STROKE

Brain Attack
Michael A. Miranda, MD

Perceptions of Stroke

Stroke is not preventable

Stroke cannot be treated
Stroke only strikes the elderly
Stroke happens in the heart
Stroke recovery ends after 6
months

Facts
Philippine Population,
July, 2013 est.
105,720,644, 12th
1.903% Growth Rate
Life Expectancy 135th
(72.21 total population; 6.05 years
difference)

Males69.26 years
Females75.31 years

10 Leading Causes of Death Philippines

1. Heart Disease
Coronary, ischemic, valvular,
inflammatory, hypertensive, hereditary,
and infectious causes

2. Vascular System Diseases

Peripheral artery disease, all types of
aneurysms and dissections,
atherosclerosis, Buergers Disease,
Raynauds phenomenon, and arterial
embolism and thrombosis.
3. Cancer
Cancers of the lung, breast, cervix, liver,
colon and rectum, prostate, stomach,
oral cavity, ovary and leukemia.

4. Accidents
5. Pneumonia
6. Tuberculosis
Among the 22 countries in the world
accounting for 80 percent of TB
worldwide, the Philippines is now
ranked number 9.

7.Signs and symptoms, abnormal

clinical, and laboratory findings,
NEC.
8. Chronic Lower Respiratory
Disease
9.Diabetes
There are more than 5million Filipinos
with diabetes today.

10. Perinatal Conditions

10 Leading Causes of Death USA

1. Heart disease - 631,636
2. Cancer - 599,888

3. Stroke (cerebrovascular diseases) 137,119

Chronic lower respiratory disease - 124,583
Accidents (unintentional injuries) - 121,599
Diabetes - 72,449
Alzheimer's disease - 72,432
Influenza & Pneumonia - 56,326
Kidney disease (nephritis, nephrotic syndrome,
nephrosis) - 45,344
10."Blood poisoning" - Septicemia - 34,234
4.
5.
6.
7.
8.
9.

Stroke Statistics
Every 3.1 minutes someone dies
of a stroke
Stroke risk increases with age.
For each decade after age 55, the
risk of stroke doubles.
72% of all strokes occur in people
over the age of 65

What is a Stroke?
Brain tissue is damaged from a
sudden loss of blood flow, resulting in
a loss of neurological function
Causes:
Blockage (blood clot) occurring inside a
blood vessel
Blood vessel leaks blood due to
rupture

Types of Strokes
Ischemic Stroke (85%)

Hemorrhagic Stroke
(15%)

Ischemic Stroke
Types of Ischemic
Stroke
Embolic Stroke
Blood clot travels to
the brain

Thrombotic Stroke
Blood flow is blocked
to the brain

Hemorrhagic Stroke
Bleeding
occurs
from
vessels
within the brain.
High blood pressure
or a rupture of a
blood vessel or an
aneurysm may be
the cause.

Transient Ischemic Attacks (TIAs)

A stroke-like event lasting minutes, or
hours, that occurs when the brain is
deprived of oxygen-rich blood temporarily,
but in which the effects wear off
completely after the blood-flow returns.
TIAs do not result in permanent brain
damage
TIA is serious and too often ignored

PLEASE
Pay Attention to these symptoms
TIAs should not be ignored
More that 1/3 of people will go on to have
an actual stroke
5% of strokes will occur within 1 month of
the TIA or first stroke
12% will occur within 1 year
20% will occur within 2 years
25% will occur within 3 years

Stroke does not Discriminate

Stroke affects people of
All Ages
All Ethnic Groups
All Backgrounds

Most strokes are preventable, take steps

NOW to reduce having a stroke!

Signs & Symptoms of Stroke

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
Sudden, severe headache with no known cause

Strokes occur
in the brain
and affect the
opposite side
of the body.

Risk Factors for Stroke

Blood Pressure over 120/80?

Smoker exposed to tobacco?
Overweight?
Diabetes?
High Cholesterol?
Heart Disease?

Risk Factors for Stroke

Family History of Stroke?
Physical activityless than a total of
30 minutes on most days?
Man over age of 45, OR a woman
over 55 years of age?

Are you sitting down?

Yes, you are at risk for a stroke, but it
doesnt mean you will have one
There are risk factors that can be
controlled and risk factors that cannot
be controlled

Risk Factors
Risk factors you can control:
DIET - How we eat, do we follow our
diet?
EXERCISE - Do we exercise or get some
physical activity?
MEDICATIONS - Taking medications
correctly
SMOKING - Stop smoking

Strokes can affect different parts of the brain, this

results in patients experiencing different symptoms

Strokes are an
EMERGENCY
If someone is having a Stroke bring
to the hospital right away.

Once You are at the Hospital

Diagnostic Testing
CT or MRI of the brain
EKG
Carotid Ultrasound
Echocardiogram

EKG may show atrial fibrillation

Carotid Ultrasound will show if there is stenosis

(narrowing of the blood vessel)

Echocardiogram detects if any thrombus (blood clot)

within the heart chambers

Chest X-ray

Blood work - Labs

Any labs may be
ordered, Lipid Profile
(checking
your
cholesterol level) is
done on all patients.

Recognize the Symptoms of a

Stroke
3 Simple Questions
Ask the person to smile
Ask the person to raise
both arms
Ask the person to say a
simple sentence The sky
is blue in Boston

The sky
is blue
in
Boston

ACT IN TIME
Stroke is a medical emergency.
Every minute counts when someone
is having a stroke. The longer blood
flow is cut off to the brain, the
greater the damage. Immediate
treatment can save people's lives
and enhance their chances for
successful recovery

tPA (Tissue Plasminogen Activator)

is a clot-busting drug
Ischemic strokes, the most
common type of strokes, can
be treated with a drug called
t-PA, that dissolves blood clots
obstructing blood flow to the
brain.

TIME IS BRAIN
Time is very important in order
to receive this medication
Window of opportunity to start
treating stroke patients is three
hours, but to be evaluated and
receive treatment, patients need
to get to the hospital within 60
minutes.

Medications

Aspirin
Aggrenox
Plavix
Blood pressure
medication if
appropriate
Cholesterol lowering
medicines if needed

Hospital Treatment for Stroke

Medical Management
Dietary
Physical & Occupational
Therapy
Speech Therapy if indicated
Nursing

Hospital Treatment for Stroke

Rehabilitation
Physical Medicine
Consult
Determine what type
of therapy best for
patient

Rehab Unit
Subacute Rehab
Extended Care Facility
Home Care with PT/OT

Discharge Planning
Starts upon admission to the hospital
Consult social worker or care coordinator to
help identify discharge needs
Provide patient/family with Stroke
education
Stroke Support Group meetings

The 5 Longevity
"Virtues
There are 5 basic types of good behavior:
1. regular exercise
2. not smoking
3. alcohol consumption within guidelines
4. maintaining a low BMI (body mass index)
5. eating a predominantly plant-based diet

The 5 Longevity
"Virtues
Thus, if one practices 4 or 5 of those
"virtues," compared with men who practice
none:
the reduction in the risk for cardiovascular
disease is around 67%;
the reduction in the incidence of diabetes is
73%;
the reduction in developing cancer is 20%-25%;
remarkably, the reduction in dementia is 65%;
the reduction in all-cause mortality is 32%.

The 5 Longevity
"Virtues
Most of the reduction in cancer risk is
related to smoking, and frankly the
other forms of behavior in cohort
studies did not affect the
development of cancer very
remarkably.

LET US ALL CHOOSE TO

LIVE WELL!
THANK YOU