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.
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.
What Is Stroke?
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.
Risk Factors for Stroke
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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