American Heart Association

World Stroke Day

Stroke Care in India

Deepak GulatiDeepak Gulati, MD

I am writing this blog post on stroke care in India given my strong interest and a recent encounter with one of my family members requiring stroke care services in Chennai and New Delhi.

The stroke burden in India is enormous with more than 1.5 million stroke cases per year, much higher than Western industrialized countries. Stroke is the second most common cause of death in India. The most common cause of ischemic stroke in India is intracranial atherosclerosis as per some of the studies conducted in large academic centers from northern and southern India. There are reports of a high proportion of young stroke (first-ever stroke onset below 40 years of age), ranging between 15 and 30% of ischemic strokes.

World Stroke Day: A Call for Action to Get #UpAgainAfterStroke

Alan Charles CameronAlan Charles Cameron, MB ChB, BSc (Hons), MRCP

On World Stroke Day 2018, we are fortunate to have many therapies that reduce the burden of stroke, including intravenous thrombolysis, endovascular therapy, acute stroke unit care, primary and secondary prevention, and multi-modality rehabilitation. We have recently discovered that the substantial benefits achieved with intravenous thrombolysis and endovascular therapy can extend to imaging-selected patients with wake-up stroke, whilst dual anti-platelet therapy with aspirin and clopidogrel is associated with maximum benefit and lowest risk in the first 21 days after high-risk TIA or minor stroke. However, access to effective treatments for stroke remains limited in many developed countries, and basic aspects of stroke care are not available in many developing countries. There is clear global and regional variation in access to stroke care when we speak with colleagues and friends from around the world.

By |October 29th, 2018|clinical, World Stroke Day|Comments Off on World Stroke Day: A Call for Action to Get #UpAgainAfterStroke

World Stroke Day: Improving Stroke Care in Low-Income Countries

Robert W. RegenhardtRobert W. Regenhardt, MD, PhD

Regenhardt RW, Biseko MR, Shayo AF, Mmbando TN, Grundy SJ, Xu A, et al. Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania. International Journal for Quality in Health Care. 2018

As the second leading cause of death in the world, stroke is a global problem. With the recent advances in treatment of acute stroke from large vessel occlusion, World Stroke Day reminds us that in many parts of the world, these therapies are unavailable. There are large disparities between high- and low-income countries and opportunities to dramatically influence outcomes by implementing system changes in resource-limited settings. As stroke care providers, there are different levels within stroke care systems where we can implement changes to improve care. These levels include prevention at the population level, access to acute therapies at the community infrastructure level, guideline adherence during the acute admission at the hospital system level, and rehabilitation and follow-up care thereafter. Each of these is critically important.

By |October 29th, 2018|clinical, World Stroke Day|Comments Off on World Stroke Day: Improving Stroke Care in Low-Income Countries

Hope in Recovery After Stroke

Kara Jo Swafford

Kara Jo Swafford, MD

Stroke can be a devastating disease that afflicts millions of individuals and their families worldwide. Many survivors are left with long-term disability, compromising their quality of life. Stroke, however, is largely preventable and treatable, with new approaches for improving poststroke recovery being developed. Advances such as the use of thrombolytic therapy (clot busting drugs) and the advent of the use of clot removing devices can now minimize the effects of stroke and increase selected patients’ chances for survival and recovery.

By |October 29th, 2018|clinical, World Stroke Day|Comments Off on Hope in Recovery After Stroke

World Stroke Day: How Do We Think About Cerebrovascular Disease With a Global Perspective?

Nerses SanossianNerses Sanossian, MD, Blogging Stroke Editor

World Stroke Day is an opportunity for us to recognize that the burden of cerebrovascular diseases is not equally distributed throughout the world. As North America, Western Europe, and other regions of the world with advanced care struggle with issues such as implementation of endovascular coverage, most of the world struggles with issue of basic stroke care, including diagnosis and prevention.

The World Stroke Congress (WSC) held earlier this month in Montreal was an opportunity to learn about the disparities in stroke pathophysiology, systems, and care throughout the world. The World Stroke Organization (WSO) is a leading organization tasked with reducing the global burden of stroke and sponsors the WSC. Improvements in stroke care in developing nations has to be one of the priorities among WSO representatives from nations with excellent stroke infrastructure, but how can this be achieved? This is one of the challenges that the stroke community faces.

World Stroke Day: Sunday, October 29

Nerses Sanossian, MD, and José G. Merino, MD
Blogging Stroke Editors

World Stroke Day is an opportunity to focus on how to reduce the global burden of the deadliest and most morbid brain disease. Stroke is a global disease that exerts a particularly high burden on developing nations, where it is the second leading cause of death. Stroke remains a leading cause of death and disability throughout the United States and Europe despite many recent advances in stroke care. However, World Stroke Day also allows us an opportunity to recognize breakthroughs in stroke care and review priorities for the future.

