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Q: Effects of strokes ( Answered 4 out of 5 stars,   1 Comment )
Subject: Effects of strokes
Category: Health
Asked by: alb-ga
List Price: $5.00
Posted: 07 Nov 2002 06:41 PST
Expires: 07 Dec 2002 06:41 PST
Question ID: 101123
Is my perception of the effects of strokes correct in that control of
speech is almost always affected (if so, why)?  What other control
centers, such as hearing, are commonly affected?  What is the
mechanism involved?  What
are the best immediate (on the spot) and longer term
(ambulance/hospital) treatments?
Subject: Re: Effects of strokes
Answered By: wayga-ga on 07 Nov 2002 07:39 PST
Rated:4 out of 5 stars
Hi alb-ga,

The following information is from The American Stroke Association, a
division of The American Heart Association.

About Stroke

Every 53 seconds, someone in America has a stroke. About 600,000
Americans will have a stroke this year and 160,000 of them will die.
In fact, stroke is our nation's No. 3 killer and is a leading cause on
severe, long-term disability.

Impact of Stroke

Every 53 seconds, someone in America has a stroke. Every 3.3 minutes,
someone dies of one.

Stroke killed an estimated 158,448 people in 1998 and is the nation's
third leading cause of death, ranking behind diseases of the heart and
all forms of cancer. Stroke is a leading cause of serious, long-term
disability in the United States.

About 4,500,000 stroke survivors are alive today.

Data from the National Heart, Lung, and Blood Institute's Framingham
Heart Study, show that about 600,000 people suffer a new or recurrent
stroke each year. About 500,000 of these are first attacks.

In 1998 females accounted for 61.4 percent of stroke fatalities.

Estimates are that stroke accounts for half of all patients
hospitalized for acute neurological disease.

According to the NHLBI's Framingham Heart Study, 28 percent of annual
stroke victims are under age 65.

From 1988 to 1998 the death rate from stroke declined 15.1 (15.5)
percent, but the actual number of stroke deaths rose 5.3 percent. (The
first percentage is based on the 1940 age-adjusted U.S. population.
The second is based on the year 2000 population.)

The 1998 death rates per 100,000 population for stroke were 24.5
(57.6) for white males and 46.8 (86.4) for black males; and 22.0
(56.6) for white females and 37.2 (75.3) for black females. (The first
death rates listed are based on the 1940 age-adjusted U.S. population.
The second, in parentheses, are based on the year 2000 population.)

Types of Stroke

What causes a stroke?

Stroke is a cardiovascular disease that affects the blood vessels
supplying blood to the brain.

A stroke occurs when a blood vessel bringing oxygen and nutrients to
the brain bursts or is clogged by a blood clot or some other particle.
Because of this rupture, or blockage, part of the brain doesn't get
the flow of blood it needs. Deprived of oxygen, nerve cells in the
affected area of the brain can't function and die within minutes. When
nerve cells can't function, the part of the body they control can't
function either. The devastating effects of stroke are often permanent
because dead brain cells aren't replaced.

What Are the Effects of Stroke?

The brain is an extremely complex organ that controls various body
functions. If a stroke occurs and blood flow can't reach the region
that controls a particular body function, that part of the body won't
work as it should.

If the stroke occurs toward the back of the brain, for instance, it's
likely that some disability involving vision will result. The effects
of a stroke depend primarily on the location of the obstruction and
the extent of brain tissue affected.

Right Brain 
The effects of a stroke depend on a number of factors including the
location of the obstruction and how much brain tissue is affected.
However, because one side of the brain controls the opposite side of
the body, a stroke affecting one side will result in neurological
complications on the side of the body if affects. For example, if the
stroke occurs in the brain's right side, the left side of the body
(and the right side of the face) will be affected, which could produce
any or all of the following:

Paralysis on the left side of the body 
Vision problems 
Quick, inquisitive behavioral style 
Memory loss 
Left Brain 
If the stroke occurs in the left side of the brain, the right side of
the body (and the left side of the face) will be affected, producing
some or all of the following:
Paralysis on the right side of the body 
Speech/language problems 
Slow, cautious behavioral style 
Memory loss 


A new treatment for acute ischemic stroke has the potential to raise
standards of care in communities by reducing disability caused by this
disease. This treatment promises to help improve the medical outlook
for the thousands of people who suffer a new or recurrent stroke each

For this treatment to be effective, it must be started quickly. The
following are seen as essential.
Rapid recognition and reaction to stroke warning signs. Recognize the
warning signs and note the time when they first occur. Call 9-1-1
immediately. Tell the operator you or the person you are with is
having stroke warning signs.

