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EXCITE Program Monthly Newsletter

Welcome to the first issue of the Stroke Savvy newsletter for participants in the EXCITE research study. We hope that you enjoy these newsletters and find the information useful. Please feel free to send comments or suggestions for the newsletter to Carol Giuliani at carol_giuliani@med.unc.edu or (919) 966-9797. In this issue we would like to acquaint you with some facts and figures about effects of stroke. Hopefully you will find the statistics and other information interesting. Enjoy!! Types of Stroke...1 The Stroke Belt and Other Interests3 Left vs. Right-Sided Stroke.2 Getting the Facts Straight4

Types of Stroke
In everyday life, blood clotting is beneficial. When you are bleeding from a wound, blood clots work to slow and eventually stop the bleeding. In the case of stroke, however, blood clots are dangerous because they can block arteries and cut off blood flow, a process called ischemia. An ischemic stroke can occur in two ways: embolic and thrombotic strokes. Embolic Stroke: In an embolic stroke, a blood clot forms somewhere in the body (usually the heart) and travels through the bloodstream to your brain. Once in your brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke. The medical word for this type of blood clot is embolus. Thrombotic Stroke: In the second type of blood-clot stroke, blood flow is impaired because of a blockage to one or more of the arteries supplying blood to the brain. The process leading to this blockage is known as thrombosis. Strokes caused in this way are called thrombotic strokes. That's because the medical word for a clot that forms on a blood-vessel deposit is thrombus. Blood-clot strokes can also happen as the result of unhealthy blood vessels clogged with a buildup of fatty deposits and cholesterol. Your body regards these buildups as multiple, tiny and repeated injuries to the blood vessel wall. So your body reacts to these injuries just as it would if you were bleeding from a wound, it responds by forming clots.

Strokes caused by the breakage or "blowout" of a blood vessel in the brain are called hemorrhagic strokes. The medical word for this type of breakage is hemorrhage. Hemorrhages can be caused by a number of disorders which affect the blood vessels, including long-standing high blood pressure and cerebral aneurysms. An aneurysm is a weak or thin spot on a blood vessel wall. These weak spots are usually present at birth. Aneurysms develop over a number of years and usually don't cause detectable problems until they break. There are two types of hemorrhagic stroke: subarachnoid and intracerebral.
Editors: Shelley Piner & Carolyn Martonffy, UNC-Chapel Hill, Division of Physical Therapy Editors Note: Please dont forget to send in the quiz after youve completed the newsletter!! Copyright 2000-2001

Stroke Savvy

Vol. 1 pg. 2 Left vs. Right

The specific abilities that will be lost or affected by stroke depend on the extent of the brain damage and most importantly where in the brain the stroke occurred. The brain is an incredibly complex organ, and each area within the brain has responsibility for a particular function or ability. The brain is divided into four primary parts: the right hemisphere (or half), the left hemisphere, the cerebellum and the brain stem. Right-Hemisphere Stroke The right hemisphere of the brain controls the movement of the left side of the body. It also controls analytical and perceptual tasks, such as judging distance, size, speed, or position and seeing how parts are connected to wholes. A stroke in the right hemisphere often causes paralysis in the left side of the body. This is known as left hemiplegia. Survivors of right-hemisphere strokes may also have problems with their spatial and perceptual abilities. This may cause them to misjudge distances (leading to a fall) or be unable to guide their hands to pick up an object, button a shirt or tie their shoes. Along with their impaired ability to judge spatial relationships, survivors of righthemisphere strokes often have judgment difficulties that show up in their behavioral styles. These patients often develop an impulsive style unaware of their impairments and certain of their ability to perform the same tasks as before the stroke. This behavioral style can be extremely dangerous. It may lead the left hemiplegic stroke survivor to try to walk without aid. Or it may lead the survivor with spatial and perceptual impairments to try to drive a car. Survivors of right-hemisphere strokes may also experience left-sided neglect. Left-sided neglect causes the survivor of a right-hemisphere stroke to "forget" or "ignore" objects or people on their left side. Finally, some survivors of right-hemisphere strokes will experience problems with short-term memory. Although they may be able to recount a visit to the seashore that took place 30 years ago, they may be unable to remember what they ate for breakfast that morning. Left-Hemisphere Stroke The left hemisphere of the brain controls the movement of the right side of the body. It also controls speech and language abilities for most people. A lefthemisphere stroke often causes paralysis of the right side of the body. This is known as right hemiplegia. Someone who has had a left-hemisphere stroke may also develop aphasia. Aphasia is a catch-all term used to describe a wide range of speech and language problems. These problems can be highly specific, affecting only one component of the patient's ability to communicate, such as the ability to formulate words properly. The same patient may be completely unimpaired when it comes to writing, reading or understanding speech. In contrast to survivors of right-hemisphere stroke, patients who have had a left-hemisphere stroke often develop a slow and cautious behavioral style. They may need frequent instruction and feedback to complete tasks. Finally, patients with left-hemisphere stroke may develop memory problems similar to those of right-hemisphere stroke survivors. These problems can include shortened memory spans, difficulty in learning new information and problems in conceptualizing and generalizing.

