What is Stroke?

According to the Centers for Disease Control and Prevention (CDC), a stroke sometimes called a brain attack, occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die. A stroke can cause lasting brain damage, long-term disability, or even death. There are health conditions and lifestyle habits that can increase your risk for stroke including hypertension.

How Does Stroke Affect African American Populations?

• African Americans are 50 percent more likely to have a stroke (cerebrovascular disease), as compared to their white adult counterparts.
• Black men are 70 percent more likely to die from a stroke as compared to non-Hispanic whites.
• African American women are twice as likely to have a stroke as compared to non-Hispanic white women.

Risk Factors:

There are several risk factors related to stroke. Some of these risk factors are:

• Obesity and Overweight
• Hypertension
• High Cholesterol
• Cigarette Smoking

Prevent and Manage Stroke:

There are things that you can do to prevent and manage stroke:

• Nutrition: Eat healthy diet (increase fresh fruits and vegetables and lower salt intake)
• Weight: Maintain a healthy weight
• Exercise: Be physically active (seek advice from your doctor)
• Smoking: Do not smoke
• Alcohol: Limit alcohol intake

What is stroke?

A stroke occurs when a blocked vessel or artery prevents blood from getting to part of the brain, or when a vessel or artery bursts and spills blood into the brain. The blood supplies the brain with the oxygen and nutrients it needs to work properly. When part of the brain cannot get the blood it needs, it becomes damaged or dies. The sudden flooding of blood into the brain also can cause damage or death to the brain cells (neurons).

There are two types of stroke:

• Ischemic stroke
  Ischemic stroke happens when an artery carrying blood to the brain becomes blocked and cannot supply enough blood to the brain. Usually, a blood clot causes the blockage. Sometimes the blockage occurs when an artery becomes too narrow for enough blood to pass through it. This narrowing is called stenosis. Stenosis is caused by a buildup of plaque—a mixture of fatty substances, including cholesterol—that forms on the inner walls of the artery.
• Hemorrhagic stroke
  Hemorrhagic stroke occurs when an artery bursts and spills blood into part of the brain. In a healthy brain, the blood remains in the arteries and does not come into contact with neurons. When blood bursts into the brain during a hemorrhagic stroke, the normal flow of blood to the brain is upset, and the blood interferes with the normal chemical balance that neurons need to function.

Transient Ischemic Attack

Sometimes called a mini-stroke, a transient ischemic attack (TIA) starts with the same symptoms of a full stroke but does not progress and cause the damage of a full stroke. A TIA is a warning that a person is at risk for a more serious stroke in the future.

Each year, about 795,000 people in the United States have strokes, and of these incidents, 137,000 of the people die. About 610,000 of these cases are first strokes, and 185,000 people who survive a stroke will have another stroke within 5 years.

Ischemic strokes make up about 87% of all strokes. Hemorrhagic strokes make up the remaining 13%.

Stroke is a leading cause of death and disability in the United States. People of all ages and backgrounds can have a stroke. However, some demographic factors put certain people at higher risk of stroke or death from stroke. These include:

• Race/ethnicity. African Americans have almost two times the risk of white people of having a first stroke. Hispanic Americans and American Indian/Alaska Natives are at greater risk than whites are for having a stroke but are at less risk than African Americans. African Americans and Hispanics are more likely than whites to die after having a stroke.
• Age. Stroke risk increases with age. Three-quarters of strokes occur in people ages 65 and older.
• Geography. The highest U.S. death rates from stroke occur in the southeastern United States.
• Gender. Men are more likely than women to have a stroke.

Certain lifestyle factors and conditions also increase the risk for stroke. The most important of these include:

• High blood pressure
• Diabetes
• Heart disease (such as atrial fibrillation)
• Previous stroke or transient ischemic attack
• Cigarette smoking

Additional risk factors include:

• Physical inactivity
• Overweight or obesity
• High cholesterol
• Sickle cell disease
• Drinking too much alcohol
• Family history of stroke
• Drug abuse
• Genetic conditions, such as blood-clotting or vascular disorders (for example, Factor V Leiden or CADASIL)
• Certain medications (such as hormonal birth control pills)
• Being pregnant
• Menopause

Lesser risk factors include:

• Head and neck injuries
• Recent viral or bacterial infections

Amplification of risk occurs when a person has more than one of the risk factors listed above. This means that the combined risk of two or more risk factors is greater than simply adding their effects.

