May is National Stroke Awareness month. A stroke, also known as a brain attack, occurs when blood flow to the brain is blocked or a blood vessel inside or on the surface of the brain bursts. There are two major kinds of stroke. About 80% of all strokes are ischemic strokes, which are caused by a blood clot that blocks a blood vessel (an artery) in the brain. About 20% are hemorrhagic strokes, which are caused by a blood vessel in the brain that breaks and bleeds into the brain. A stroke is a serious medical emergency and requires immediate medical attention, just like a heart attack. Stroke is the fifth leading cause of death in the United States, the second leading cause of death world-wide, and a leading cause of disability. Stroke is highly preventable, primarily by treating high blood pressure. Unfortunately, after decades of decreasing stroke rates the most recent data indicates that stroke prevalence has increased in the last decade. NINDS is strongly committed to understanding the biological mechanisms underlying stroke, as well as advancing stroke prevention, treatment, and recovery.
This month, I want to highlight recent stroke research and some of the many ways we have been working to promote stroke awareness. To learn more, visit the new stroke resource hub on the NINDS website. This site brings all of our public education resources and information about stroke to one place, and includes toolkits, brochures, videos, and other newly designed materials, as well an overview of NINDS stroke research.
NINDS research has enabled important advances in stroke treatment, including approaches to restore blood flow to the brain after acute ischemic stroke. When performed quickly after stroke onset, these therapies can help to limit lasting disability due to stroke. However, restoring blood flow does not address all of the factors that put brain tissue affected by stroke at risk, and researchers have long sought to also develop neuroprotective therapies that can further improve outcomes. One key NINDS stroke research initiative is the Stroke Preclinical Assessment Network (SPAN), a coordinated effort among six academic laboratories to conduct late-stage preclinical research on interventions to treat acute stroke. To identify the most promising candidates to advance to clinical testing, this program tests multiple interventions in parallel and uses rigorous research methods typically followed in human clinical studies, such as blinding investigators to the outcomes and randomizing rodents to the treatment arms. Recently, SPAN researchers identified uric acid as a potential therapy to protect the brain during an acute ischemic stroke and promote recovery. In this study, published in Science Translational Medicine, researchers tested the effectiveness of six candidate therapies in reducing ischemic brain injury in rodents. The results suggest that uric acid warrants further investigation in human clinical trials. Uric acid has previously been tested in stroke patients, but not in combination with the clot removal procedure used in this study, suggesting that the drug could help protect the brain in that setting. We are encouraged by these initial results and look forward to seeing more highly promising treatment candidates emerge from the SPAN initiative. The next research phase for SPAN will expand to include more testing sites and five new interventions.
While initiatives like SPAN identify novel stroke therapies to bring to the clinic, the NIH StrokeNet conducts clinical trials and research studies to advance acute stroke treatment, prevention, and recovery and rehabilitation following a stroke. Since its inception in 2013, StrokeNet has completed nine stroke studies and is currently conducting 17 more. The StrokeNet Thrombectomy Endovascular Platform (STEP) is a new platform trial that seeks to determine the optimal treatment strategies for patients with acute ischemic stroke due to large or medium vessel occlusions (i.e., blockages of blood vessels that prevent blood from passing through). Using a master protocol, this platform will allow for multiple trials to be conducted simultaneously using separate arms with shared controlled groups and will leverage existing robust, high-quality national clinical registries to minimize data collection and streamline the conduct of the trials. The STEP platform is integrated within the NIH StrokeNet clinical trials network and includes over 40 of the best comprehensive StrokeNet centers across the United States optimized to perform endovascular thrombectomy-related trials under the master protocol.
Recognizing the signs of a stroke and acting fast to seek treatment can reduce disability. One critical tool in the stroke resource hub is the NIH Stroke Scale, which was originally developed over 30 years ago by NINDS-funded researchers. This scale was initially created for research purposes, but now it is used routinely to evaluate stroke patients in clinical settings. This resource can help healthcare providers assess the severity of a stroke by asking the person to answer questions and perform several physical and mental tests. Recent updates to the NIH Stroke Scale include more relatable, modern-day pictures and is available for download(pdf, 4218 KB). The updated NIH Stroke Scale features a new illustration, the “Precarious Painter,” that shows a young person falling from a stepladder while painting a wall. Patients are asked to describe the detailed scene to evaluate their language skills, attention, and level of consciousness following a stroke. The updated pictures include objects that are recognizable and relevant worldwide and have been validated by research that appeared in the journal Stroke.
Stroke can affect people of all ages and backgrounds and can cause lasting brain damage, so it is important to raise broad awareness about the symptoms and risk factors. However, NINDS is also committed to reducing disparities in stroke risks and health outcomes across different populations. For example, stroke is the third leading cause of death in Hispanic women and fourth leading cause of death in Hispanic men. Additionally, the average age for strokes in the Hispanic population is lower compared to non-Hispanic white populations. Our colleagues at the American Stroke Association recently adopted the acronym R.Á.P.I.D.O., a direct counterpart to the English act F.A.S.T. campaign, to help native Spanish speakers recognize stroke signs and ultimately improve stroke outcomes in the Spanish-speaking community.
Hypertension, or high blood pressure, is the most important and controllable risk factor for stroke and heart disease, and it is also a risk factor for dementia. Chronic hypertension can damage blood vessels throughout the body, including those that supply the brain with valuable nutrients and oxygen. Black Americans have a higher prevalence of stroke than any other racial group. According to the Centers for Disease Control and Prevention, over 55% of Black Americans have hypertension, Black Americans are 50% more likely to have a stroke compared to White adults, and Black men are 70% more likely to die from a stroke compared to non-Hispanic White adult men. Through the NINDS Mind Your Risks campaign, we offer a variety of outreach and educational resources to encourage Black men to control their blood pressure to help lower their risk of developing stroke and dementia.
The exciting updates I have shared today are just part of our work at NINDS to promote stroke awareness and support research to improve stroke prevention, treatment, and recovery for all. I hope you will explore the comprehensive information and resources within our stroke resource hub, so that together, we can disrupt stroke.