Approximately 15 million people worldwide have a stroke every year. Of these, almost 6 million die, while a further 5 million are left permanently disabled. But although stroke is one of the leading causes of death globally, many people remain unaware of the signs and symptoms to look out for, therefore putting their health at risk.
Furthermore, a recent AHA/ASA study revealed that many women in the US are unaware of stroke warning signs, even though they are at much greater risk of stroke than men.
"This lack of recognition of stroke signs and symptoms could be a significant barrier to reducing death and disability related to stroke in the US," says Dr. Lori Mosca, who led the study. "This is critically important because delays in getting care costs lives and hinders functional recovery."
May is National Stroke Awareness Month - an annual campaign introduced in 1989 that aims to increase public awareness of stroke in an attempt to tackle the condition once and for all.
In line with this campaign, this week's spotlight feature looks at the signs and symptoms of stroke, the risks associated with the condition and what can be done to increase stroke awareness.
What is stroke?
A stroke occurs when an artery or blood vessel becomes blocked, restricting blood flow to the brain. This leads to brain cell death, and, subsequently, brain damage.
How a person is affected by stroke depends on where in the brain the stroke occurs and how much of the brain is disturbed. Many stroke patients experience impaired speech, movement and memory. In severe cases, patients may suffer paralysis or even death.
There are two main types of stroke - ischemic stroke and hemorrhagic stroke. Ischemic stroke is the most common, accounting for around 87% of all strokes. This occurs when the arteries are blocked by blood clots or a gradual build-up of plaque and other fatty deposits.
Hemorrhagic stroke occurs when a blood vessel in the brain splits, leaking blood into the brain. Although only 13% of all strokes are caused by this, it is responsible for more than 30% of all stroke deaths.
The risk factors
There are many risk factors for stroke, many of which are out of our control. For example, individuals over the age of 55 are at greater risk of stroke, as are African-Americans, Hispanics and Asian/Pacific Islanders. Individuals who have a family history of stroke or TIA (Transient Ischemic Attack) are also more likely to have stroke themselves.
And women are more likely to have stroke than men. In the US, around 55,000 more women than men have a stroke every year.
Individuals with high blood pressure are one and a half times more likely to have a stroke than those with normal blood pressure.
But there are also risk factors for stroke that are within our control - one of the most important being high blood pressure, or hypertension. According to the National Stroke Association, people who have high blood pressure are one and a half times more likely to have stroke than those who have normal blood pressure.
"The No. 1 stroke risk factor is high blood pressure. It's important to check your blood pressure regularly and talk to your doctor about healthy levels for you," says Dr. Jeffrey L. Saver, professor of Neurology at the University of California Los Angeles and a spokesperson for the ASA.
High cholesterol also increases the risk of stroke, as cholesterol can block blood flow in the arteries. Furthermore, high cholesterol can raise the risk of heart disease and atherosclerosis - risk factors for stroke in themselves.
Smoking is another risk factor. Compared with non-smokers, those who smoke are at double the risk of stroke. It reduces the amount of oxygen in the blood, meaning the heart has to work harder to pump blood around the body. This means blood clots find it easier to form in the arteries, which can cause a blockage.
Those who are overweight or obese are also at increased risk of stroke. Excessive weight can increase the risk of high blood pressure, high cholesterol and diabetes.
But, regardless of the array of risk factors for stroke, the ASA state that 58% of Americans do not know if they are at risk for the condition. A 2009 UK study found that of more than 2,000 participants, less than half were able to identify stroke risk factors.
Talking to Medical News Today, Dr. Kate Holmes, assistant director of research at the UK Stroke Association, says such lack of awareness is a concern:
"There is an urgent need to raise more awareness about the risk factors for stroke. It has been estimated that at least half of strokes could be prevented if people made simple lifestyle changes, such as keeping blood pressure under control and exercising more."
It seems that the lack of identification of stroke risk factors is not the only concern. There is a serious lack of awareness regarding the warning signs and symptoms of stroke. As stated earlier, only 1 in 3 Americans know what symptoms to look out for.
The main symptoms of stroke include sudden drooping or numbness on one side of the face, weakness or numbness in one arm and difficulty with speech. F.A.S.T is an easy acronym to remember these symptoms, and it instructs what you should do if you notice these symptoms in an individual:
- F. Face drooping: Ask the person to smile. Is their smile uneven?
- A. Arm Weakness: Ask the person to raise both arms. Does one arm drift downward?
