According to the Centers for Disease Control and Prevention (CDC)Trusted Source, over 795,000 people in the United States have a stroke every year, and around 610,000 are first strokes.

In 2019, stroke was the leading cause of mortality globally, accounting for 11% of deaths.

There are three main types of stroke. The first and most common, accounting for 87% of cases, is an ischemic stroke. It occurs when blood flow through the artery that supplies oxygen to the brain becomes blocked.

The second is a hemorrhagic stroke, caused by a rupture in an artery in the brain, which in turn damages surrounding tissues.

The third type of stroke is a transient ischemic attack (TIA, which is sometimes called a “ministroke.” It happens when blood flow is temporarily blocked to the brain, usually for no more than 5 minutes.

While stroke is very common, it is often misunderstood. To help us dispel myths on the topic and improve our understanding, we got in touch with Dr. Rafael Alexander Ortiz, chief of Neuro-Endovascular Surgery and Interventional Neuro-Radiology at Lenox Hill Hospital.

1. Stroke is a problem of the heart

Although stroke risk is linked to cardiovascular risk factors, strokes happen in the brain, not the heart.

“Some people think that stroke is a problem of the heart,” Dr. Ortiz told MNT. “That is incorrect. A stroke is a problem of the brain, caused by the blockage or rupture of arteries or veins in the brain, and not the heart.”

Some people confuse stroke with a heart attack, which is caused by a blockage in blood flow to the heart, and not the brain.

2. Stroke is not preventable 

“The most common risk factors [for stroke] include hypertension, smoking, high cholesterol, obesity, diabetes, trauma to the head or neck, and cardiac arrhythmias,” said Dr. Ortiz.

Many of these risk factors can be modified by lifestyle. Exercising regularly and eating a healthy diet can reduce risk factors such as hypertension, high cholesterol, obesity, and diabetes.

Other risk factors include alcohol consumption and stress. Working to reduce or remove these lifestyle factors may also reduce a person’s risk of stroke.

3. Stroke does not run in families 

Single-gene disorders such as sickle cell disease increase a person’s risk for stroke.

Genetic factors including a higher risk for high blood pressure and other cardiovascular risk factors may also indirectly increase stroke risk.

As families are likely to share environments and lifestyles, unhealthy lifestyle factors are likely to increase stroke risk among family members, especially when coupled with genetic risk factors.

4. Stroke symptoms are hard to recognize 

The most common symptoms for stroke form the acronym “F.A.S.T.“:

• F: face dropping, when one side of the face becomes numb and produces an uneven “smile”
• A: arm weakness, when one arm becomes weak or numb and, when raised, drifts slowly downward
• S: speech difficulty, or slurred speech
• T: time to call 911

Other symptoms of stroke include:

• numbness or weakness in the face, arm, leg, or one side of the body
• confusion and trouble speaking or understanding speech
• difficulty seeing in one or both eyes
• difficulty walking, including dizziness, loss of balance and coordination
• severe headaches without a known cause

5. Stroke cannot be treated 

“There is an incorrect belief that strokes are irreversible and can’t be treated,” explained Dr. Ortiz.

“Emergency treatment of a stroke with injection of a clot busting drug, minimally invasive mechanical thrombectomy for clot removal, or surgery can reverse the symptoms of a stroke in many patients, especially if they arrive to the hospital early enough for the therapy (within minutes or hours since the onset of the symptoms),” he noted.

“The longer the symptoms last, the lower the likelihood of a good outcome. Therefore, it is critical that at the onset of stroke symptoms — ie. trouble speaking, double vision, paralysis or numbness, etc — an ambulance should be called (911) for transport to the nearest hospital,” he continued.

Research also shows that those who arrive within 3 hours of first experiencing symptoms typically have less disability 3 months afterward than those who arrived later.

6. Stroke occurs only in the elderly 

Age is a significant risk factor for stroke. Stroke risk doubles every 10 years after age 55. However, strokes can occur at any age.

One study examining healthcare data found that 34% of stroke hospitalizations in 2009 were under age 65.

A review in 2013 points out that “approximately 15% of all ischemic strokes occur in young adults and adolescents.”