Ischemic Stroke

Ischemic stroke is caused by a blockage in an artery carrying blood to the brain. The blocked artery cuts off the blood supply to part of the brain. Usually, a blood clot causes the blockage. Sometimes the blockage occurs when an artery becomes too narrow for enough blood to pass through it. This narrowing is called stenosis. Stenosis is caused by a buildup of blood clots and plaque—a mixture of fatty substances, including cholesterol—on the inner walls of the artery.

Problems with blood clotting become more frequent as people age. Certain medications, such as hormonal birth control pills, also can increase the risk of blood clots. Stenosis is caused most commonly by a blood vessel disease called atherosclerosis. In atherosclerosis, plaque builds up on the inner walls of arteries. This causes the artery walls to become thick, hard, and less flexible, and decreases blood flow. The presence of plaque also leads to the formation of blood clots. Eating foods high in saturated fat and cholesterol can make the amount of cholesterol in the body too high. Having high cholesterol can lead to its buildup in plaque in the artery walls. High blood pressure also contributes to atherosclerosis.

Hemorrhagic Stroke

Hemorrhagic stroke is caused by a burst artery that spills blood into part of the brain. In a healthy brain, the blood remains in the arteries and does not come into contact with neurons. When blood bursts into the brain during a hemorrhagic stroke, the normal flow of blood to the brain is upset, and the blood interferes with the normal chemical balance that neurons need to function.

High blood pressure can weaken artery walls and make them more likely to break or burst. Poor blood clotting also can increase the risk of bleeding in a hemorrhagic stroke. Poor blood clotting may be caused by blood disorders or medications that decrease clotting. Another cause of hemorrhagic stroke is abnormalities in the structure of blood vessels that form during brain development.

Stroke symptoms come on suddenly and include:

• Numbness or weakness of the face, arm, or leg, especially on one side of the body
• Confusion, trouble talking, or trouble understanding what others are saying
• Dizziness, trouble walking, or loss of balance or coordination
• Trouble seeing in one or both eyes
• Sudden severe headache with no known cause

If you believe you or someone you know is having any of these symptoms, do not wait. Call 911 immediately. A person suffering a stroke must receive medications as soon as possible at a hospital to prevent or minimize brain damage.

The symptoms of a transient ischemic attack (TIA) are similar to those of a more serious stroke, but unlike a serious stroke, a TIA usually lasts only a few minutes and goes away within an hour. However, it is impossible to tell the difference between the symptoms of a TIA and a more serious stroke. You should not wait to see if the symptoms go away. Assume that all stroke symptoms signal an emergency.

Recovery from a stroke may take months or years. Many people who have had a stroke never fully recover.

A person who has had a stroke may have the following temporary or permanent symptoms:

• Inability to move on one side of the body
• Weakness on one side of the body
• Problems with thinking, awareness, attention, learning, judgment, and memory
• Problems understanding or forming speech
• Problems with controlling or expressing emotions
• Numbness or strange sensations
• Pain in the hands and feet that worsens with movement and temperature changes
• Depression

Types of Treatment for Stroke

Stroke treatment includes:

• Emergency treatment
• Preventing another stroke
• Rehabilitation

Emergency Treatment

When a person is able to get to the hospital within a few hours of having a stroke, health care providers will treat a stroke with medications, surgery, or both, depending on the type of stroke.

Medication for Ischemic Stroke

• Thrombolytic agents
  These medications are used to treat an ongoing ischemic stroke caused by a blocked artery. They stop the stroke by dissolving the blood clot that has blocked blood flow to the brain.
• Blood-thinning medications
  These drugs include antiplatelet drugs and anticoagulants and work to prevent blood clotting that causes ischemic stroke.

Surgery

In the case of ischemic stroke, a surgeon can clear out the clogged artery to allow blood to resume flowing to the affected part of the brain. Surgery can also repair structural abnormalities in arteries in the case of hemorrhagic stroke.

Preventing Another Stroke

A patient who has had a stroke may continue taking blood-thinning medications, referred to as blood thinners, to prevent another stroke. Surgery performed to treat a stroke may also help to prevent another stroke. Health care providers will also advise stroke survivors to make lifestyle changes, such as eating a healthy diet, exercising, and treating related medical conditions.

