Myths and Facts: Stroke

This year, approximately 795,000 individuals in the U.S. will suffer a stroke. While the number of strokes fell 18 percent and the stroke death rate fell 33.5 percent from 1996 to 2006, stroke is still the third-leading cause of death in the U.S., killing about 137,000 people each year and leaving many with serious, long-term disability.¹

Unfortunately, it is a lack of understanding about stroke that causes death and disability. In a recent study, 40 percent of people were unable to name a single stroke symptom.² And, almost 60 percent of stroke patients don’t get to a doctor or hospital until 24 hours after the stroke — too late for effective treatment.³ Doctors say they see misconceptions about stroke and their devastating repercussions all the time. Therefore, it’s imperative for people to understand the myths about stroke that lead to mistakes and how to avoid them.

Separating Myth from Fact

Myth: Strokes are rare.

Fact: A stroke occurs every 45 seconds in the U.S., causing thousands of deaths each year.

Myth: Strokes happen to the heart.⁴

Fact: A stroke happens to the brain, and it also is known as a “brain attack.”⁵ A stroke occurs when a blood vessel in the brain bursts or gets clogged.⁶

Myth: There is only one type of stroke.

Fact: There are two major types of stroke. The most common is called ischemic, which occurs when arteries are blocked by blood clots or by the gradual buildup of plaque and other fatty deposits. About 87 percent of all strokes are ischemic.^1,7 Ischemic strokes include silent strokes and mini strokes (also known as transient ischemic attacks, or TIAs). A silent stroke is found incidentally on an MRI of the brain, and typically, the individual never remembers experiencing any symptoms. A mini stroke is a brief but discrete and memorable clinical event that causes symptoms of a stroke for a few minutes to a few hours that disappear in less than 24 hours. By age 69, approximately 10 percent to 11 percent of people who consider themselves stroke-free have suffered at least one ischemic stroke.⁸ Up to 25 percent of people who suffer a TIA die within one year, and up to 17 percent of all TIAs are followed by a stroke — most of them within 30 days of the TIA occurrence.²

The second type of stroke is called hemorrhagic, which occurs when a blood vessel in the brain breaks, leaking blood into the brain. Hemorrhagic strokes account for 13 percent of all strokes, yet they are responsible for more than 30 percent of all stroke deaths.⁷ Up to 70 percent of strokesseen in the hospital are ischemic, while the remaining 30 percent are a mixture of TIAs and hemorrhagic strokes.²

Myth: Only the elderly suffer strokes.

Fact: A stroke can strike anyone at any age, even infants, regardless of race, sex or age. Nearly 25 percent of all strokes occur in people younger than 65 years of age. After age 35, the risk of having a stroke doubles every 10 years.⁴ And, while men’s stroke incidence rates are greater than women’s at younger ages, this is not true at older ages.⁵

The percentage of adults from each race affected by stroke are: American Indians/Alaska natives, 5.3 percent; AfricanAmericans, 3.2 percent; whites, 2.5 percent; and Asians, 2.4 percent.² African-Americans have almost twice the risk of first-ever stroke compared with whites.¹

Myth: The risks for suffering a stroke do not run in the family.

Fact: The risk of having a stroke increases if a parent, grandparent or sibling has had a stroke.⁴

Myth: It’s easy to detect stroke symptoms because they are noticeable and painful.

Fact: Symptoms of a stroke are not painful. Common stroke symptoms include sudden numbness or weakness of the face, arm or leg (especially on one side of the body); sudden confusion, trouble speaking or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, loss of balance or coordination; and sudden severe headache with no known cause.¹ Oftentimes, strokes can cause even subtler neurological sensations, and some strokes are called silent strokes because they cause no symptoms.⁹

An individual can recognize if they are having a stroke by using the FAST (face, arms, speech, time) test. To employ the test, an individual simply looks in the mirror to determine whether one side of their face droops when smiling or whether one arm drifts downward when raising both arms, and to hear whether their speech sounds slurred or strange when speaking. If any one of these signs is present, it’s time to seek treatment.¹

Myth: It’s OK to wait to see if stroke symptoms will subside.