The researchers noted that stroke risk factors including hypertension, diabetes, obesity, lipid disorders, and tobacco use were among the most common co-existing conditions among this age group.

7. All strokes have symptoms 

Not all strokes have symptoms, and some research suggests that symptom-free strokes are far more common than those with symptoms.

One study found that out of the over 11 million strokes in 1998, 770,000 presented symptoms, whereas close to 11 million were silent.

Evidence of these so-called silent strokes appears on MRI scans as white spots from scarred tissue following a blockage or ruptured blood vessel.

Often, silent strokes are identified when patients receive MRI scans for symptoms including headaches, cognitive issues, and dizziness.

Although they occur without symptoms, they should be treated similarly to strokes with symptoms. Silent strokes put people at risk of future symptomatic strokes, cognitive decline, and dementia.

8. A ministroke is not so risky

“The term ministroke has been used incorrectly as some think that it is related to small strokes that carry low risk,” said Dr. Ortiz. “That statement is incorrect, as a ministroke is a transient ischemic attack (TIA).”

“It is not a small stroke, but a premonition that a large stroke can occur. Any symptom of acute stroke, transient or persistent, needs emergency workup and management to prevent a devastating large stroke,” he added.

9. Stroke always causes paralysis 

Stroke is a leading cause of long-term disability, but not everyone who has a stroke will experience paralysis or weakness. Research shows that stroke leads to reduced mobility in over half of stroke survivors aged 65 and over.

However, the long-term impacts of stroke vary on many factors, such as the amount of brain tissue affected and the area affected. Damage to the left brain, for example, will affect the right side of the body and vice versa.

If the stroke occurs in the left side of the brain, effects may include:

• paralysis on the right side of the body
• speech and language problems
• slow and cautious behavior
• memory loss.

If it affects the right side of the brain, paralysis may also occur, this time on the left side of the body. Other effects may include:

• vision problems
• quick and inquisitive behavior
• memory loss.

10. Stroke recovery happens fast

Recovery from stroke can take months, if not years. However, many may not fully recover. The American Stroke Association says that among stroke survivors:

• 10% will make an almost complete recovery
• another 10% will require care in a nursing home or another long-term facility
• 25% will recover with minor impairments
• 40% will experience moderate to severe impairments

Research suggests there is a critical time window between 2–3 months after stroke onset, during which intensive motor rehabilitation is more likely to lead to recovery. Some may also be able to spontaneously recover during this period.

Beyond this window, and beyond the 6-month mark, improvements are still possible although are likely to be significantly slower.

Public Health Crises: Five Big Ones Facing America Right Now

• Obesity
• Heart Disease
• Addiction/Substance Abuse
• Dementia
• Food Safety

Obesity, dementia, and heart disease – these are among some of the most concerning public health crises faced by the US today. Why are we facing some of these issues, and what are the known facts at this point? Follow along for the scoop on five of today’s most pressing public health crises in the US.

1. Obesity

The advantages of living in a modernized society include more luxury and more ready access to consumables of all sorts. This becomes a problem when the end result is obesity in a significant portion of the population. According to most research, the 1980s marked the beginning of the obesity epidemic in America today.

So, what does this particular health crisis look like? U.S. News shares that around 40 percent of Americans over the age of 20 are said to be obese. These numbers and the numbers of obese children are steadily on the rise. At the end of the day, what makes this such a critical issue overall is the fact that obesity is directly linked to early death and the onset and even further complication of diabetes, heart disease, liver disease, cancer, and many other ailments.

2. Heart Disease

As discussed above, heart disease itself is often a derivative of obesity. In other cases, it can be brought on by unhealthy lifestyle choices, environmental factors, and sometimes, genetics. At the end of the day, this condition is a major problem plaguing Americans’ health at present.

Heart disease, often called by several other names, is essentially stress and damage taken on by the heart that can worsen and lead to heart attacks, strokes, and even fatal events, ultimately in some cases. Factors that help to remediate the various forms of heart disease include healthy dietary choices, regular exercise, and avoidance of illicit drug and alcohol use. These remediating factors are many of those very same ones that Americans struggle to healthily maintain so often in today’s times.