Rehabilitation

Stroke is the leading cause of serious adult disability in the United States. Several types of therapies can help a stroke survivor regain some or all of the functions damaged by the stroke. These therapies include:

• Physical therapy
  A physical therapist uses training and exercises to help a patient relearn physical activities such as walking, sitting, standing, and lying down. A special type of physical therapy called constraint-induced movement therapy (CIMT) can improve the use of a weakened or paralyzed arm. CIMT involves training and exercise for the affected arm while the unaffected arm is restrained by a special mitt.
• Occupational therapy
  Occupational therapy involves exercise and training to help a patient relearn daily activities such as eating, drinking, dressing, bathing, cooking, reading, writing, and using a toilet.
• Speech therapy
  Speech therapy helps patients relearn language and speaking, including swallowing.
• Psychological therapy
  Stroke survivors may suffer from depression, anxiety, frustration, and anger. Talk therapy, medications, or both can treat these symptoms.

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

African Americans are already almost twice as likely as whites to die from stroke. Now, new research finds that African Americans who smoke have more than double the risk of stroke, compared with African Americans who have never smoked.

A National Institutes of Health study, which followed 4,410 African American men and women for 15 years, suggests that African Americans could significantly cut their risk of stroke if they stopped smoking. In fact, the study found that the risk drops to about the same level as African American nonsmokers.

Numerous studies have shown a link between smoking and stroke. But this was the largest to focus just on the risk to African Americans. During the 15-year study period, 5.2% of participants who were former smokers, 6.6% who smoked up to 19 cigarettes a day, and 7.2% who smoked more than 20 cigarettes a day experienced a stroke, compared with 3.4% of participants who were nonsmokers. 

"The bottom line is the more a person smokes, the greater their chance is of having a stroke," says Adebamike Oshunbade, M.D., M.P.H., the lead author on the study.

A “Prime Example” of How Stroke Can Happen to Anyone

The day was like any ordinary day for metro-Atlanta resident Adrian Cushenberry. On a February morning in 2017, the 49-year-old was headed to work after his usual workout and stopped to buy an orange juice. The drive-through attendant suspected something might be wrong; she told Adrian he’d fallen asleep. Adrian didn’t believe it. But just seconds later, he drove his car into two parked vehicles. He couldn’t move the left side of his body. A police officer arrived and immediately knew that Adrian was having a stroke. The officer called for an ambulance right away, and Adrian was successfully treated at Atlanta’s Emory University Hospital—just 8 minutes from the scene of the stroke.

Before his stroke, Adrian worked out 5 days a week and ran in nearly 30 road races each year. He didn’t smoke, rarely drank, was careful with his diet, and considered himself to be in great health. What he didn’t know was that as an African American man, he was at a higher risk of stroke. A scan at the hospital revealed that the clot had formed in an abnormal web of blood vessels in his neck—a condition found in some African American men.

A Family History of Stroke Risk

African-American men are at greater risk of having a stroke than any other group of men in the United States. Compared to white men, they are twice as likely to have a stroke, have strokes at younger ages, die from stroke, or have stroke-related disability that affects their daily activities. Two in 5 African-American men have high blood pressure, just like Adrian, his twin brother, and their father. Adrian’s grandfather also had a stroke. This family history of stroke and high blood pressure meant Adrian’s stroke risk was higher than average, too—despite his healthy lifestyle.

Luckily, Adrian was in such good health that he was a prime candidate for a special surgery to remove the blood clot that caused his stroke. He credits his physical fitness before the stroke, along with fast treatment from emergency responders and at the hospital, with how well he has been able to recover. Plus, Adrian says, he has an “entourage” of supporters, including friends, family members, and his “fit family,” who work out with him regularly.

“Stroke can happen to anybody. I’m a prime example of that, because I knew I was a fit individual. I knew what I could push my body to do, and I knew I was living life right, health-wise. What I didn’t know was that I was at a higher risk of stroke because of my family history.”

—Adrian Cushenberry, 50, stroke survivor

Running Toward Health

Today, Adrian continues to work hard to recover his high level of physical fitness. He takes medicine to prevent blood clots and control his blood pressure, and he is determined not to let stroke stop him from doing what he loves. An avid runner, on the anniversary of his stroke, Adrian ran Atlanta’s Hot Chocolate 15K Race, a 9.4-mile race, finishing just a few minutes behind his previous time.

After his stroke, Adrian says he re-evaluated his life. “I started to slow down and recognize that nothing really matters other than friends and family,” he said. “Now I call friends and family more often to say, ‘I love you.’” Adrian adds that it’s important for stroke survivors to know they are not alone and that they can live a productive life after having a stroke. “You have the opportunity to write the next chapter of your life,” he says.

