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Stroke - Skyaid.org updated 10/12/02

See also Medical
See also Automatic External Defibrillator, Sudden Cardiac Death & CPR

Overview

Brain attack statistics and charts   from National Stroke Association
730,000 strokes annually in US of which 10-18% will experience another stroke within a year
Incidence rate is 180 /100,000 for whites, but a higher 290 for African-Americans
African-Americans also die of stroke about 2X more than whites do
    - due to their higher risk factors of hypertension, diabetes, obesity, and sickle cell anemia
4 million Americans are living with the effects of a stroke: 1/3 mild, 1/3 moderate, 1/3 severe
Risk of getting hit by a second stroke is 20-34% within 3 years
Cost of strokes to US $30 billion per year,
1/3 of strokes hit people under age 65
Over a lifetime, four out of every five American families will be touched by a stroke
Stroke risk doubles each decade after age 55 added 10/15/00

Stroke - good overview from nonprofit organization in South Africa
What it is, how to prevent it, what is TIA, how to recover, etc. added 10/03/01

Items from http://www.strokepreventionplus.com added 11/24/00

STROKE is a BRAIN attack and is the third leading cause of death in the U.S.
75-80% of all STROKES are associated with blockages in the carotid arteries – and are preventable!
Almost half of the people who are going to have a STROKE have no symptoms prior to the time of stroke.
STROKE – the #1 reason for admission into nursing homes.

Medicinenet.com has lots of medical information, http://www.medicinenet.com/Script/Main/hp.asp
including stroke http://www.focusondiabetes.com/script/main/art.asp?articlekey=489

Virtual Hospital has good descriptions of stroke problems added 08/25/01

Reminder from the Internet: STROKE WARNING SIGNS

   1. Sudden weakness or numbness of the face, arm or leg.
   2. Sudden dimness or loss of vision, particularly in one eye.
   3. Sudden difficulty speaking or understanding speech.
   4. Sudden severe headache with no known cause.
   5.Unexplained dizziness, unsteadiness, or sudden falls, especially with any of the other signs.

Causes and Treatment of Strokes CNN Aug 2, 2000 nice brief summary with video. Strokes strike 600,000 Americans, killing 160,000 annually, tPA is a good clot-buster if used "early on" 8/22/00

Many people, especially the elderly, know only a single stroke warning sign. added 10/30/01

Cooling

Cooling for Sudden Cardiac Arrest too. added 02/20/02

May be possible to cool blood 5 degrees in 10 minutes by use of a cooling fluid in the lungs. Reminder: it is very important to cool the blood of stroke patients to reduce brain damage. added 08/26/01

Stroke - keep cool after calling for help Sat. Evening Post, March 2001
This is the first lay article we have seen about keeping cool after a stroke
Detailed suggestions about having a cooling blanket in the freezer.
Skyaid intends to have body cooling available in every EMS vehicle added 07/08/01

Cool the stroke/heart attack blood directly - article from Technology Review added 06/16/01

Influence of Admission Body Temperature on Stroke Mortality added 10/05/00

Quickly cooling stroke victim by 1 degree decreases stroke mortality by 50% 9/1/00

Treatment

Stroke: treating quickly transcript added 07/05/01

Aspirin before and after, but not during stroke added 10/29/01

Acute Stroke Care from EMS Magazine - online Fall 2001 added 10/08/01

STROKE: It appears that oxygen levels in the blood are higher for stroke patients who sit up than those who lie down. abstract of research article from Cerebrovascular Diseases added 09/18/01

STROKE: Future possible drug to reduce cell suicide after strokes. AM-36 may not be available for 8 years - but could extend lives of brain cells following stroke for up to 12 hours. article in April 2001 issue of British Journal of Pharmacology Incorporation of sodium channel blocking and free radical scavenging activities into a single drug, AM-36, results in profound inhibition of neuronal apoptosis added 09/18/01

Neuroprotectives are used at different times after an ischemic stroke added 5/11/01

European Stroke Care abstract and PDF article added 3/09/01

Stroke: 30 Years of tests, yet very little change in how strokes are treated. added 07/02/01