Stroke Savvy

Vol. 1 pg. 3 The "Stroke Belt"

Twelve contiguous states and the District of Columbia have stroke death rates that are consistently more than 10 percent higher than the rest of the country. These states (Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Arkansas, Tennessee, Kentucky and Indiana), along with Washington, D.C., are often referred to as the "stroke belt." Their higher incidence and mortality may be linked to a number of factors, including: A higher than average population of African-Americans A higher than average population of older adults Dietary factors

United States presidents who have experienced strokes:

Famous Leaders and Celebrities whove experienced Stroke:

Mary Kay Ash - Cosmetics entrepreneur Ann Baxter - Actress Barbara Bel Geddes - Actress Les Aspin - Fr U.S. Defense Sec. Joseph Biden - U.S. Senator Justice Brennan - Supreme Court Justice Harry Caray - Sports commentator Margaret Chase Smith - Politician Winston Churchill - Former Prime Minister of England Claudette Colbert - Actress Joseph Cotten - Actor Bette Davis - Actress Agnes de Mille - Broadway actress Charles Dickens - Novelist Kirk Douglas - Actor Dale Evans - Cowgirl performer Federico Fellini - Italian film director William Fulbright - Former Senator Lady Bird Johnson - Fr First Lady Marv Johnson - Motown singer Grandpa Jones - Actor Quincy Jones - Record producer Raul Julia - Actor Ken Keasey - Author Ruby Keeler - Actress Gene Kelly - Actor/dancer Rose Kennedy - Kennedy family matriarch Ed Koch - Former Mayor of NYC Burt Lancaster - Actor Burton Lane - Composer Johnathan Larson - Pulitzer Prizewinning playwright William Leonard - Fr CBS News Pres. Princess Margaret - Sister of Queen Elizabeth David Merrick - Broadway producer Thelonius Monk - Jazz musician Bill Monroe - Father of bluegrass music Patricia Neal - Actress Pat Nixon - Former First Lady Minnie Pearl - Country music performer Oscar Peterson -Jazz pianist Martha Rae - Actress/singer Della Reese - Actress/singer J.R. Richard - Baseball player Jerome Robbins - Choreographer and Director Hugh Rodham - Father of First Lady Hillary Rodham Clinton Ginger Rogers - Dancer/actress Josef Stalin - Russian leader Cobert Lewis Stevenson - Author Potter Stewart - Former Supreme Court Justice Bill Tavoulareas - Former Mobil Oil President Mel Torme - Singer Jackie Mayer Townsend -Miss America 1963 Fred Waring - Pennsylvanians' conductor Ted Williams - Major league baseball player Deng Xiao Ping - Chinese political leader

Stroke Savvy

Vol. 1 pg. 4

Changing the Perception of Stroke Myth Reality * Stroke is unpreventable * Stroke is largely preventable * Stroke requires emergency * Stroke cannot be treated treatment * Stroke only strikes the elderly * Stroke can happen to anyone * Stroke happens to the heart * Stroke is a "Brain Attack" * Stroke recovery only happens for a few * Stroke recovery continues months following a stroke throughout life

Strokes and heart attacks are not the same thing. A stroke is an attack of the brain, not the heart.

Strokes usually hit with some warning. Strokes are preceded by episodes of symptoms known as transient ischemic attacks or TIAs. These are temporary interruption of the blood supply to an area of the brain. TIAs can appear hours, months, days, weeks or months before a full stroke. There is recovery after stroke. Life does go on and can for a long time!!

Complete your Newsletter Quiz and mail it back to your site to receive credit for the month.
The medical information and figures presented in this newsletter were obtained with the permission of the National Stroke Association for reproduction in this newsletter. All content contained in this newsletter is copyright protected by the National Stroke Association and may not be reproduced, sold, broadcast or disseminated in any form without permission from the National Stroke Association. Additional material was provided by the University of North Carolina at Chapel Hill, Division of Physical Therapy and is copyright protected and may not be reproduced, sold, broadcast or disseminated in any form without permission from the UNC-CH Division of Physical Therapy.

Vol. 1 EXCITE Program Quiz Please answer the following questions using the information provided and return this portion of the document. Good Luck! Complete and return to:____________________________________________________ 1. Name 3 states within the Stroke Belt. _____________________ ______________________ ____________________ 2. What are common factors of the 12 states within the Stroke Belt? a. dietary factors b. decreased elderly population c. increased African American population d. a & c Matching: 3. ___ Embolic Stroke a. a blood vessel wall ruptures in the brain 4. ___ Thrombotic Stroke 5. ___ Hemorrhagic Stroke b. a type of ischemic stroke where a blood clot forms somewhere in the body and lodges in the brain c. blockage at an artery due to buildup of fatty deposits and cholesterol

6. Name 3 presidents who had a stroke. _____________________ _________________________ ______________________

7. A right-sided brain injury often results in: a. quick, impulsive behavior b. speech-language deficits c. memory deficits d. a & b e. a & c 8. Left-sided weakness usually is a result of a left-sided brain injury. T___ F___ 9. Stroke hits without warning. Stroke cannot be treated. Stroke happens to the heart. Stroke only strikes the elderly. 10. What is another name for stroke? a. Heart Attack b. Brain Attack c. a & b T___ T___ T___ T___ F___ F___ F___ F___

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