Do you know a friend or relative who has had a Do you know a friend or relative who has had a stroke, or have you ever had a stroke yourself?stroke, or have you ever had a stroke yourself?

Where in the body does a stroke happen?Where in the body does a stroke happen?

Facts About StrokeFacts About Stroke• 3rd leading cause of death in the 3rd leading cause of death in the

United StatesUnited States

• Risk increases with age, but people of Risk increases with age, but people of any age can have a strokeany age can have a stroke

• Leading cause of adult disability in Leading cause of adult disability in the U.S.the U.S.

• Without treatment, 62% of people Without treatment, 62% of people who have a stroke will have moderate who have a stroke will have moderate to severe impairmentto severe impairment

DisabilityDisabilityLoss of ability to:Loss of ability to:• Walk Walk • TalkTalk• SeeSee• Make facial expressionsMake facial expressions• Shower and dressShower and dress• Go to the bathroomGo to the bathroom• Feed oneselfFeed oneself• Read and writeRead and write• DriveDrive

DisabilityDisability• Loss of independence and qualityLoss of independence and quality

of lifeof life• Emotional and financial strain of Emotional and financial strain of

families and loved onesfamilies and loved ones• $41.8 billion a year is spent nationally $41.8 billion a year is spent nationally

caring for people disabled by stroke caring for people disabled by stroke

Get Rapid Treatment! Get Rapid Treatment! • Treatment can reduce Treatment can reduce

stroke damagestroke damage

• Person having a stroke must be Person having a stroke must be admitted immediatelyadmitted immediately

The Problem in The Problem in Massachusetts!Massachusetts!• Average time to hospital is 22 hoursAverage time to hospital is 22 hours

Why it takes so long:Why it takes so long:– Most strokes do not cause painMost strokes do not cause pain

– Symptoms can be subtleSymptoms can be subtle

– Person having a stroke may be Person having a stroke may be unaware or unable to communicateunaware or unable to communicate

– Observers do not think there is a Observers do not think there is a serious problemserious problem

FASTFAST

FASTFAST

Only one symptom is necessary to indicate stroke

F = FaceF = Face• Droops on left or right side

• Sudden drooling

• Numbness

Ask person to smileAsk person to smile

A = ArmsA = Arms• Look for difficulty holding things or putting on clothing

• Numbness

• One arm drifts down orwon’t go up

• May have trouble walking

Ask person to raise Ask person to raise

both armsboth arms

S = SpeechS = Speech• Slurred speech• Doesn’t make sense• May not understand what other people are

saying• Forgets how to

read or write

Ask to repeat phrase Ask to repeat phrase

or name objector name object

T = TimeT = Time• Time lost is brain lost

• Save time and brain cells, go in an ambulance

At any sign, Call 9-1-1At any sign, Call 9-1-1

Go in an AmbulanceGo in an Ambulance• Person having a stroke will be seen Person having a stroke will be seen

more quickly more quickly

• EMTs communicate with ER doctorsEMTs communicate with ER doctors

• ER can prepare for arrivalER can prepare for arrival

• EMTs can monitor condition andEMTs can monitor condition andbegin treatmentbegin treatment

• Time saved is brain savedTime saved is brain saved

Other Warning Signs of StrokeOther Warning Signs of Stroke• Sudden weakness on one side Sudden weakness on one side

of the body of the body • Sudden confusion, trouble speaking or Sudden confusion, trouble speaking or

understanding understanding • Sudden trouble seeing Sudden trouble seeing • Sudden trouble walkingSudden trouble walking

or loss of balance or loss of balance • Sudden, severe headacheSudden, severe headache

What is a stroke?What is a stroke?

A stroke occurs when something A stroke occurs when something happens to interrupt the steady happens to interrupt the steady flow of blood to the brain.flow of blood to the brain.

Normal path ofNormal path ofblood through the blood through the

brainbrain

Blood flowBlood flowthrough brain through brain

blockedblocked

Three Types of StrokesThree Types of Strokes• Mini-Stroke - or Transient Ischemic Mini-Stroke - or Transient Ischemic

Attacks (TIA)Attacks (TIA)• Ischemic caused by blood clotIschemic caused by blood clot• Hemorrhagic caused by bleeding Hemorrhagic caused by bleeding

Mini-StrokeMini-Stroke• Brief episodes of confusionBrief episodes of confusion• Difficulty speaking or understandingDifficulty speaking or understanding• Visual problems, dizziness or lossVisual problems, dizziness or loss

of balanceof balance• Warning signal for major ischemic strokeWarning signal for major ischemic stroke• 30% of strokes are preceded by30% of strokes are preceded by

mini-strokesmini-strokes• Mini-strokes may occur during sleepMini-strokes may occur during sleep• Call 9-1-1 Call 9-1-1

Ischemic StrokeIschemic Stroke• Clot blocks flow of blood to brainClot blocks flow of blood to brain

• Over 80% of strokes are ischemicOver 80% of strokes are ischemic

• Clot busting drugs Clot busting drugs must be administered must be administered immediatelyimmediately

Hemorrhagic StrokeHemorrhagic Stroke• Bleeding in the brain caused by burst Bleeding in the brain caused by burst

blood vessel or aneurysmblood vessel or aneurysm

• Can be treatedCan be treatedwith surgery with surgery

A True StoryA True Story

Wife became alarmed when her husband’s Wife became alarmed when her husband’s speech sounded strange and his face speech sounded strange and his face drooped.drooped.

