Read the text and answer the question: Who suffers more from strokes?

What is it? A stroke, or brain attack, is caused by the sudden loss of blood flow to the brain or bleeding inside the head. Each can cause brain cells to stop functioning or die. When nerve cells in the brain die, the function of body parts they control is harmed or lost. Depending on the part of the brain affected, people can lose speech, feeling, muscle strength, vision, or memory. Some people recover completely; others are seriously disabled or die.

You can reduce your chances of death or disability if you recognize the signs of stroke and get immediate medical help. Quick medical attention and treatment can save lives. It can also prevent more serious, long-lasting problems. People who are suffering a stroke must get immediate medical care. It is very important they get to a hospital within 60 minutes of the onset of a stroke. Time is of the essence.

Every year, about 700, 000 people in the United States suffer a stroke. That’s about one person every 45 seconds. And one person dies from stroke every 3 minutes, or nearly 170, 000 a year. This means stroke is the nation’s number three killer, after heart disease and cancer. It is the major cause of adult disability. The cost of stroke in the US is between $30 and $40 billion per year.

Stroke risk increases sharply with age, doubling every decade after the age of 55. However, stroke can occur at any age. About 28 percent of those who have a stroke are under 65 years old. Men have slightly more strokes than women. Strokes claim the lives of more women than breast cancer. African-Americans have twice the risk of strokes than Caucasians. And people with a family history of stroke and heart disease have an increased stroke risk.

There are also very important risk factors that often can be controlled:

· Monitoring and reducing high blood pressure

· Limiting tobacco use

· Managing cholesterol levels

· Maintaining a healthy weight

· Controlling diabetes

· See your doctor for help in addressing these risk factors.

What is the cause? The brain is affected by two types of stroke, " ischemic" and " hemorrhagic."

Eighty percent of all strokes are ischemic. Ischemic strokes can be caused by narrowing of the large arteries to the brain. This is also called " atherosclerosis." Ischemic strokes include:

· Embolic: clots travel from the heart or neck blood vessels and lodge in the brain, sometimes due to an irregular heartbeat, called " atrial fibrillation"

· Lacunar: small vessels in the brain are blocked, often due to high blood pressure or diabetes damage

· Thrombotic: clots form in the brain blood vessels, often due to " arteriosclerosis, " or hardening of the arteries

When blood cannot get to the brain cells, they die within minutes to a few hours. Doctors call this area of dead cells an " infarct."

The lack of normal blood flow to brain cells sets off a chain reaction called the " ischemic cascade." Over hours, this endangers brain cells in an increasingly larger area of brain where blood supply is reduced but not completely cut off. Quick medical treatment offers the best chance of rescuing this area of brain cells, called the " penumbra."

Hemorrhagic strokes involve bleeding into or around the brain, including:

· Subarachnoid: weak spots on brain arteries, called " aneurysms, " burst and blood covers the brain

· Bleeding into the brain: blood vessels in the brain break because they have been weakened by damage due to high blood pressure, diabetes, and aging

What are the symptoms? Stroke symptoms may not be as dramatic or painful as a heart attack. But the results can be just as life-threatening. Stroke is an emergency. Get medical help immediately and know when the symptoms started. Common symptoms include:

· Sudden numbness or weakness of face, arm, or leg, especially on one side of the body

· Sudden confusion, trouble speaking or understanding speech

· Sudden difficulty seeing in one or both eyes

· Sudden trouble walking, dizziness, loss of balance or coordination

· Sudden severe headache with no known cause

Call 911 immediately if you or someone you know experiences any of the above warning signs. Write down the time the symptoms started. Sometimes these warning signs last for only a few minutes and then go away. Even if this happens, or if you think you are getting better, call for help.

How is it diagnosed? The neurologist or emergency doctor must examine you to understand your condition and find out what caused the stroke. Diagnostic tests to determine treatment could include:

· Neurologic exam

· Brain imaging tests (CT, or computerized tomography scan; MRI, or magnetic resonance imaging) to understand the type, location, and extent of the stroke

· Tests that show blood flow and bleeding sites (carotid and transcranial ultrasound and angiography)

· Blood tests for bleeding or clotting disorders

· EKG (electrocardiogram) or an ultrasound examination (echocardiogram) of the heart to identify cardiac sources of blood clots that could travel to the brain

· Tests that measure mental function

What are the treatments? Immediate medical care is important. New treatments work only if given within a few hours after a stroke begins. For example, a clot-busting drug must be given within three hours.