3. Addiction/Substance Abuse

Addiction and substance abuse represent some of the most notable public health crises happening right now in the US. The reasons for this current epidemic are many and complex, but the effects of it are crippling to the individual sufferer and entire communities alike. According to the National Institute on Drug Abuse, an average of more than 130 people die each day in the US from opioid overdose alone. The economic burden placed on the country as a whole, just from prescription opioid abuse itself, is estimated by officials to be around $78.5 billion each year. With these kinds of figures, it’s easy to begin to see how detrimental this particular crisis has become in recent times.

4. Dementia

Dementia, the detrimental mental degradation associated with many cognitive diseases, is yet another looming and major public health crisis faced by the US right now. According to a group of top U.S. Surgeons General in a pivotal op-ed featured in the Orlando Sentinel recently, the public was made aware of the impending weight of the crisis at hand. It was therein estimated by experts that dementia numbers in the public double every five years and the numbers of those affected are unequivocally unprecedented and a potentially system-overwhelming problem.

5. Food Safety

Food safety is rated by a number of government and research organizations as another, top crisis concern for the US right now. This is because of the mass number of food producers, production associations, and even weak points in the continuum of the food markets. Food-born illness spread en-mass can quickly affect thousands of people, while cases of intentional endangerment to the food supply, such as through tampering or deceitful production practices, also can have major implications. For these many, compounding reasons, food safety in the US is a major concern today.

Public health crises can certainly be a great cause for concern. However, with the application of science and subsequent public awareness, many “worst-case scenarios” can be avoided altogether. As of now, the five above-mentioned public health crises are widely regarded as being among the most important and foreshadowing to address.

Substance abuse, homelessness and access to health services are among the issues that city officials say demand more resources in a new US Conference of Mayors survey.

An “unprecedented” mental health crisis is overwhelming US cities, which lack adequate resources to address growing challenges, according to a new report released today by the US Conference of Mayors. In recent years, the Covid-19 pandemic exacerbated mental health issues, particularly involving substance abuse, said a survey of mayors of 117 cities in 39 states.

“Addressing this surging mental health crisis is one of the most pressing issues facing America’s cities,” said Tom Cochran, executive director of the US Conference of Mayors, a nonpartisan organization of cities with populations of 30,000 or more. The report also cited “staggering increases in stress, depression, isolation, loneliness, and accompanying mental health hurdles faced by Americans of all ages.”

In a survey conducted this spring, 97% of mayors said requests for mental health services increased in their city in the past two years, but 88% lack resources to address the crisis. Participating cities spanned the US, and included Chicago; Seattle; Montgomery, Alabama; and Atlanta.

Substance abuse was the main cause for increasing mental health problems, 85% of cities reported. That was followed by Covid-19, homelessness and economic concerns.

Substance use disorders topped the list of mental and behavioral health problems in 65% of cities, followed by homelessness stemming from mental illness in 56%. Other challenges included shortages of mental and behavioral health workers, including school counselors, as well as a lack of access to behavioral health services.

Among youth, depression is the leading primary mental health problem, according to 89% of cities. More than 43% said teen suicide is a significant problem. 

Nineteen cities called for more funding for services, but several noted that most funding goes to county — not city — governments. 

Although the vast majority of cities reported inadequate mental health resources, 82% have developed new initiatives and/or increased funding to mental health programs. Ninety-three percent reported they have improved their emergency response to behavioral health crises. Meanwhile, 94% of cities said their police department provides mental health programs to officers. 

Examples of initiatives cited in the surveyinclude Mesa, Arizona, where its police department is coordinating with a nonprofit crisis line and system. Since 2018, the cityhas increased the types of emergency calls transferred, including children with behavioral issues, second-hand suicide reports, as well as dementia, psychosis, anxiety, PTSD, and basic problem-solving help. In 2022 alone, more than 3,500 911 calls were sent directly to its crisis hotline, away from Mesa’s police and fire departments, according to the city’s survey response. 

In Las Vegas, an outreach team provides services to unhoused people to divert them from emergency rooms and into appropriate treatment. A crisis response team also works with the fire department to deescalate non-emergency mental health issues.

Long Beach, California, has established mobile homeless and behavioral health services, and teams of mental health clinicians to do homeless outreach. In 2022, Hartford, Connecticut, launched a non-law enforcement crisis intervention program in response to emergency 911 calls for people in mental health crises.

