gender. Men have a higher risk for stroke in young and middle age, but rates even out at older ages, and more women die from stroke. Men generally do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival.
• Race. People from certain ethnic groups have a higher risk of stroke. For African Americans, stroke is more common and more deadly—even in young and middle-aged adults—than for any ethnic or other racial group in the United States. Studies show that the age-adjusted incidence of stroke is about twice as high in African Americans and Hispanic Americans as in Caucasians, and while stroke incidence has declined for whites since the 1990s, there has not been a decline for Hispanics or black Americans. An important risk factor for African-Americans is sickle cell disease, which can cause a narrowing of arteries and disrupt blood flow. The incidence of the various stroke subtypes also varies considerably in different ethnic groups.
• Family history of stroke. Stroke seems to run in some families. Several factors may contribute to familial stroke. Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for high blood pressure (hypertension) or diabetes. The influence of a common lifestyle among family members also could contribute to familial stroke.

Some of the most important treatable risk factors for stroke are:

• High blood pressure, or hypertension.
  Hypertension is by far the most potent risk factor for stroke. Hypertension causes a two-to four-fold increase in the risk of stroke before age 80. If your blood pressure is high, you and your doctor need to work out an individual strategy to bring it down to the normal range. Some ways that work: Maintain proper weight. Avoid drugs known to raise blood pressure. Eat right: cut down on salt and eat fruits and vegetables to increase potassium in your diet. Exercise more. Your doctor may prescribe medicines that help lower blood pressure. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.

• Cigarette smoking.
  Cigarette smoking causes about a two-fold increase in the risk of ischemic stroke and up to a four-fold increase in the risk of hemorrhagic stroke. It has been linked to the buildup of fatty substances (atherosclerosis) in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, nicotine raises blood pressure; carbon monoxide from smoking reduces the amount of oxygen your blood can carry to the brain; and cigarette smoke makes your blood thicker and more likely to clot. Smoking also promotes aneurysm formation. Your doctor can recommend programs and medications that may help you quit smoking. By quitting, at any age, you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer.

• Heart disease.
  Common heart disorders such as coronary artery disease, valve defects, irregular heart beat (atrial fibrillation), and enlargement of one of the heart's chambers can result in blood clots that may break loose and block vessels in or leading to the brain. Atrial fibrillation—which is more prevalent in older people—is responsible for one in four strokes after age 80, and is associated with higher mortality and disability. The most common blood vessel disease is atherosclerosis. Hypertension promotes atherosclerosis and causes mechanical damage to the walls of blood vessels. Your doctor will treat your heart disease and may also prescribe medication, such as aspirin, to help prevent the formation of clots. Your doctor may recommend surgery to clean out a clogged neck artery if you match a particular risk profile. If you are over 50, NINDS scientists believe you and your doctor should make a decision about aspirin therapy. A doctor can evaluate your risk factors and help you decide if you will benefit from aspirin or other blood-thinning therapy.

• Warning signs or history of TIA or stroke.
  If you experience a TIA, get help at once. If you’ve previously had a TIA or stroke, your risk of having a stroke is many times greater than someone who has never had one. Many communities encourage those with stroke's warning signs to dial 911 for emergency medical assistance. If you have had a stroke in the past, it's important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by asking the unaffected brain regions to do double duty. That means a second stroke can be twice as bad.

• Diabetes.
  In terms of stroke and cardiovascular disease, having diabetes is the equivalent of aging 15 years. You may think this disorder affects only the body's ability to use sugar, or glucose. But it also causes destructive changes in the blood vessels throughout the body, including the brain. Also, if blood glucose levels are high at the time of a stroke, then brain damage is usually more severe and extensive than when blood glucose is well-controlled. Hypertension is common among diabetics and accounts for much of their increased stroke risk. Treating diabetes can delay the onset of complications that increase the risk of stroke.

• Cholesterol imbalance.
  Low-density lipoprotein cholesterol (LDL) carries cholesterol (a fatty substance) through the blood and delivers it to cells. Excess LDL can cause cholesterol to build up in blood vessels, leading to atherosclerosis. Atherosclerosis is the major cause of blood vessel narrowing, leading to both heart attack and stroke.
• Physical inactivity and obesity.
  Obesity and inactivity are associated with hypertension, diabetes, and heart disease. Waist circumference to hip circumference ratio equal to or above the mid-value for the population increases the risk of ischemic stroke three-fold.

Some of the most important risk factors for stroke can be determined during a physical exam at your doctor's office. If you are over 55 years old, the information here can help you estimate your risk of stroke and show the benefit of risk factor control.