Advances in acute stroke have created major disparities in care nationwide and worldwide. The four most impactful stroke treatments of the past 30 years — stroke units, intravenous thrombolysis, emergency/prehospital systems, and endovascular therapy — are currently available to the minority of people around the word. Most countries are just starting to develop stroke units. Intravenous thrombolysis is unavailable or beyond the financial means for most people in the world. Emergency systems of care are non-existent in most countries. Many countries do not have a single neuroendovascular practitioner. In a world where basic medical care is limited, how can advances in stroke care be translated into meaningful results?

By |October 27th, 2017|World Stroke Day|Comments Off on World Stroke Day: Sunday, October 29

World Stroke Day 2015 – “I am Woman”

In recognition of World Stroke Day 2015 and the theme “I am woman”, Stroke interviewed Cheryl Bushnell, MD, MHS, Professor of Neurology, Director at Wake Forest Baptist Stroke Center. Learn more about World Stroke Day

Stroke: World Stroke Day is on Thursday the 29th October 2015. The World Stroke Organization’s theme for World Stroke Day 2015 is ‘I am Woman’. What is the most important message for women when it comes to stroke?
Dr. Bushnell:
The most important message for women is to know what a stroke is, what to do if one is occurring, and how to prevent a stroke. Women have unique risk factors, including pregnancy complications and use of hormones, so they need to know that these are risks of stroke. One of the key messages of our stroke prevention in women guidelines is that women with a history of preeclampsia (high blood pressure during pregnancy plus protein in the urine) are at risk for stroke for up to 30 years after childbirth.

Stroke: Are women at higher risk of stroke?
Dr. Bushnell:
No, if you measure stroke incidence, men are at higher risk. But, because women live longer, they are at higher risk over an entire lifetime. Women have a 20% lifetime risk of stroke after age 55, whereas men have a 17% lifetime risk.

Stroke: How does pregnancy affect a woman’s risk of stroke?
Dr. Bushnell:
Yes, it appears to double the risk of stroke compared to a woman who is not pregnant. This is especially true in the postpartum time period, and applies to most stroke types, including ischemic and hemorrhagic stroke, as well as cerebral venous thrombosis.

Stroke: Does taking birth control pills or hormonal replacement affect a woman’s stroke risk? 
Dr. Bushnell: Yes, birth control pills double the risk of stroke compared to women not taking these pills. However, the absolute risk of a healthy young woman taking these pills is still low. For example, a young woman’s risk of stroke may be 10/100,000, and taking OCPs increases this to 20/100,000. However, if a woman has high blood pressure, high cholesterol, diabetes, obesity, or smokes cigarettes, all of these accentuate the risk of stroke in a woman using OCPs compared to women not taking OCPs. For hormone replacement, older women have about a 40% increased risk of stroke compared to women not taking the drug. It is important to realize these women were at least 10 years past menopause on average. The recent study of women who are recently menopausal (within 5 years), had no significant increase in markers of stroke risk (carotid wall thickening) compared to women not using hormone therapy. Therefore, hormone replacement is not recommended for older women and those with an increased risk of stroke (such as hypertension, diabetes, high cholesterol, prior heart disease).

Stroke: Are women underrepresented in clinical research studies of stroke?
Dr. Bushnell:
Yes, with only a couple of exceptions, women make up 35% to 40% of stroke prevention trials.

Stroke: What can health care providers do to reduce the burden of stroke in women? 
Dr. Bushnell: Improve stroke awareness and what to do, and promote a healthy lifestyle. Women who incorporate the most healthy strategies in their daily lives have a 70% decreased risk of stroke compared to women with none of these strategies. This includes regular physical activity, healthy diet, normal body mass index, moderate alcohol use, and not smoking. Another important strategy is to maintain normal blood pressure. The healthy lifestyle can do this, but women tend to have high blood pressure at older ages, and these women are also less likely to have their blood pressure controlled. Therefore, education about blood pressure in older women is extremely important.

Stroke: A recent study showed that 81% of stroke center directors are men. What can be done to increase the role of women in stroke leadership positions?
Dr. Bushnell:
For those of us in these leadership positions, hopefully we function as role models to promote more women as stroke center directors as a career choice. More women are going into stroke fellowships, so this will take time for the next generation to reach these leadership roles. Given the multidisciplinary nature of stroke centers and the tendencies for women to be collaborative, I believe women are likely to be successful in this role.  

Learn more about World Stroke Day

By |October 29th, 2015|author interview, World Stroke Day|Comments Off on World Stroke Day 2015 – “I am Woman”