Once the doctor completes the diagnostic tests, the treatment is chosen. For all stroke patients, the aim is to prevent further brain damage. If the stroke is caused by blocked blood flow to the brain, treatment could include:

· t-PA (tissue plasminogen activator), a clot-busting drug that is injected within three hours of the start of a non-bleeding stroke

· Drugs that thin the blood, including anticoagulants (warfarin) and antiplatelet medications (aspirin or ticlopidine); a combination of aspirin and sustained release dipyridamole

· Surgery that opens the insides of narrowed neck blood vessels (carotid endarterectomy)

If bleeding causes the stroke, treatment could include:

· Drugs that maintain normal blood clotting

· Surgery to remove blood in the brain or decrease pressure on the brain

· Surgery to fix the broken blood vessels

· Blocking off bleeding vessels by inserting a coil

· Drugs that prevent or reverse brain swelling

· Inserting a tube into a hollow part of the brain to lower pressure

After a stroke, a person may have some disability. The disability depends on the size and location of the stroke. The right side of the brain controls the left side of the body; in right-handed individuals it is important for attention and visual-spatial skills. The left side of the brain controls the right side of the body; in right-handed individuals (and 50 percent of left-handed people) it controls language – speaking and understanding. Language disorders are also called " aphasias."

Rehabilitation helps regain functions lost from damage due to stroke. During rehabilitation, most people will get better. However, many do not recover completely. Unlike skin cells, nerve cells that die do not recover and are not replaced by new cells. However, the human brain is adaptable. People can learn new ways of functioning, using undamaged brain cells.

This rehabilitation period is often a challenge. The patient and family work with a team of physical, occupational, and speech therapists, along with nurses and doctors. Most of the improvement will take place in the first three to six months of the process. But some people can make excellent progress over longer periods.

Progress through research. Throughout the world, thousands of scientists are studying all aspects of stroke: genetic factors; new diagnostic tools to detect early stroke; and drugs and techniques to prevent or reduce stroke and open blocked blood vessels. Researchers are working on drugs to improve stroke recovery and new methods for prevention and rehabilitation.

To date, the most important progress has been increased understanding and prevention of the causes of stroke and improved emergency care of stroke patients. Much of this progress and all new treatments have come from studies using animal models of stroke.

Participation in clinical research trials can be rewarding for stroke sufferers and their families. These trials offer frequent contacts with healthcare providers. They help increase knowledge of the disorder and the rehabilitation process.

Prevention. Some risk factors, such as age, sex, race, and a history of stroke in the family, cannot be changed. However, many others can be controlled. Most controllable factors relate to the health of the heart and blood vessels. Doing these things can help you prevent a stroke:

· Have regular medical check-ups

· Control high blood pressure

· Do not smoke – and stop if you do

· Treat heart disease, especially an irregular heart beat called " atrial fibrillation"

· Improve your diet: Avoid excess fat, salt, and alcohol

· Exercise

· Manage diabetes

· Seek immediate medical attention for warning signs of stroke

Some people are at risk for stroke because of known health factors, such as high blood pressure, diabetes, and heart disease. Also, having had a stroke puts you at greater risk of another attack. Fortunately for people in these situations, there are medical treatments that can help prevent stroke:

Antiplatelets and anticoagulants. Doctors can prescribe antiplatelet medications (such as aspirin) and anticoagulants (such as warfarin) to reduce the blood’s ability to form clots.

Angioplasty and stents. To remove blockages, doctors may thread a balloon angioplasty through a major vessel in the leg or arm to reach the affected vessel. A steel screen called a " stent" is sometimes inserted in a vessel to expand its diameter and improve blood flow.

Carotid endarterectomy. A blockage is removed from the carotid artery in the neck in this surgical procedure.

Living with. According to the American Stroke Association, there are about 4.7 million stroke survivors alive today in the US. Many people recover without complications. But more than a million adults have limitations that affect their daily lives. These limitations can include:

· Problems controlling movement

· Communication problems, such as difficulty expressing yourself or understanding others (e.g. aphasia)

· Loss of vision, often on one side

· Loss of sensation on one side of the body

· Loss of balance

· Problems with thinking and memory

· Emotional problems, such as depression

Treatments and help are available for many of these problems. For others, the goal may be to minimize the impact they have on your life.

Many people find that support groups are a source of help, comfort, and information. You can ask questions, share stories, and make friends with people who understand. Information about devices and techniques designed for stroke survivors is also available.

Preventing a second stroke. People who have had a stroke are at a much greater risk of having another stroke than those who have never had a stroke. Talk to your neurologist about ways to prevent a second stroke. These may include medications and changes to your lifestyle. Lifestyle changes may include: