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Strokes still largely misunderstood

despite often debilitating, deadly consequences

Howard Manly | , Karen Miller | 7/11/2013, 10:57 a.m.

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Natalia S. Rost, M.D., M.P.H. Associate Director, Acute Stroke Service Massachusetts General Hospital

One would think that a disease that strikes every 40 seconds, kills 133,000 people a year and disables thousands more would get a little more attention.

Yet, stroke, the overall fourth leading cause of death in the United States, remains an enigma. Commonly known as a brain attack, stroke is a complex condition with a wide array of consequences that can permanently change a person’s physical and emotional well-being.

There are two types of stroke. Ischemic stroke is the most common with roughly 87 percent of the incidences. This type of stroke is caused by a blood clot that cuts off the blood supply to the brain. One of the biggest culprits is atherosclerosis — fatty deposits, or plaque, in the vessel wall. Over time the plaque can grow large enough to narrow the artery, causing the blood to flow abnormally — if at all.

The second type is called hemorrhagic stroke and occurs when the walls of a weakened artery rupture and cause bleeding in the brain. This kind of stroke is often triggered by high blood pressure. Although they constitute only about 13 percent of the cases, hemorrhagic strokes account for more than 30 percent of all stroke deaths, according to the American Heart Association (AHA).

In both types the brain is robbed of much needed oxygen and nutrients, and if left untreated, can cause irreparable damage. The AHA estimated in 2010 that the direct and indirect cost of stroke in the United States was almost $74 billion.

And strokes are not one-shot deals. Having one stroke increases the risk for another. Of the 795,000 strokes that occur each year, almost one-fourth are recurrent.

Regardless of the type, stroke can leave significant damage and is the nation’s leading cause of disabilities. The impairments depend on the severity of the stroke and where in the brain it strikes. Common consequences are partial paralysis, difficulty seeing, changes in behavior, reduced ability to speak and comprehend speech and memory loss.

Although anyone is a potential target, the typical patient is male, older than 55, or has a family or individual history of the disease. Blacks are impacted disproportionately by stroke and are twice as likely as whites to be afflicted.

Minorities are also targets at a younger age. In Massachusetts, roughly one-third of the deaths from strokes in blacks and Hispanics occur before the age of 64, compared to only 8 percent in whites, as noted in Massachusetts Deaths 2010, a report published by the Massachusetts Department of Public Health.

While stroke has fallen to the fourth most common cause of death for most in this country, it still remains the third leading cause of death among blacks. So common is this condition that a swath of Southeastern states (Alabama, Arkansas, Louisiana, Mississippi, North Carolina, South Carolina, Georgia and Tennessee) with large black populations is aptly called the “stroke belt.”

It is the stroke belt that intrigued researchers at Ohio University’s School of Public Health Sciences and Professions. They conducted a survey of African American residents of Mississippi aged 18 to 74 to determine their awareness of stroke, including symptoms and risk factors. Only one-fourth of those surveyed could correctly identify the five warning signs. Worse news is that 17 percent could not identify any.