Stroke

Introduction

Stroke is defined as the unprecedented death of neuronal cells caused by oxygen deprivation. The anatomical etiology behind strokes is often blockage of end arteries supplying the brain or rapture of a vessel in the brain that compromises delivery of oxygen to the brain. Types of strokes can be broadly categorized into three categories including; ischemic stroke which results from occlusion of blood vessels supplying the brain mostly through the coagulation process, transient ischemic attack which is caused by a transient appearance of a clot in a crucial artery supplying the brain that resolve within a duration of 24 hours, and hemorrhagic stroke which as the name suggest, involves the dramatic rapture of a vessel that is weakened by ischemic atrophy of the media. Hemorrhagic strokes are heavily associated with arterio-venous abnormalities and aneurysms. There is a fourth category of strokes referred to as cryptogenic stokes-they are of unknown origin. This type affects 25-35% of Americans with stroke and is thus equally significant. Potential causes of cryptogenic stokes include blood clotting disorders, atherosclerosis in great vessels, a Patent Foramen Ovale and an irregular heartbeat (atrial fibrillation).On the other hand , risk factors for the three main types of strokes include but are not limited to hypertension , abuse of cigarettes, high blood sugar ,hypercholesterolemia and increase in age ( Sacco et al.,2001). Strokes in the population of people under the age of 49 is associated with drug abuse, (cocaine and methamphetamine use), genetic predisposition as in homocystinuria and raptured aneurysms.
A stoke can easily be devoid of any warning signs or predictive syndromes. For example, dangerous levels of high blood pressure may go undetected prior to a cerebrovascular event. Other patients experience transient ischemic attacks (TIA) that are thought to be strokes that disappear without medical intervention. Another warning sign is the transient one unilateral loss of vision, caused by occlusion of vessels supplying that particular eye –this is defined as Amaurosis fugax (Sacco et al., 2001). Symptoms associated with stroke are related to the functions of the specific sections of the brain that are deprived of oxygen rich blood. Patients with stroke present with a host of symptoms-these include diplopia, numbness, and varying levels of consciousness, partial loss of vision, speech problems, and acute paralysis affecting part of the body, ataxia and vertigo ( Sacco et al.,2001). Moreover, patients with stroke experience considerable vomiting and migraine headache. In America, arm weakness, face drooping and speech difficulty are widely appreciated as the three golden danger signs of stroke in response to which American citizens, as recommended by the American Stroke Association, are supposed to dial for emergency help.
Background
For many years, spanning all the way back to the 1950s, cerebrovascular accidents have been rampant in the African American community. Cardiovascular diseases are recognized to be the leading cause of death in the middle aged population in the United States, yet these numbers are full of racial bias. Most of the mortality and morbidity associated with cardiovascular diseases arises in the African American population. Many theories and explanations have been formulated to explain why –despite adoption of almost similar lifestyles in a developed country- African Americans are the choice victims of incidences of stroke and stroke-related events. The African American population has also been a source of interesting scientific mystery in reference to the poor outcome of pharmacological therapy in the ethnic group in the management of cardiovascular conditions such as hypertension and heart failure. This report, therefore, seeks to establish the risk factors for stroke and the types of stroke affecting the American-American population in particular.
Results
At the age of 40-50, African Americans are four times as likely to die from stroke as compared to their Caucasian counterparts. However, while middle-aged African Americans were more likely than Caucasians to die from a stroke, there were no ethnic-based differences in the risk of death among stroke survivors. In 2014 alone, there were a reported 22,000 more stroke events in the African American ethnic group as compared with other ethnic groups. From a review of data dating back to the 1960s on mortality resulting from strokes, deaths among African Americans have always been higher, despite there being a commendable decline in mortality arising from cerebrovascular accidents because of improved health care.
The racial disparity in deaths arising from stroke is most marked in the population aged < 70, in which the race-based African American/ Caucasian mortality ratio stands at 3:7 in men within the age range of 40-55 years. Above 80 years of age, nonetheless, stroke related mortality is lower in African Americans as compared to that in Caucasians. The most widely recognized causes of higher incidence of stroke in African Americans and stroke related mortality in the same group are diabetes mellitus and hypertension (Howard et al, 2007).. African Americans were also found to have lower levels of education and therefore had higher incidences of unmanaged and poorly managed hypertension in addition to embracing health-promoting behavior with less enthusiasm. In addition, ischemic stroke, found to be the most prevalent type of stroke middle aged adults (44-55) , was found to be the thrice as common in African Americans as in Caucasians.
