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The increased incidence and prevalence of stroke have prompted increased interest in this debilitating disease. Worldwide, stroke kills 5 million people each year, making it the second leading cause of death. Stroke is also the leading cause of disability in the United States. Since age is a risk factor for stroke, the number of people who will suffer a stroke is expected to increase as the population of the United States gets older; for each decade one ages after 55 years, the risk of stroke doubles. As a result, economic costs of stroke are considerable. In 1999, the American Heart Association estimated that the direct and indirect costs of stroke totaled $51 billion.
In addition to monetary costs, stroke also results in diminished quality of life. Although 10% of stroke survivors recover almost completely, 25% recover with minor impairments; 40% experience moderate to severe impairments that require special care; 10% require care in a nursing home or other long-term facility; 15% die shortly after the stroke; and approximately 14% of stroke survivors experience a second stroke in the first year following a stroke. Stroke is devastating not only to those physically affected, but also to those who care for stroke survivors.
A stroke, or brain attack, occurs when an occlusion in the blood supply to the brain occurs, as a result of a clot or the rupture of a blood vessel in the brain. Because blood flow is interrupted, ischemia will cause the destruction of brain cells in the surrounding area within a few minutes, and once brain cells are destroyed, they cannot be revived. Activities of the body that are controlled within those areas of the brain that are destroyed, such as movement, speech, and vision, are impaired or lost. The extent to which these activities are impaired or lost depends on both the size and the area in the brain where the stroke occurs.
There are numerous modifiable and nonmodifiable risk factors for stroke. A history of stroke or transient ischemic attack presents the greatest risk factor for stroke, increasing the degree of stroke risk by a factor of 10. Both hypertension and atrial fibrillation increase the degree of stroke risk by a factor of 6. Hypertension is the primary cause of hemorrhagic stroke. A hemorrhagic stroke occurs when a blood vessel wall in the brain weakens to such an extent that it ruptures. Hypertension is also a risk factor for the development of atrial fibrillation. Stroke resulting from atrial fibrillation is considered embolic. Embolic strokes result from clots formed outside the brain, which eventually lodge within the cerebral circulation. Since hypertension is easily detected, monitored, and controlled, treatment of hypertension should reduce the incidence of strokes.
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