15

I waked and sat upwhen I felt a confusion and indistinctness in my head which lasted, I suppose about half a minute. Soon after I perceived that I had suffered a paralytick stroke, and that my Speech was taken from me. Samuel Johnson, England, 1783

Global burden of stroke

Healthy years of life lost to stroke

ICELAND
FINLAND SWEDEN NORWAY ESTONIA UNITED KINGDOM DENMARK IRELAND NETH. BELGIUM LUX. FRA NCE GERMANY POLAND CZECH UKRAINE REPUBLIC SLOVAKIA BELARUS LATVIA LITHUANIA RUSSIAN FEDERATION

DALYs lost per 1000 population, age-standardized 2002

Disability-adjusted life years combine years of potential life lost due to premature death with years of productive life lost due to disability

20 and above 1519

REP. MOLDOVA

59 below 5 no data

Stroke is the brain equivalent of a heart attack. Blood must flow to and through the brain for it to function. If its flow is obstructed, by a blood clot moving to the brain, or by narrowing or bursting of blood vessels, the brain loses its energy supply, causing damage to tissues leading to stroke. Annually, 15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on family and community. Stroke is uncommon in people under 40 years; when it does occur, the main cause is high blood pressure. Stroke also occurs in about 8% of children with sickle cell disease. The major risk factors for stroke are similar to those for coronary heart disease, with high blood pressure and tobacco use the most significant modifiable risks. Atrial fibrillation, heart failure and heart attack are other important risk factors. The incidence of stroke is declining in many developed countries, largely as a result of better control of high blood pressure, and reduced levels of smoking. However, the absolute number of strokes continues to increase because of the ageing population.

ANDORRA PORTUGAL SPAIN

AUSTRIA HUNGARY ROMANIA BOSNIA & SLOVENIA HERZEGOVINA S. MARINO SERBIA & CROATIA MONTENEGRO BULGARIA MONACO ITALY ALBANIA FYR MACEDONIA SWITZ. GREECE

1014

RUSSIAN FEDERATION

C A N A D A

KAZAKHSTAN MO NG O LIA
DPR KOREA KYRGYZSTAN TAJIKISTAN REP. KOREA

The increased risk of stroke from taking oral contraceptive pills is substantially reduced by using the modern, low-dose pill.
U S A

MALTA

MEXICO

CUBA

BAHAMAS

the ke is gle o r t S in est s r bigg of majo e e h caus lity in t . i m b disa Kingdo d e Unit
MAURITANIA CAPE VERDE SENEGAL GAMBIA

GEORGIA ARMENIA TURKEY CYPRUS LEBANON ISRAEL SYRIAN ARAB REPUBLIC

UZBEKISTAN AZERBAIJAN TURKMENISTAN

JAPAN

MOROCCO

TUNISIA

IRAQ
JORDAN BAHRAIN

ISL . RE P. IRA N
KUWAIT QATAR UAE

AFGHANISTAN

C H I N A
MARSHALL ISLANDS

ALGERIA

LIBYAN ARAB JAMAHIRIYA

PAKISTAN

NEPAL

BHUTAN
KIRIBATI NAURU

EGYPT

GUATEMALA

JAMAICA BELIZE HONDURAS

EL SALVADOR NICARAGUA COSTA RICA

GHANA TOGO BENIN

DOMINICAN REP. ANTIGUA & HAITI BARBUDA ST KITTS & NEVIS DOMINICA ST LUCIA ST VINCENT & GRENADINES BARBADOS GRENADA TRINIDAD & TOBAGO

SAUDI ARABIA MALI NIGER

BURKINA FASO CTE DIVOIRE

INDIA
OMAN

BANGLADESH MYANMAR LAO PDR THAILAND PHILIPPINES CAMBODIA SRI LANKA BRUNEI DAR. MALAYSIA SINGAPORE VIET NAM

SAMOA TUVALU FIJI VANUATU COOK ISLANDS NIUE TONGA

CHAD

ERITREA

YEMEN DJIBOUTI

SUDAN

PANAMA

VENEZUELA COLOMBIA

GUINEA-BISSAU GUINEA SIERRA LEONE LIBERIA

NIGERIA ETHIOPIA
SOMALIA MALDIVES
PALAU

GUYANA SURINAME

CENTRAL AFRICAN REPUBLIC EQUATORIAL CAMEROON GUINEA GABON CONGO

UGANDA KENYA

ECUADOR

SAO TOME & PRINCIPE

DEM. REP. CONGO

RWANDA BURUNDI UNITED REP. TANZANIA COMOROS

SEYCHELLES

47

47
I N D O N E S I A
TIMOR-LESTE PAPUA NEW GUINEA SOLOMON ISLANDS

PERU

BRAZIL

Treati ng hypert can reension duce the ri of a s sk t by up roke to 40%.

ANGOLA
ZAMBIA MALAWI

BOLIVIA
NAMIBIA

MADAGASCAR
ZIMBABWE BOTSWANA MAURITIUS

CHILE

PARAGUAY

MOZAMBIQUE

33
AUSTRALIA

SWAZILAND

SOUTH AFRICA
URUGUAY

LESOTHO

ARGENTINA

Stroke in young people

Number of new cases of stroke per 100 000 people per year selected populations 19861997

25

26

NEW ZEALAND

en burd rise e k Stro cted to d oje is pr m aroun LYs o fr DA illion 0 to 38 m y in 199 Ys all AL glob illion D m 20. 61 in 20

14 10 9

14 10

age 1749 years 1544 Israel Italy

Florence

1544 Italy
North

039 Kuwait

4049 Kuwait

50

1540 2054 Libyan South Africa Arab Blacks Jamahiriya

Benghazi

1150 Spain
Cantabria

2044 USA
Northern Manhattan

2044 USA
Northern Manhattan

2044 USA
Northern Manhattan

Blacks

Hispanics Whites

51