Stroke Treatment Advances history 1920-2000 from American Stroke Association

Reperfusion of Acute Stroke highlights with links to full articles added 1/25/01

Stroke - 6 potential treatments being explored Lancet Sept 2001 added 10/01/01

FDA Approves New Indication For Altace (Ramipril), "Rates of reduction of cardiovascular events reported from the HOPE study include 32 % for stroke, 20 % for heart attack, 26 % for cardiovascular death, and 22 % for all three endpoints combined." various restrictions as to who can take the medicine. "Altace is the first and only ACE inhibitor to receive FDA approval to reduce the risk of stroke, myocardial infarction and death from cardiovascular causes in patients 55 and over either with a history of coronary artery disease, stroke, or peripheral vascular disease or with diabetes and one other cardiovascular risk factor (e.g., elevated cholesterol levels, cigarette smoking, etc.)." added 11/04/00

Stroke Patients Treated Effectively By Emergency Room Physicians "There was a need to evaluate whether emergency doctors could administer TPA safely and effectively. Our results showed that it could be done." " In the study, neurologists evaluated and treated 20 stroke patients, and emergency medicine physicians evaluated and treated 23 stroke patients following phone consultation with a neurologist and review of brain scans by a radiologist." Reported at American Stroke Association Conference Feb 2000 added 11/04/00

D-serine - a future stroke medicine? in Repairing the Brain - Forbes Magazine Aug 7, 2000 added 10/18/00

Lasers might be able to zap blood clots in brain which have caused a stroke. {PDF file 168KBytes}
from Lawrence Livermore Labs added 3/29/01

TIA

Stroke: do not ignore the warning TIA (mini-stroke) transcript added 07/05/01

Silent Strokes article from March 13, 2001 added 6/05/01
Silent strokes may hit 4% of US population annually added 2/17/01

Rehabilitation / Recovery

Stroke Recovery - aided by computer software added 11/02/01
http://www.bungalowsoftware.com/ Software
http://www.brain-train.com/ Software - including freeware
http://www.cnn.com/2000/HEALTH/aging/09/11/stroke.home.ap/ story at CNN
http://www.parrotsoftware.com/

After Stroke how to recover from stroke which affects 10.7 million people annually added 09/30/00

The only stroke rehab device approved by the FDA. AutoMove Therapy applies additional electronic pulses only when the stroke survivor tried to activate the muscle being focused on. Has been in use in Europe for 15 years. Is intended to be used at home and most insurance companies pay for it. Can start to be used anytime from weeks to years after a stroke. 90% achieve significant improvement within 4 weeks. It is not biofeedback, TENS, or muscle stimulation. http://strokerecoverysystems.com added 11/24/00

Prevention

Review of stroke prevention drugs at http://www.neurologychannel.com/stroke/treatment.shtml added 11/24/00

Ischemic Stroke Prevention: {PDF file 141KBytes} from Circulation, Jan 2001 added 3/22/01
   20 page overview of knowledge:
   Risk factors -nonmodifiable and modifiable - both well documented and potential risk factors
   Treatments- drugs and surgery
   Types of diseases

Determination

Perhaps can determine if stroke is ischemic or hemorrhagic before getting to hospital. Proof of concept a few years ago at Lawrence Livermore National Labs in California. Concept uses micropower impulse radar (MIR)
Likelihood of probability of success estimated to be in the range of 30% - 50% updated 4/09/01

Pre-hospital Stroke determination - which is just part of a large EMS booklet in PDF format. Created by Regions Hospital in St. Paul MN. added 12/12/00

EMS and Stroke

EMS/911 should not be called in case of a stroke because they typically:
  Are not paid to carry the victim to a distant stroke center
  Give a probable stroke victim Oxygen - which is bad for stroke
  Give a probable stroke victim aspirin - which is bad for 1/8 of strokes
  Lie a victim down - which is bad for stroke
  Keep a victim warm - which is bad for stroke
  Give a stroke victim a low priority (typical hospital cannot do much anyway)

Strokes can be identified before arriving at the hospital. added 10/11/00

Validation: 91% sensitivity, 97% specificity, positive predictive value 86%, and negative predictive value 98%. Published in Stroke Journal, Jan 2000. A simple set of observations which includes the measurement of blood glucose is all that is required to greatly decrease the mortality and disability from stroke. However, > 95% of the possible stroke patients who could benefit from it, do not get it in the United States. Details at: http://stroke.ahajournals.org/cgi/content/abstract/31/1/71

Journal of Emergency Medical Services Oct, 2000 has an article: 20 Questions about Emergency Stroke and Cardiac Care 2 pages of the article are imaged here page 24-5 and page 26 - Interview of Stroke neurologist David Lee Gordon, MD, associate professor of clinical neurology and director of EMS training at the Center for Research in Medical Education, Univ. of Miami School of Medicine.

