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SUBJECT: SUCCESSFUL AGING

National Institute on Aging
National Heart, Lung, and Blood Institute

Stroke: Prevention and Treatment

Stroke can often be prevented today. In fact, the death rate from stroke has fallen as much as 50 percent since 1970. This decline in deaths has come about, in part, because of new diagnostic tests and treatments. In addition, many Americans are adopting-sensible health habits such as controlling their high blood pressure. These new habits may lower the risk of stroke.

Yet stroke remains a leading cause of death among older people and is the cause of a large number of nursing home admissions.

What Is a Stroke?

A stroke is a sudden disruption in the flow of blood to an area of the brain. Deprived of blood, the affected brain cells either become damaged or die. While cell damage can often be repaired and the lost function regained, the death of brain cells is permanent and results in disability. There are three major types of stroke:

The thrombotic stroke is most common. Fatty deposits (plaques) build up in the arteries (blood vessels) that supply blood to the brain. This severely reduces the blood flow until, eventually, a clot or clump (called a thrombus) in an artery entirely blocks the path of blood.

An embolic stroke results when a blood clot forms somewhere else in the body (usually in arteries of the heart or neck), and the clot travels through the circulatory system to the brain. The traveling clot is an embolus.

A hemorrhagic stroke is the most severe type of stroke. It occurs when a blood vessel in the brain bursts, allowing blood to pour into the brain outside of normal channels.

Diagnosis and Treatment

A stroke is a medical condition that requires immediate care in a hospital. Patients may be treated by a family doctor, internist, or geriatrician and may then be referred to a neurologist -a doctor specializing in the diagnosis and treatment of disorders of the brain and nervous system. The neurologist first evaluates the patient to determine if a stroke in progress has been completed. The entire episode can last from minutes to hours and sometimes (although rarely) days.

An early diagnosis is made by evaluating symptoms, reviewing the patient's medical history, and performing routine tests. Tests that may be given include an electrocardiogram (a test that measures the electrical activity of the heart), an electroencephalogram (a test that measures nerve cell activity in the brain), a computerized tomography scan (a 3-dimensional x-ray technique making pictures that look like slices), and a magnetic resonance imager (a test that can show, for example, blockage of the main artery in the neck).

Treatment begins as soon as the stroke is diagnosed to ensure that no further damage to brain cells occurs. Anticoagulant drugs may be prescribed to prevent blood clots from becoming larger; or, in the case of a hemorrhagic stroke, drugs may be prescribed to lower the blood pressure, which is usually high.

What You Can Do To Prevent Stroke

Stroke was once viewed as a single devastating attack, but we now know it develops over a period of many years. The risk factors or conditions that lead to stroke include high blood pressure, atherosclerosis,* heart disease, diabetes, smoking, and being overweight.

You can help prevent stroke by taking these steps: Control your blood pressure. Have your blood pressure checked regularly, and if it is high follow your doctor's advice on how to lower it.

Stop smoking.

Eat a healthy diet: choose, prepare, and eat foods that contain lower amounts of total fat, saturated fatty acids, and cholesterol.

Exercise regularly. There is evidence that exercise strengthens the heart and improves circulation. It will also help in weight control; being overweight increases the chance of developing high blood pressure, heart disease, and atherosclerosis.

Control diabetes. If untreated, diabetes can cause destructive changes in the blood vessels throughout the body.

Promptly report warning signs to your doctor. Sometimes people experience "little strokes" (transient ischemic strokes - TIA'S) which are the clearest warning that a stroke may occur. TIA's produce symptoms of a stroke that disappear completely within hours.

* A condition in which deposits of fat form on the inner walls of blood vessels. The blood vessels become narrower and eventually the flow of blood is blocked.

Rehabilitation for Stroke

Rehabilitation should begin as soon as possible after the patient's condition is stable and for most, continues at home. It consists of various types of therapy: physical therapy to strengthen muscles and improve balance and coordination; speech and language therapy; and occupational therapy to improve eye-hand coordination and skills needed for tasks such as bathing and cooking. A team of health care experts (physicians, physical and occupational therapists, nurses, social workers, and speech and language specialists) coordinates activities for the patient and family.

Progress in rehabilitation varies from person to person. For some, recovery is completed within weeks following a stroke; for others, it may take many months or years.

Where To Get Help

For more information on high blood pressure or other stroke risk factors, contact the National High Blood Pressure Education Program, 4733 Bethesda Avenue, Suite 530, Bethesda, MD 20814-4820.

For information on treatment or rehabilitation services, call a university teaching hospital in your area or write to the American Heart Association, 7320 Greenville Avenue, Dallas, TX 75231.

The National Institute of Neurological Disorders and Stroke can answer your questions on stroke research. Write to the NINDS Information Office, Building 31, Room 8AO6, Bethesda, MD 20892.

The National Stroke Association can also answer questions about stroke. Their address is 300 East Hampden Avenue, Suite 240, Englewood, CO 80110; or call (800) 367-1990.

SOURCE: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health

OTHER RESOURCES: HEALTH INSURANCE, HMOs, SPORTSWEAR



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