- S. Speech Difficulty: Is the person's speech slurred? Are they able to speak or hard to understand? Ask them to repeat a simple sentence. Can they repeat it accurately?
- T. Time to call 911: If a person shows any of the symptoms, even if they disappear, call 911 (999 in the UK) and get them to the hospital immediately. Note the time the symptoms first appeared.
A video from the American Stroke Association explaining F.A.S.T can be viewed below:
TIA: ignoring the signs
One major sign of a stroke is the occurrence of a Transient Ischemic Attack (TIA), also known as a mini-stroke. TIA occurs when a blood vessel in the brain becomes blocked for a short time, temporarily restricting blood flow to the brain.
Symptoms of TIA are similar to those of stroke, but they tend to last for shorter periods. A person may experience sudden numbness of the face, arm or leg - particularly on one side of the body. They may also experience sudden confusion, have trouble speaking, problems with sight in one or both eyes and dizziness.
According to the US National Stroke Association, around 40% of people who experience a TIA will have a stroke.
However, a recent survey from the UK Stroke Association found that 47% of respondents who experienced TIA symptoms did not know what was happening to them, and 37% did not take any action because the symptoms they were experiencing "did not feel like a medical emergency."
But why do we have this attitude toward stroke warning signs and symptoms? Could it be down to lack of education from health care professionals?
The challenge for health care professionals
The Stroke Association say health care professionals can find it challenging to spot symptoms of TIA.
In the Stroke Association survey, more than 50% of respondents said they had received little or no information about the link between TIA and stroke.
In addition, 16% of respondents said they felt they were not taken seriously when they described their symptoms to a health care professional, while 25% said their symptoms were not recognized as a TIA. More than 31% of respondents said they felt health care professionals are too quick to dismiss TIA as "just a funny turn."
Such statistics pose the question, if health care professionals find it hard to spot these symptoms, what hope is there for the general public?
The Stroke Association say that TIA can be difficult to diagnose. The condition mimics many other conditions with similar symptoms, such as migraine, visual problems, cognitive impairment and epilepsy.
Furthermore, health care professionals frequently have to rely on what they are told by the patient, so they may not be getting enough information to accurately diagnose them.
"However," the Stroke Association add, "our survey suggests that more could be done to ensure that all health and care staff can recognize TIA symptoms and understand the need for urgent action."
Dr. Holmes agrees, telling Medical News Today:
"Clinicians and primary care staff have a crucial role to play in reducing stroke risk, identifying early warning symptoms and initiating an emergency response."
There is no doubt that efforts to increase stroke awareness have improved in recent years, with the main focus surrounding the annual F.A.S.T campaign - first launched in the UK in 2004.
In the first 4 months of the campaign, the number of emergency calls related to stroke increased by 55% in the UK, and it seems the campaign has had continued success. In the 2 months after the hard-hitting F.A.S.T television campaigns ran in 2011, England's NHS saw a 24% increase in the stroke-related emergency calls, and there was a 16% rise in the number of stroke patients receiving faster medical attention.
Because of the impact the F.A.S.T initiative had in the UK, it has now been adopted over many countries. The ASA have even launched a free F.A.S.T mobile app for iOS and Android.
But aside from media campaigns, what else is being done to raise stroke awareness?
In 2011, the US Department of Health and Human Services launched the Million Hearts campaign - a national initiative that aims to prevent 1 million heart attacks and strokes across the country by 2017.
Medical News Today recently reported on the first US guidelines for stroke prevention in women, set by the AHA/ASA, after a review of a series of studies found that certain risk factors for stroke are much more common among women than men.
The AHA/ASA also launched a Together to End Stroke campaign - an initiative that aims to educate all Americans that stroke is preventable, treatable and beatable.
Of course, all of these initiatives help in the battle against stroke. But what more can be done? Dr. Holmes says there should be more community-based services required for individuals who are at risk of stroke:
"More research into stroke prevention and treatment also needs be done and implemented to reduce the devastating impact of stroke."
But for now, the main focus is on ensuring the general public are aware of stroke warning signs and symptoms.
"Prevention is the best cure, but in the event of a stroke emergency, quick recognition and treatment may have a dramatic impact on the outcome," says Dr. Mark Turco, chief medical officer of Covidien Vascular Therapies, who sponsor the Together to End Stroke campaign.
"If you are at risk for stroke or spend time with someone who is, learning and sharing the stroke warning signs should be a priority."
To find out more about stroke and how you can help increase awareness of the condition, please visit the American Stroke Association website if in the US, or the Stroke Association website if in the UK.