He is clearly upset that many EMS do not give high priority to stroke victims (Q7);
that many hospitals do not treat stroke victims quickly (Q3);
that various EMS give stroke victims oxygen and glucose (Q2);
that EMS give stroke victims aspirin (Q9).
He states that t-PA, given quickly, decreases risk of disability by close to 30% (Q4) added 11/07/00

No Stroke questions in the EMT-Basic exam 2nd edition, 2001.
Not one of the 3 sets of 150 questions appeared to be concerned with Stroke, yet EMT-B personnel should be aware that there is a significant decrease in mortality if the victim is rushed to a stroke center, is not kept horizontal, is not given Oxygen, and is kept cool. There is an opportunity for just-in-time information being provided to both the EMT staff and the stroke victim. added 10/08/01

Stroke: One EMS reader was concerned about use of low-flow instead of high-flow Oxygen for field management of stroke victims. It seem pretty clear in the literature that Oxygen should NOT be applied to stroke victims. Clearly the word has not gotten out to some of the EMS community. In letters to the editor March 2001 JEMS (Journal of Emergency Medical Service) added 3/31/01

"All of the recent advances against ischemic stroke will be for naught, if patients fail to reach medical centers in time for thrombolytic therapy to be administered. " Emergency Medicine Magazine June 2000
Note: not just any medical center, but a stroke critical care center. added 3/09/01

Better outcome from a stroke if person was aware of stroke symptoms and had an action plan to get to a hospital. These two factors resulted in a delay time of 'only' 2.85 hours vs. 4.03 hours. Stroke. 2000;31:2591 and Stroke. 2000;31:2585. added 11/04/00

Skyaid wants to reduce the time to get to not just a hospital, but a stroke center to about 1 hour
- so that tPA can be used and thus the effects of a stroke can be greatly reduced.

Position Paper on Stroke {Adobe Acrobat} from PreHospital Emergency Care added 12/31/00

Stroke Units

BBC 1999 Subheadline of a long article:"If you are lucky enough to live near a hospital with a specialist stroke unit you will have a 30% better chance of surviving your stroke." added 10/27/01

Establishing Stroke Centers in Hospitals Would Reduce Deaths and Disabilities, Say Stroke Experts. First-Ever Recommendations Published in June 21, 2000 Issue of JAMA added 10/16/00

List of the 50 or so Stroke Centers in the US, Canada and UK - not complete 8/24/00

Stroke Centers Save Lives

Hyperlinks to 72 "Stroke Center" active URLs on web 8/12/00

Stroke center checklist for communities - from Brain Attack Coalition added 11/04/01

Doctors Views

Stroke: Quality of life estimates vary widely over 67 journal articles added 07/02/01

Review of a variety of Stroke Scales (both: is this a stroke, and how strong is the stroke)
http://www.strokecenter.org/trials/scales/ added 10/27/01

5 stroke scales added 11/04/01

Stroke information for Doctors http://www.pslgroup.com/strokes.htm added 10/01

Stroke-Scale - a new Stoke Scale from Japan is quantitative
From Stroke Journal added 10/14/01

Stroke - Doctors Guide lots of news items added 12/30/00

News items from Neurology World / Stroke added 12/30/00

Medical names for causes of Stroke added 12/29/00

Ischemic Stroke and EMS - MD level description - updated Nov 2000 added 12/12/00

More strokes in hospital occur after a surgery if doctor did not have much experience with CEA surgery, which the study reported in November 2000 issue of Annals of Surgery. Thus the study found that African Americans had a 3.1% chance of stroke vs. 1.6% chance for whites - due to having doctors of hospitals with less experience with CEA (carotid endarterectomy = clean the plaque from arteries) added 11/04/00

Management of Ischemic Stroke book synopsis 8/12/2000

Management of Acute Ischemic Stroke - 1999 for Doctors added 10/27/01

Stroke Quiz - 10 multiple choice questions with answers added 07/05/01

Heart Rate Variability

Letter to Neurologist - can we use heart rate variability to detect stroke? added 1/14/01