Each year in the United States, there are more than 795,000 strokes. Stroke is the fifth leading cause of death in the country. And stroke causes more serious long-term disabilities than any other disease. Nearly three-quarters of all strokes occur in people over the age of 65 and the risk of having a stroke more than doubles each decade after the age of 55.

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.

Learning about stroke can help you act in time to save a co-worker, friend, or relative. And making changes in your lifestyle can help you prevent stroke.

New treatments are available that greatly reduce the damage caused by a stroke. But you need to arrive at the hospital within 60 minutes after symptoms start to prevent disability. Knowing stroke symptoms, calling 911 immediately, and getting to a hospital are critical.

What is a stroke?

A stroke is serious - just like a heart attack. A stroke is sometimes called a "brain attack." Most often, stroke occurs when blood flow to the brain stops because it is blocked by a clot. The 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 kinds of stroke. The most common kind of stroke, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind of stroke, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain.

What disabilities can result from a stroke?

Stroke damage in the brain can affect the entire body - resulting in mild to severe disabilities. These include paralysis, problems with thinking, problems with speaking, and emotional problems.

Stroke Symptoms

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

What should you do?

Because stroke injures the brain, you may not realize that you are having a stroke. The people around you might not know it either. Your family, friends, or neighbors may think you are confused. You may not be able to call 911 on your own. That's why everyone should know the signs of stroke - and know how to act fast.

Don't wait for the symptoms to improve or worsen. If you believe you are having a stroke - or someone you know is having a stroke - call 911 immediately. Making the decision to call for medical help can make the difference in avoiding a lifelong disability.

Call 911

If you believe you are having a stroke - or someone you know is having a stroke - call 911 immediately.

When I walked into the locker room at work, I realized something was wrong. I couldn't speak. I tried to pick up my lock, but my right hand couldn't grab it. One of my co-workers noticed something was wrong and asked if I could write. With my left hand, I scribbled 911 on a piece of paper. Luckily, my friend knew the signs of stroke and got help. She called an ambulance, and I was rushed to the emergency room. The doctors ran some tests and put a drug into my IV. Within 10 minutes I could speak again. I didn't know a thing about stroke before I had one. Now, I make sure that all my family knows the signs of stroke so they can get help if they need it.

Ruth Junious
Stroke Survivor

Know Stroke Prevention

Conditions that can cause stroke are very common among African Americans. The best treatment for stroke is prevention. You can reduce your risk of having a stroke by taking action to improve your health.

What can you do to prevent a stroke?

While family history of stroke plays a role in your risk, there are many risk factors you can control.

• If you have high blood pressure, work with your doctor to get it under control. Many people do not realize they have high blood pressure, which usually produces no symptoms but is a major risk factor for heart disease and stroke. Managing your high blood pressure is the most important thing you can do to avoid stroke.
• If you smoke, quit.
• If you have diabetes, learn how to manage it. As with high blood pressure, diabetes usually causes no symptoms but it increases the chance of stroke.
• If you are overweight, start maintaining a healthy diet and exercising regularly.

Every minute counts. The longer blood flow is cut off to the brain, the greater the damage. The most common kind of stroke, ischemic stroke, can be treated with a drug that dissolves clots blocking the blood flow. The window of opportunity to start treating stroke patients is three hours. But a person needs to be at the hospital within 60 minutes of having a stroke to be evaluated and receive treatment.

Where Can You Learn More About Stroke?

Talk to your doctor about your personal risk factors for having a stroke. For more information about stroke prevention and treatment, call the National Institute of Neurological Disorders and Stroke at 1-800-352-9424.

STROKE PREVENTION

• Manage your diabetes
• Eat right
• Control your high blood pressure
• Exercise
• Don't smoke

I had a stroke when I was 49 years old. I am 67 now and have gone almost 20 years without another stroke. Until I had my stroke, I didn't do anything good for my health. I had high blood pressure, I was overweight, and I smoked. When bad things happen to people, they tend to think "why me?" But, when I think about my stroke, I think "why not me?" I had all the risk factors and wasn't taking care of myself like I am now. I've learned a lot of important lessons from my stroke, which have caused me to change my eating habits, quit smoking, and really control my high blood pressure for the first time in my life. I hope people realize they can prevent stroke. It doesn't have to happen to them.

Ted Turner
Stroke Survivor