City leaders from Orlando, Florida, expressed their support for the “Housing First” model as a means of addressing homelessness, and said mental health challenges are easier to address when people are housed. But respondents from the city of Fontana, California commented, “Hiding someone away in an apartment or hotel room does not cure them from mental illness. Housing first without mental health support DOES NOT WORK.” [SIC]

Officials from Issaquah, Washington, observed: “Stable housing must be coupled with other intensive support services. Housing alone does not improve mental health outcomes.” Theyadded that for chronically unhoused people, “adjusting to living indoors is often underestimated and if housing is not accompanied by extra supports to help with the transition, people are more likely to fall back into homelessness.”

Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps blood. High blood pressure, or hypertension, is when this force against your artery walls is too high. There are different types of high blood pressure in pregnancy:

• Gestational hypertension is high blood pressure that you develop while you are pregnant. It starts after you are 20 weeks pregnant. You usually don’t have any other symptoms. In many cases, it does not harm you or your baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood pressure in the future. It sometimes can be severe, which may lead to low birth weight or preterm birth. Some women with gestational hypertension do go on to develop preeclampsia.
• Chronic hypertension is high blood pressure that started before the 20th week of pregnancy or before you became pregnant. Some women may have had it long before becoming pregnant but didn’t know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic hypertension can also lead to preeclampsia.
• Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually happens in the last trimester. In rare cases, symptoms may not start until after delivery. This is called postpartum preeclampsia. Preeclampsia also includes signs of damage to some of your organs, such as your liver or kidney. The signs may include protein in the urine and very high blood pressure. Preeclampsia can be serious or even life-threatening for both you and your baby.

What causes preeclampsia?

The cause of preeclampsia is unknown.

Who is at risk for preeclampsia?

You are at higher risk of preeclampsia if you:

• Had chronic high blood pressure or chronic kidney disease before pregnancy
• Had high blood pressure or preeclampsia in a previous pregnancy
• Have obesity
• Are over age 40
• Are pregnant with more than one baby
• Are African American
• Have a family history of preeclampsia
• Have certain health conditions, such as diabetes, lupus, or thrombophilia (a disorder which raises your risk of blood clots)
• Used in vitro fertilization, egg donation, or donor insemination

What problems can preeclampsia cause?

Preeclampsia can cause:

• Placental abruption, where the placenta separates from the uterus
• Poor fetal growth, caused by a lack of nutrients and oxygen
• Preterm birth
• A low birth weight baby
• Stillbirth
• Damage to your kidneys, liver, brain, and other organ and blood systems
• A higher risk of heart disease for you
• Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing seizures or coma
• HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to the liver and blood cells. It is rare, but very serious.

What are the symptoms of preeclampsia?

Possible symptoms of preeclampsia include:

• High blood pressure
• Too much protein in your urine (called proteinuria)
• Swelling in your face and hands. Your feet may also swell, but many women have swollen feet during pregnancy. So swollen feet by themselves may not be a sign of a problem.
• Headache that does not go away
• Vision problems, including blurred vision or seeing spots
• Pain in your upper right abdomen
• Trouble breathing

Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.

How is preeclampsia diagnosed?

Your health care provider will check your blood pressure and urine at each prenatal visit. If your blood pressure reading is high (140/90 or higher), especially after the 20th week of pregnancy, your provider will likely want to run some tests. They may include blood tests other lab tests to look for extra protein in the urine as well as other symptoms.

What are the treatments for preeclampsia?

Delivering the baby can often cure preeclampsia. When making a decision about treatment, your provider take into account several factors. They include how severe it is, how many weeks pregnant you are, and what the potential risks to you and your baby are:

• If you are more than 37 weeks pregnant, your provider will likely want to deliver the baby.
• If you are less than 37 weeks pregnant, your health care provider will closely monitor you and your baby. This includes blood and urine tests for you. Monitoring for the baby often involves ultrasound, heart rate monitoring, and checking on the baby’s growth. You may need to take medicines, to control your blood pressure and to prevent seizures. Some women also get steroid injections, to help the baby’s lungs mature faster. If the preeclampsia is severe, you provider may want you to deliver the baby early.