Fact: Two million brain cells die every minute during a stroke, which increases the risk of permanent brain damage, disability or death. 1 Generally, there is an eight-hour window for stroke treatment, but during that time period, treatment becomes less effective. Ideally a stroke victim should be treated within the first three hours of symptoms.⁷ Unfortunately, only 20 percent to 25 percent of patients who are admitted to the hospital with a stroke arrive in the emergency department within three hours of the onset of symptoms.²

Myth: It’s OK for a family member orfriend to drive someone suffering from stroke symptoms to the hospital.

Fact: If someone is having a stroke, 911 should be immediately dialed. Having a family member or friend drive a stroke victim to the hospital wastes time. An ambulance provides the stroke patient with the fastest access to medical care because paramedics and EMTs can evaluate the person and relay information to the doctors while the patient is en route to the hospital, allowing treatment to begin sooner.⁷

Myth: Strokes cannot be prevented.

Fact: While some risk factors for stroke are beyond a person’s control, including being over age 55, being a male, being African-American, having diabetes and having a family history of stroke, there are many medical and lifestyle changes that can be made to help prevent stroke. Medical risk factors include a previous stroke, previous episode of TIA, high cholesterol, high blood pressure, heart disease, atrial fibrillation and carotid artery disease — all of which can be controlled and managed. Lifestyle risk factors include smoking, being overweight and drinking too much alcohol. Quitting smoking, maintaining a healthy weight and limiting alcohol consumption can help to control these risks.¹

Myth: Strokes cannot be treated.

Fact: More people are surviving stroke due to better health education and medical advances. A clot-dissolving drug commonly referred to as t-PA (tissue plasminogen activator) can reduce long-term disability if it is given within the first three hours after an ischemic stroke starts. Unfortunately, t-PA is not used as it could be because many people don’t seek medical treatment as quickly as they should.⁶ Between three to six hours after onset of symptoms, the clot can be dissolved with drugs delivered directly to the brain vessel by way of a catheter. And, up to eight hours after onset of symptoms, a clot can be mechanically removed through a catheter. However, noninvasive actions are always the first choice.⁷

Treatment also includes rehabilitation, which needs to begin in the hospital as soon as possible after the stroke. The goal of rehabilitation is to improve function so that the stroke survivor may regain a level of independence. Stroke survivors may be seen in a rehabilitation unit in the hospital, a subacute care unit, a rehabilitation hospital or a long-term care facility providing therapy and skilled nursing care. Home therapy or a combination of home and outpatient therapy also may be options, depending on the stroke survivor’s individual needs.⁵

Myth: There are no long-term effects of stroke.

Fact: The effects of a stroke depend on several factors including the location of the obstruction of blood to the brain and how much brain tissue is affected. Each side of the brain controls the opposite side of the body. If a stroke occurs on the right side of the brain, long-term effects can include paralysis on the left side of the body; vision problems; quick, inquisitive behavioral style; and memory loss. If a stroke occurs on the left side of the brain, the effects may include paralysis on the right side of the body; speech/language problems; slow, cautious behavioral style; and memory loss.⁶

Approximately 38 percent of stroke survivors experience severe spasticity — tight or stiff muscles that make movement, especially of the arms and legs, difficult or uncontrollable. Severe spasticity can be very painful and can make simple activities of daily living time-consuming and difficult.When spasticity limits activity for long periods, it can cause additional medical problems such as sleep disturbances, pressure sores and pneumonia.

Age, severity of stroke, and success and timing of treatment all determine the recovery rates of stroke survivors. General recovery guidelines show that 10 percent of survivors recover almost completely, 25 percent recover with minor impairments, 40 percent experience moderate to severe impairments requiring special care, 10 percent require care in a nursing home or other long-term care facility, and 15 percent die shortly after suffering a stroke.⁵

Dispelling the Myths Now

Statistics show that four out of five American families are affected by stroke,⁵ a devastating illness that affects not only the stroke victims, but also their families who care for them and the public who pays the bill. In 2007, it was estimated that the total cost of stroke was $62.7 billion in the U.S.² In the face of its ruinuous impact on health and finances, it is more important than ever to minimize the risks of stroke. Dispelling the myths about this disease can bring about a better understanding of its symptoms, risks and the need to get treatment quickly, thereby reducing the number of stroke victims.