The worksheet was developed from NINDS-supported work in the well-known Framingham Study. Working with your doctor, you can develop a strategy to lower your risk to average or even below average for your age.

Many risk factors for stroke can be managed, some very successfully. Although risk is never zero at any age, by starting early and controlling your risk factors you can lower your risk of death or disability from stroke. With good control, the risk of stroke in most age groups can be kept below that for accidental injury or death.

Americans have shown that stroke is preventable and treatable. In recent years, a better understanding of the causes of stroke has helped Americans make lifestyle changes that have cut the stroke death rate nearly in half.

Scientists at the NINDS predict that, with continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones, Americans should be able to prevent 80 percent of all strokes.

Score your stroke risk for the next 10 years-MEN

Key: SBP = systolic blood pressure (score one line only, untreated or treated); ; Diabetes = history of diabetes;Cigarettes = smokes cigarettes; CVD (cardiovascular disease) = history of heart disease; AF = history of atrial fibrillation;LVH = diagnosis of left ventricular hypertrophy

Score your stroke risk for the next 10 years-WOMEN

Key: SBP = systolic blood pressure (score one line only, untreated or treated); ; Diabetes = history of diabetes;Cigarettes = smokes cigarettes; CVD (cardiovascular disease) = history of heart disease; AF = history of atrial fibrillation;LVH = diagnosis of left ventricular hypertrophy

This example helps you assess your risk of stroke. Tally your points to score your stroke risk over the next 10 years.

Martha, age 65, wanted to determine her risk for having a stroke, so she took this stroke risk profile. This is how she arrived at her 10-year probability risk for having a stroke:

Interpretation:
15 points carries a 16 percent, 10-year probability of having a stroke. If Martha quits smoking she can reduce her points to 12, which carries a 9 percent, 10-year probability of having a stroke.

Her current point total does not mean Martha will have a stroke, but serves as a wake-up call to ways she can lower her risk or even prevent a stroke. A lower percent score doesn’t mean that Martha won’t have a stroke, only that she is at a lower risk of having one.

No matter what your score is, it is important to work on reducing your risk factors as Martha did in this example by quitting smoking.

Source: D’Agostino, R.B.; Wolf, P.A.; Belanger, A.J.; & Kannel, W.B. “Stroke Risk Profile: The Framingham Study.” Stroke, Vol. 25, No. 1, pp. 40-43, January 1994.

Making healthy choices and managing medical conditions can diminish your risk of stroke. These include:

• Eating a healthy diet, which includes plenty of fruits and vegetables and foods low in saturated fat, cholesterol, and sodium
• Maintaining a healthy weight
• Staying physically active
• Not smoking
• Limiting alcohol use
• Checking your cholesterol
• Monitoring your blood pressure
• Managing diabetes
• Taking medication to treat high cholesterol, high blood pressure, or diabetes
• Talking to your health care provider regularly about preventing or treating the medical conditions that lead to heart disease or increase your risk of stroke

You can help prevent stroke by making healthy choices and controlling any health conditions you may have.

Healthy living

Many strokes could be prevented through healthy lifestyle changes and working with your health care team to control health conditions that raise your risk for stroke.

You can help prevent stroke by making healthy lifestyle choices.

Choose healthy foods and drinks

Choosing healthy meal and snack options can help you prevent stroke. Be sure to eat plenty of fresh fruits and vegetables.

Eating foods low in saturated fats, trans fat, and cholesterol and high in fiber can help prevent high cholesterol. Limiting salt (sodium) in your diet can also lower your blood pressure. High cholesterol and high blood pressure increase your chances of having a stroke.

Keep a healthy weight

Having overweight or obesity increases your risk for stroke. To determine whether your weight is in a healthy range, doctors often calculate your body mass index (BMI). If you know your weight and height, you can calculate your BMI at CDC’s Assessing Your Weight website. Doctors sometimes also use waist and hip measurements to measure excess body fat.

Get regular physical activity

Physical activity can help you stay at a healthy weight and lower your cholesterol and blood pressure levels. For adults, the surgeon general recommends 2 hours and 30 minutes of moderate-intensity aerobic physical activity, such as a brisk walk, each week. Children and teens should get 1 hour of physical activity every day.

Don’t smoke

Cigarette smoking greatly increases your chances of having a stroke. If you don’t smoke, don’t start. If you do smoke, quitting will lower your risk for stroke. Your doctor can suggest ways to help you quit.

Limit alcohol

Avoid drinking too much alcohol, which can raise your blood pressure. Men should have no more than two drinks per day, and women should have no more than one per day.