Heart rate ceases to vary after a person gets an ischemic stroke.
The heart rate normally appears to vary by 0.3 Hz.
This lack of heart rate variation should be noticed by a Skyaid Watch.
A neurologist may need to look at the heart rate variability data to determine if the Skyaid Watch wearer has just experienced an ischemic and a call should be made for to get him to a stroke care center so that the tPA treatment can be applied within 2 hours.
The graphic is from the May 1999 issue of Stroke Journal added 12/10/00

"Brain is Time"

Strokes at night more likely to delay care added 07/03/01

Must get a victim to hospital in 2 hours to use tPA to reverse the consequences of stroke added 09/30/00

Other

Sharon Stone got a stroke at age 43 Oct 3 she got a subarachnoid hemorrhage, or bleeding into the space between the brain and the middle membrane covering the brain
Strokes hit 10,000 apparently healthy Britons under 55 each year.
The Stroke Association says more than 8,500 people in the UK, mainly women, suffer the same kind of stroke as Stone annually. More than half are between 18 and 26. added 10/08/01

Puget Sounders are in the U.S. "Stroke Belt" in that they are more likely to die in Puget Sound after having a stroke than in many other regions of the US. added 08/10/01

11 Neuro myths to retire now - article in Registered Nurse magazine June 1997. added 06/08/01
Just 4 years ago this article reminded professional nurses of the breakthroughs in stroke treatment. It is easy to understand that the lay public is not aware of the improvements yet.
#4 MYTH: Stroke is virtually untreatable, so there's no reason for patients to seek emergency care or for nurses to rush patients into treatment protocols.
#5 MYTH: If a patient with acute ischemic stroke is also suffering from hypertension, treat it quickly to prevent hemorrhage.
#10 MYTH: Acute stroke patients do just as well on a medical/surgical unit as they would on an acute stroke unit.

Risks associated with SCA, Heart Attack, and Stroke

Stroke, traumatic brain injury links also from New Zealand added 5/201/01

Stroke part of How We Die book added 2/17/01

The life you save may be your own Nov 2000 Stroke Journal News Release added 12/24/00

Seven titles of articles on strokes from Univ. of Wash. medical library
Summary of all articles: Stroke is a big problem, and there are some possible solutions,
but most organizations are not implementing them.   added 12/28/00
    Stroke - a medical emergency
    Predictors of Stroke Outcome - in Neurologic Clinics May 2000
    Magnitude of the Problem - Impact on Health Care
    Developing Effective Emergency Systems for Stroke
    Outcomes Science and Stroke
    Predicting Disability in Stroke - A critical Review of the Literature
          - Age and Ageing 1996 25:479-489
    Brain Attack - How good is the early management of subarachnoid hemorrhage in accident and emergency departments? in Journal of Accident and Emergency Medicine 2000 17:176-179

Brain Attack Coalition has a nice web site - with lots of detailed information. added 12/28/00

Brain Attack - published in Medical Computing Today Nov 1998 added 12/12/00

Stroke: overview of 15 medical articles added 10/31/00
Overview: mortality, cooling by 1 degree is great , cooling good for animals with strokes 10 years ago, pre-hospital diagnosis, OK to thin blood before air trip to hospital, 750,000 strokes per year in US, more strokes in the morning.

Lifetime Cost of Stroke in the United States. ischemic stroke $91,000 added 10/05/00

Skyaid and Skyaid Watch can substantially improve outcome of an ischemic stroke. 8/12/00

Stroke Risk Factors American Heart Association 2000

Stroke Statistics Stroke Treatments both from American Heart Association

Operation Stroke Rural Stroke patients not getting treatment 8/16/00

Stroke section of Health Heart for Dummies 8/17/00

Stroke Sensor detects blood vibrations when mounted on the eyelid, etc.
from Technology Review July 2001 added 06/16/01

Gum Disease doubles risk Of Stroke
In a study reported in Archives of Internal Medicine (Oct ? 2000) of 9,900 adults ages 25-74.
"Compared with no periodontal disease, the relative risks for incident
Non-hemorrhagic stroke were
    1.24 for gingivitis,
    2.11 for periodontitis and
    1.41 for edentulousness.
For all cerebrovascular accidents, the relative risks were
    1.02 for gingivitis,
    1.66 for periodontitis and
    1.23 for edentulousness." added 11/04/00