This document discusses strokes, including what they are, their causes, symptoms, types, risk factors, prevalence, and management. It defines a stroke as the sudden death of brain cells due to interrupted blood flow to the brain, and outlines the two main types - ischemic caused by blockages, and hemorrhagic caused by bleeding. Risk factors discussed include hypertension, smoking, atrial fibrillation, and others. The document also provides statistics on stroke prevalence worldwide and in India. It describes India's National Programme for Prevention and Control of Stroke, which focuses on screening, treatment, capacity building, and promoting healthy lifestyles.

1. Presesnted by:
Harsh Rastogi,
M.Sc. Nursing 1st year,
King George’s Medical University,
Institute of Nursing,
Lucknow.

2.  Stroke or
 apoplexy (ancient Greek word meaning ‘a striking
away’)
 means bleeding within organ and the accompanying
symptoms.

3.  Stroke, the sudden death of some brain cells due to
lack of oxygen when the blood flow to the brain is lost
by blockage or rupture of an artery to the brain.
WHO

4.  A stroke is caused by the interruption of the blood
supply to the brain, usually because a blood vessel
bursts or is blocked by a clot. This cuts off the supply
of oxygen and nutrients, causing damage to the brain
tissue.

5.  A disturbance of cerebral function is caused by 3
morphological abnormalities:
 Stenosis- an abnormal narrowing in a blood vessel or
other tubular organ or structure.
 Occlusion- the blockage or closing of a blood vessel or
hollow organ or
 Rupture of the arteries

6.  The most common symptom of a stroke is sudden
weakness or numbness of the face, arm or leg, most
often on one side of the body. Other symptoms
include: confusion, difficulty speaking or
understanding speech; difficulty seeing with one or
both eyes; difficulty walking, dizziness, loss of balance
or coordination; severe headache with no known
cause; fainting or unconsciousness.
 Coma, hemiplegia, paraplegia, monoplegia, multiple
paralysis, speech disturbances, nerve paresis, sensory
impairment, etc.

8.  The effects of a stroke depend on which part of the
brain is injured and how severely it is affected. A very
severe stroke can cause sudden death.

9.  Two main categories:
 Ischemic strokes
 Hemorrhagic Stroke

11.  They are caused by sudden occlusion of arteries
supplying the brain, either due to a thrombus at the
site of occlusion or formed in another part of the
circulation.
 It account for 50-85% of all strokes worldwide.
 Two main categories: thrombotic strokes and embolic
strokes.
 Thrombotic strokes may be preceded by one or more
transient ischemic attacks (TIAs). About 15% of
embolic strokes occur in people with atrial fibrillation.

12.  They are caused by subarachnoid hemorrhage,
bleeding from one of the brain’s arteries into the brain
tissue or intra-cerebral hemorrhage, arterial bleeding
in the space between meninges.
 About 20% of strokes are caused by hemorrhage.

13.  Cerebro-vascular diseases are leading cause of
death from Non-Communicable Diseases.
Cerebro-vascular disease all the leading cause of
disability in adults and a million of stroke
survivors have to adopt life with restriction in
activities of daily living as a consequence of stroke.

14.  Worldwide, cerebro-vascular accidents (stroke) are the
second leading cause of death and the third leading
cause of disability.
 Annually 15 million people worldwide suffer a stroke.
Of these 5 million die and another 5 million are left
permanently disabled.
 Stroke is the third most common cause of death in
developed countries.
 Uncommon in persons <40 years.

15.  Incidence in many developed countries is declining,
largely as a result of better control of high blood
pressure and reductions in tobacco use. However, the
absolute numbers of stoke continues to increase
because of ageing populations.
 Globally, 70% of strokes and 87% of both stroke-
related deaths and disability-adjusted life years occur
in low- and middle-income countries.

16.  Over the last four decades, the stroke incidence in low-
and middle-income countries has more than doubled.
During these decades stroke incidence has declined by
42% in high-income countries.
 Deaths rates from stroke for people <65 years have
fallen by 23% in the last 10 years. Recently rates have
declined at a slower rate particularly among younger
age groups.
 On average, stroke occurs 15 years earlier in – and
causes more deaths of – people living in low- and
middle-income countries, when compared to those in
high-income countries.

17.  The most important modifiable risk factor for stroke is
high blood pressure; for every 10 people who die of
stroke, 4 could have been saved if their blood pressure
had been regulated.
 Smoking - among persons aged >65 years, two-fifths of
deaths from stroke are linked to smoking.
 Atrial fibrillation, heart failure and heart attack are
other important risk factors.

19.  Oral contraceptives
 Elevated blood lipids
 Diabetes
 Blood clotting & viscosity
 Glucose intolerance
 Previous stroke

20.  Stroke is one of the leading causes of death and
disability in India.
 The estimated adjusted prevalence rate of
stroke range, 84-262/100,000 in rural and 334-
424/100,000 in urban areas.
 The incidence rate is 119-145/100,000 based on the
recent population based studies.
Sep 27, 2013

21.  A transient ischemic attack (TIA) is a brief episode
(of less than 24 hours) of neurological dysfunction
caused by loss of blood flow in the brain.

22.  Host factors:
 Age: Age greater than 55. In India about 1/5th of all
strokes occurs below the age of 40 (called ‘stroke in
young’).
 Sex: The incidence rate is higher in males than in
females.
 Personal History: ¾ Stroke patients already have
associated diseases such of cardiovascular or diabetes.

23.  National Programme for Prevention and Control
of Cancer, Diabetes, Cardiovascular Diseases &
Stroke (NPCDCS)

24.  Health promotion through behavior change with
involvement of community, civil society, community
based organizations, media etc.
 Outreach Camps for opportunistic screening at all
levels in the health care delivery system from sub-
centre and above for early detection of diabetes,
hypertension, stroke.

25.  Management of chronic Non-Communicable diseases,
especially Diabetes, CVDs and Stroke through early
diagnosis, treatment and follow up through setting up
of NCD clinics.
 Build capacity at various levels of health care for
prevention, early diagnosis, treatment, operational
research and rehabilitation.

26.  Provide support for diagnosis and cost effective
treatment at primary, secondary and tertiary levels of
health care.
 Provide support for development of database of NCDs
through a robust Surveillance System and to monitor
NCD morbidity, mortality and risk factors.

27.  Health promotion, Awareness generation and
promotion of healthy lifestyle - The focus of
health promotion activities will be on:
 Increased intake of healthy foods
 Salt reduction
 Increased physical activity/regular exercise
 Avoidance of tobacco and alcohol
 Reduction of obesity
 Stress management
 Awareness about warning signs of cancer etc.
 Regular health check - up

28.  Screening and early detection – Stroke, diabetes and
high blood pressure screening of target population (age 30
years and above) will be conducted either through
opportunistic and/or camp approach at different levels of
health facilities and also in urban slums of large cities.
 Timely, affordable and accurate diagnosis
 Access to affordable treatment
 Rehabilitation