Rapid start of pre-hospital care. Receive early assessments and
pre-hospital care by Emergency Medical Personnel.

Rapid Emergency Medical Services (EMS) system transport and hospital
prenotification. Get to an appropriate hospital quickly via EMS,
ambulance personnel will notify the emergency room.

Rapid diagnosis and treatment at the hospital. Receive prompt
evaluation of medical data and treatment to restore blood flow to the
brain or other treatments as appropriate by a properly staffed and
equipped hospital

The newest and most promising treatment for stroke.

What are accepted ways to treat stroke?

Surgery, drugs, acute hospital care and rehabilitation are all
accepted treatments for stroke.

When a neck artery has become partially blocked, surgery might be used
to remove the buildup of atherosclerotic plaque. This is called
carotid endarterectomy.

Cerebral angioplasty is a new, experimental technique. Balloons,
stents and coils are used to treat some types of cerebral vascular
problems. Its widespread use will require more study of its safety and

What about tissue plasminogen activator (tPA)?

The Food and Drug Administration approved the clot-dissolving drug
tissue plasminogen activator (tPA) to treat stroke in 1996. This was a
major advance because physicians can use this approved treatment for
ischemic strokes caused by blood clots, which constitute 80 percent of
all strokes. It is the only FDA-approved drug proven to be effective
in treating ischemic stroke. Studies have shown that tPA can
significantly reduce the debilitating effects of stroke and minimize
permanent disability, if administered promptly. For maximum benefit,
the therapy must be started within three hours of the onset of stroke
symptoms. Therefore, it's critical that caregivers, medical
professionals and the public recognize stroke as a medical emergency
and respond immediately by calling 9-1-1.

tPA carries a risk of bleeding in the brain, but its benefits outweigh
the risks when an experienced doctor uses it properly. Therefore, not
every stroke patient, particularly those experiencing a hemorrhagic
stroke, should receive tPA treatment.

What about treating heart disease?

Sometimes treating a stroke means treating the heart, because various
forms of heart disease can contribute to the risk of stroke. For
example, damaged heart valves may need to be surgically treated or
treated with anti-clotting drugs to reduce the chance of clots forming
around them. Blood clots can also form in patients with atrial
fibrillation, a type of arrhythmia (abnormal heart rhythm). If clots
form, there's a chance they could travel to the brain and cause a

So to summarize, the effects of stroke depend on what part of the
brain is effected. Speech, vision, balance, sensation and balance may
all be affected to greater or lesser degrees.

The mechanism involved is the interruption of blood flow to a part of
the brain, either through blockage (thrombosis), or hemmorhage
(ruptured aneurysm).

The best immediate treatment is early recognition of the signs and
symptoms of stroke and seeking emergency medical care.

The best hospital care will depend on the type of stroke and whether
or not treatment is begun quickly and may include surgery or treatment
with drugs designed to dissolve clots and restore blood flow to the
area of the brain affected.


American Stroke Association

Warning signs

National Stroke Association

I hope this answer meets your needs and please feel free to ask for
more information or a clarification if needed.

Thanks, wayga-ga

Request for Answer Clarification by alb-ga on 08 Nov 2002 05:54 PST
Thanks for the interesting info, wayga, but I don't think is exactly
answers the question.  Is the slurring of speech the statistical main
symptom of stroke, and if so, why is it so prevalent?  Are hearing
problems,say, as prevalent?  What are the main surgeries if neck
artery is OK?  EMS does what on the way to the hospital?  First on
scene should do what?  Thanks!