The symptoms usually go away within 6 weeks of delivery. In rare cases, symptoms may not go away, or they may not start until after delivery (postpartum preeclampsia). This can be very serious, and it needs to be treated right away.

1. Physical Activity and Nutrition
2. Overweight and Obesity
3. Tobacco
4. Substance Abuse
5. HIV/AIDS
6. Mental Health
7. Injury and Violence
8. Environmental Quality
9. Immunization
10. Access to Health Care

Physical Activity and Nutrition

Research indicates that staying physically active can help prevent or delay certain diseases, including some cancers, heart disease and diabetes, and also relieve depression and improve mood. Inactivity often accompanies advancing age, but it doesn’t have to. Check with your local churches or synagogues, senior centers, and shopping malls for exercise and walking programs. Like exercise, your eating habits are often not good if you live and eat alone. It’s important for successful aging to eat foods rich in nutrients and avoid the empty calories in candy and sweets.

Overweight and Obesity

Being overweight or obese increases your chances of dying from hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, dyslipidemia and endometrial, breast, prostate, and colon cancers. In-depth guides and practical advice about obesity are available from the National Heart Lung and Blood Institute of the National Institutes of Health.

Tobacco

Tobacco is the single greatest preventable cause of illness and premature death in the U.S. Tobacco use is now called “Tobacco dependence disease.” The Centers for Disease Control and Prevention (CDC) says that smokers who try to quit are more successful when they have the support of their physician.

Substance Abuse

Substance abuse usually means drugs and alcohol. These are two areas we don’t often associate with seniors, but seniors, like young people, may self-medicate using legal and illegal drugs and alcohol, which can lead to serious health consequences. In addition, seniors may deliberately or unknowingly mix medications and use alcohol. Because of our stereotypes about senior citizens, many medical people fail to ask seniors about possible substance abuse.

HIV/AIDS

Between 11 and 15% of U.S. AIDS cases occur in seniors over age 50. Between 1991 and 1996, AIDS in adults over 50 rose more than twice as fast as in younger adults. Seniors are unlikely to use condoms, have immune systems that naturally weaken with age, and HIV symptoms (fatigue, weight loss, dementia, skin rashes, swollen lymph nodes) are similar to symptoms that can accompany old age. Again, stereotypes about aging in terms of sexual activity and drug use keep this problem largely unrecognized. That’s why seniors are not well represented in research, clinical drug trials, prevention programs and efforts at intervention.

Mental Health

Dementia is not part of aging. Dementia can be caused by disease, reactions to medications, vision and hearing problems, infections, nutritional imbalances, diabetes, and renal failure. There are many forms of dementia (including Alzheimer’s Disease) and some can be temporary. With accurate diagnosis comes management and help. The most common late-in-life mental health condition is depression. If left untreated, depression in the elderly can lead to suicide. Here’s a surprising fact: The rate of suicide is higher for elderly white men than for any other age group, including adolescents.

Injury and Violence

Among seniors, falls are the leading cause of injuries, hospital admissions for trauma, and deaths due to injury. One in every three seniors (age 65 and older) will fall each year. Strategies to reduce injury include exercises to improve balance and strength and medication review. Home modifications can help reduce injury. Home security is needed to prevent intrusion. Home-based fire prevention devices should be in place and easy to use. People aged 65 and older are twice as likely to die in a home fire as the general population.

Environmental Quality

Even though pollution affects all of us, government studies have indicated that low-income, racial and ethnic minorities are more likely to live in areas where they face environmental risks. Compared to the general population, a higher proportion of elderly are living just over the poverty threshold.

Immunization

Influenza and pneumonia and are among the top 10 causes of death for older adults. Emphasis on Influenza vaccination for seniors has helped. Pneumonia remains one of the most serious infections, especially among women and the very old.

Access to Health Care

Seniors frequently don’t monitor their health as seriously as they should. While a shortage of geriatricians has been noted nationwide, URMC has one of the largest groups of geriatricians and geriatric specialists of any medical community in the country. Your access to health care is as close as URMC, offering a menu of services at several hospital settings, including the VA Hospital in Canandaigua, in senior housing, and in your community.