• Wife immediately called 9-1-1 Wife immediately called 9-1-1 • Husband was diagnosed andHusband was diagnosed and given tPA within 2 hoursgiven tPA within 2 hours• Husband survived with mildHusband survived with mild disabilitydisability

Risk Factors for StrokeRisk Factors for Stroke

What is the number one controllable What is the number one controllable risk factor of stroke?risk factor of stroke?

High Blood PressureHigh Blood Pressure• High blood pressure is present in High blood pressure is present in

70% of people who have a stroke70% of people who have a stroke

• Have blood pressure checked Have blood pressure checked regularly regularly

• Take medication as directedTake medication as directed

Other Controllable Risk Other Controllable Risk FactorsFactors• SmokingSmoking

• Diabetes Diabetes

• ObesityObesity

• High CholesterolHigh Cholesterol

Physical Activity Physical Activity • Walk 30 minutes a dayWalk 30 minutes a day• Exercise prevents stroke, heart Exercise prevents stroke, heart

disease and other conditionsdisease and other conditions• Always wear comfortable shoesAlways wear comfortable shoes

Eat RightEat Right• Reduce intake of fatty foodsReduce intake of fatty foods• Eat more fruits and vegetablesEat more fruits and vegetables• Your plate:Your plate:

– 1/2 vegetables1/2 vegetables– 1/4 meat1/4 meat– 1/4 starch1/4 starch

FASTFAST

Can you remember whatCan you remember whatFAST stands for?FAST stands for?

At any At any signsign, call 9-1-1, call 9-1-1

For More InformationFor More Information

Contact the Massachusetts Contact the Massachusetts Department of Public HealthDepartment of Public Health

1-800-487-11191-800-487-1119

email email heart.stroke@state.ma.usheart.stroke@state.ma.us

For More InformationFor More Information• American Academy of Neurology (AAN)American Academy of Neurology (AAN)

www.aan.comwww.aan.com

• American Stroke Association (ASA)American Stroke Association (ASA)www.strokeassociation.orgwww.strokeassociation.org 1-888-4-STROKE 1-888-4-STROKE

• Brain Attack Coalition (BAC)Brain Attack Coalition (BAC)www.stroke-site.orgwww.stroke-site.org

• National Institute of Neurological Disorders National Institute of Neurological Disorders and Stroke (NINDS)and Stroke (NINDS)www.ninds.nih.gov/disorders/stroke/stroke.htmwww.ninds.nih.gov/disorders/stroke/stroke.htm

• National Stroke Association (NSA)National Stroke Association (NSA)www.stroke.orgwww.stroke.org 1-800-STROKES 1-800-STROKES

CreditsCredits• Produced by Produced by GEOVISIONGEOVISION for the for the

Massachusetts Department of Massachusetts Department of Public HealthPublic Health

• Made possible with funding from the Made possible with funding from the U.S. Centers for Disease Control and U.S. Centers for Disease Control and PreventionPrevention

ReferencesReferences1.1. Broderick JP, William M. Feinberg Lecture. Broderick JP, William M. Feinberg Lecture. Stroke Stroke

therapy in the year 2025: Burden, breakthroughs, therapy in the year 2025: Burden, breakthroughs, and barriers to progress. Stroke 2004; and barriers to progress. Stroke 2004; 3535(1): p. 205-(1): p. 205-11. 11.

2.2. Improving the Chain of Recovery for Acute Stroke Improving the Chain of Recovery for Acute Stroke in Your Community: Task Force Reports, December in Your Community: Task Force Reports, December 12-13, 2002. National Institute of Neurological 12-13, 2002. National Institute of Neurological Disorders and Stroke Symposium, NIH Publication Disorders and Stroke Symposium, NIH Publication No. 03-5348, September 2003 (page 60)No. 03-5348, September 2003 (page 60)

3.3. Kothari RU, Pancioli A, Brott T, Broderick J: Cincinnati Kothari RU, Pancioli A, Brott T, Broderick J: Cincinnati Prehospital Stroke Scale: Reproducibility and Prehospital Stroke Scale: Reproducibility and Validity. Ann Emerg Med. April 1999; 33:373-378 Validity. Ann Emerg Med. April 1999; 33:373-378

4.4. Medline Plus, Adam Health Illustrated Encyclopedia Medline Plus, Adam Health Illustrated Encyclopedia