Control your medical conditions

Talk with your doctor about steps you can take to lower your risk for stroke.

If you have heart disease, high cholesterol, high blood pressure, or diabetes, you can take steps to lower your risk for stroke.

Check cholesterol

Your doctor should test your cholesterol levels at least once every 5 years. Talk with your health care team about this simple blood test. If you have high cholesterol, medicine and lifestyle changes can help lower your risk for stroke.

Control blood pressure

High blood pressure usually has no symptoms, so be sure to have it checked on a regular basis. Talk to your health care team about how often you should check your levels. You can check your blood pressure at home, at a doctor’s office, or at a pharmacy.

If you have high blood pressure, your doctor might prescribe medicine, suggest some changes in your lifestyle, or recommend that you choose foods with lower sodium (salt).

Control diabetes

If your doctor thinks you have symptoms of diabetes, he or she may recommend that you get tested. If you have diabetes, check your blood sugar levels regularly.

Talk with your health care team about treatment options. Your doctor may recommend certain lifestyle changes, such as getting more physical activity or choosing healthier foods. These actions will help keep your blood sugar under good control and help lower your risk for stroke.

Treat heart disease

If you have certain heart conditions, such as coronary artery disease or atrial fibrillation (irregular heartbeat), your health care team may recommend medical treatment or surgery. Taking care of heart problems can help prevent stroke.

Take your medicine

If you take medicine to treat heart disease, high cholesterol, high blood pressure, or diabetes, follow your doctor’s instructions carefully. Always ask questions if you don’t understand something. Never stop taking your medicine without first talking to your doctor or pharmacist.

Work with your health care team

You and your health care team can work together to prevent or treat the medical conditions that lead to stroke. Discuss your treatment plan regularly, and bring a list of questions to your appointments.

If you’ve already had a stroke or TIA, your health care team will work with you to prevent further strokes. Your treatment plan will include medicine or surgery and lifestyle changes to lower your risk for another stroke. Be sure to take your medicine as directed and follow your doctor’s instructions.

While stroke is one of our country’s leading causes of death and serious, long-term disability in adults, the good news is that treatments are available that can greatly reduce the damage. However, you need to recognize the symptoms of a stroke and get the stroke victim, which could be you, to a hospital quickly. Getting treatment within 60 minutes can prevent disability.

About Stroke

There are more than 800,000 strokes each year in our nation. Sometimes called a “brain attack,” a stroke occurs when blood flow to the brain is interrupted. When this happens, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.

What causes a stroke?

There are two major kinds of stroke. About 80 percent are ischemic strokes, which are caused by a blood clot that blocks or plugs a blood vessel or artery in the brain. About 20 percent are hemorrhagic strokes, which are caused by a blood vessel in the brain that breaks and bleeds into the brain.

What disabilities can result from a stroke?

Although stroke is a disease of the brain, it can affect the entire body. The effects of a stroke range from mild to severe and can include paralysis, problems with thinking, problems with speaking, and emotional problems. Patients may also experience pain or numbness.

Know the Signs

Because stroke injures the brain, victims may not realize they’re having one and bystanders may think they just look unaware or confused. That’s why stroke victims have the best chance if someone around them recognizes the signs and acts quickly.

What are the signs of a stroke?

The symptoms are distinct because they happen quickly:

• Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
• Sudden CONFUSION, trouble speaking, or trouble understanding speech
• Sudden TROUBLE SEEING in one or both eyes
• Sudden TROUBLE WALKING, dizziness, or loss of balance or coordination
• Sudden SEVERE HEADACHE with no known cause

What should a bystander do?

If you think someone is having a stroke—if they suddenly lose the ability to speak, move an arm or leg on one side, or experience facial paralysis on one side—call 911 immediately.

Act in Time

Stroke is a medical emergency. Every minute counts because the longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people’s lives and enhance their chances for successful recovery.

Why is there a need to act fast?

Ischemic strokes, the most common type, can be treated with the drug t-PA, which dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treatment is three hours, but patients need to get to the hospital within 60 minutes to be evaluated and receive treatment.

What’s the benefit of treatment?

A five-year study by NINDS found that some stroke patients who received t-PA within three hours of the start of stroke symptoms were at least 30 percent more likely to recover with little or no disability after three months.

How can I reduce my risk of stroke?

The best treatment for stroke is prevention. Several factors increase your risk:

• High blood pressure
• Heart disease
• Smoking
• Diabetes
• High cholesterol
• Physical inactivity/obesity

If you smoke–quit. If you have high blood pressure, heart disease, diabetes, or high cholesterol, get them under control. If you’re overweight, start a healthy diet and exercise regularly.