Clarification of Answer by wayga-ga on 08 Nov 2002 12:12 PST
Hi alb-ga, and thanks for your clarification request.

I'll take your clarification requests one at a time...

Is the slurring of speech the statistical main symptom of stroke, and
if so, why is it so prevalent?

According to Britain's National Health Service... 

"...the most common initial symptom of stroke is paralysis of one side
of the body...

...and this site, The Stroke Center, from

"The most common sign of stroke is sudden weakness of the face, arm or
leg, most often on one side of the body."

The site goes on to say...

"Other warning signs can include:

 Sudden numbness of the face, arm, or leg, especially on one side of
the body
 Sudden confusion, trouble speaking or understanding speech  
 Sudden trouble seeing in one or both eyes  
 Sudden trouble walking, dizziness, loss of balance or coordination  
 Sudden severe headache with no known cause"

On the sites I looked at, speech difficulties are always listed among
the most common initial symptoms of stroke. The reason speech problems
are so common has to do with the speech center's location in the
brain. According to a live chat with Dr. Peter Lawrence, August 26,

"...the reason many patients have a speech difficulty is the speech
center is in the path of one of the largest arteries in the brain."

In most people the speech center is located on the left side of the
brain, so a stroke on that side is likely to affect speech.
Right-sided strokes may affect speech in left-handed people, about a
third of whom have their speech centers on the right side.

 Are hearing problems, say, as prevalent? 

In the context of stroke, hearing and speech are closely interrelated.
Aphasia, the partial or total loss of the ability to express ideas or
understand spoken or written language, resulting from damage to the
brain caused by injury or disease, is the term used to describe the
problems caused by strokes to the language center of the brain.
I haven't seen any mention of hearing loss, as in deafness, being a
result of stroke. The problem arises in the brain's ability to process
what is heard and respond, either verbally or in writing.

A chart showing the incidence of post-stroke disability, including
various speech problems can be found at this National Institutes of
Health site in PDF format.

You need Adobe Acrobat Reader to view this document. Most computers
have this already installed but if yours doesn't you can get it free
at the Adobe website

What are the main surgeries if neck artery is OK?

A stroke caused by rupture of an artery in the brain (aneurysm)can be
repaired if the area is accessable to surgery and new techniques are
making more areas accessable. Here is a page from the Stanford
University website that outlines some of the traditional and cutting
edge surgical techniques. This site also addresses new techniques that
may be used to surgically treat strokes caused by blockage of blood

EMS does what on the way to the hospital?  First on scene should do

Prehospital care is primarily focused on recognition of stroke and in
urgent transport to a hospital where definitive treatment can take
place. In addition, determining the time of onset of the symptoms is
vital to determine if the patient is a candidate for thrombolytic
(clot busting) drugs. Treating high blood pressure is downplayed as
maintaining cerebral blood flow is vital in stroke patients.
Information on current prehospital guidelines can be found at the
eMedicine website...

The best thing that the first person on the scene can do is to
recognize the signs and symptoms of stroke and call 911. The various
groups involved in stroke care and prevention have promoted treating a
stroke as a "Brain Attack," to stress the importance of early
recognition and treatment and you can look at their take on this issue
of early intervention at their website which also has links to
community action and prehospital treatment.

The Brain Attack Coalition

I hope this gives you the information you need, but if anything is not
clear or you need more information please post another clarification

Thanks, wayga-ga
alb-ga rated this answer:4 out of 5 stars
Excellent on-target clarification.  Thanks, wayga.

Subject: Re: Effects of strokes
From: answerfinder-ga on 07 Nov 2002 10:33 PST
Your perception may be correct. Although not all stroke victims lose
their speech, speech can be affected. Language is usually controlled
from the left side of the brain, music is generally controlled from
the right side. As a result, the normal intonation and expression that
we put into speech can be lost and the voice sounds flat if the right
side is affected by a stroke. It is usually accompanied by difficulty
in 'non-verbal communication' - facial expression and gesture.

The voice can also be affected if there is slurring of speech due to
weakness or poor control of the muscles that are used in speaking.
This is called dysarthria.



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