In addition, African Americans are twice as likely to be obese as compared to their Caucasian counterparts. Approximately 48% of African Americans are obese – a statistic that includes 33% of women and 32% of men. An excess of 70% of African Americans are overweight as compared to 66% of Caucasians. These figures include 70% of men and 83% of women in the African American population and 73% of men and 64% of women in the Caucasian population.
Discussion
According to the data provided on stroke in minorities, African Americans are twice as likely to succumb to stroke as compared to their Caucasian counterparts while their incidence of stroke is double that of the Caucasian population. Also, strokes have an earlier onset among the African-American population. The outcome of stroke in this particular group has been shown to be poor as compared with other ethnic groups, including Hispanics Americans, Asian –Americans, American Indians and Native Hawaiians among other recognized ethnicities, is relatively poor. African Americans are more likely to experience disability and hardship in their daily life as compared to their counterparts. Despite limited information on the exact cause of such statistics, research points to several risk factors as to be significant causes behind the racial disparity in stroke incidence and outcome (Howard et al, 2007). Foremost, hypertension, the most essential risk factor for stroke, has the greatest incidence among African Americans. It is suggested that a third of all individuals in this ethnic group suffer from a certain grade of hypertension which they are likely to fail to diagnose and have properly managed as compared to their non-Hispanic Caucasian counterparts. Sickle cell anemia, the most common inherited blood disorder in this a particular ethnic group, can be singled out as another important cause of predisposition to stroke because of the occlusive action of sickle shaped red blood cells that cause symptoms such as painful crisis in affected persons. The sickle shape, a shape adopted by the red cells in the event of lower oxygen levels, compromises the integrity of the cell membranes of the cells in the maze of vessels that guide circulation of blood around the body. These cells, therefore, can block arterial vessels anywhere in the body and if this occurs in the brain, the result is an infarct which causes a stroke. Individuals with diabetes have been documented to have a higher risk of stroke as compared to their non-diabetic counterparts. Also, there is data to suggest that approximately 30% of African American adults use tobacco. There is however, according to the Centers for Disease Control and Prevention, scant research data on the reasons behind higher death rates in African Americans who smoke tobacco despite the fact that they have late onset of smoking and smoke fewer units of cigarettes as compared to their Caucasian counterparts. There is significant correlation between higher poverty rates with obesity, explained by limited access to affordable and healthy food in the African American population. Their resorting to cheaper cholesterol rich food as in fast foods explains the higher rates of stroke in this population because of large-artery atherosclerosis (Virani et al., 2011). The data presented on obesity in the African American population is consistent with popular diets adopted by this particular ethnicity.
The report, nonetheless, suggests the need for proper investment into research on the genetic factors associated with .cardiovascular diseases. Most research data presented no information on blood pressure and cholesterol levels of affected adults in their youth. It is highly likely that the foundation for hypertension, atherosclerosis and obesity was set in African American adults at a younger age- and as a result, stroke in the affected adults could be avoidable if the risk factors are identified at a younger age (Virani et al., 2011). Researchers also ought to give economic factors for stroke more focus by weighing the predilection for stroke in both the wealthy and poor limited to study participants from the African American community.
Conclusion
There needs to be comprehensive efforts by federal and state agencies and the community as a whole to curb alarming figures of stroke in the African American population. Given that studies on the efficacy of common pharmacological products has found to be below par ,and the fact that millions of African Americans are predisposed to this deadly disease, more efforts have to be assigned to reducing cerebrovascular events in this group. The efforts required include, proper health education, widespread screening for hypertension among African Americans and dedicated follow up on hypertensive patients and stroke survivors.

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