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Maya Schenk

Ms. Leila Chawkat

Intern/Mentor Program Period 5

Dr. Michelle Henggeler MD FACEP, Physician, Department of Emergency Medicine

Howard County General Hospital

20 December 2019

Strokes: Prediction and Prevention

Abstract

Strokes have grown to be the leading cause of disability and are a rising cause of death

around the world. Research has dictated that patient monitoring is an effective method of

predicting potential strokes in qualifying patients. Over the years, it has been said that there is no

way to know if someone is eligible to have a stroke, but new findings contradict this statement.

Recently there has been more evidence to prove that a patient with high blood pressure is more at

risk of having a stroke. If the patient is monitored over a period of time, an ambulatory device

can detect the signs of a stroke, and warn the patient. This mechanism alone has detected

multiple strokes before happening, so those patients were able to get the care they needed as fast

as possible, and it decreased the damage to their bodies afterwards. With more education on

strokes in general, the public will be able to seek out the help they may need, preventing more

strokes with severe repercussions.

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Table of Contents

Introduction ………………………………………………………………………………………3  

Literature Review …………………………………………………………………………….......3 

Background ………………………………………………………………………………………3 

Attention to the Body…....…….………………………………………………………………….3 

Understanding the Signs and Risk Factors ..……..……………………………………………....3 

Treatment After Stroke …...……….……………………………………………………………..3 

Data Collection ………………………………………………………………………………….4 

Methods of Data Collection .…………………………………………………………………….4 

Data collection process ….……………………………………………………………………….4 

Results and Analysis ……………………………………………………………………………..4 

Conclusion ………………………………………………………………………………………5 

References ……..………………………………………………………………………………...6 
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I. Introduction 
Often times when people grow older, they begin to worry about more severe health 
problems such as a heart attack, heart failure, or stroke. Many people are highly 
uninformed about the truth behind these health complications, including that they can 
be prevented throughout a lifetime of closely paying attention to their body. As of 
recent, more studies have concluded that strokes can be prediction using a process of 
monitorization over a period of time, and tracking subtle health factors. Since strokes 
have grown to be one of the highest causes of disability and unexpected death in 
patients, it is important for the public to be informed about them because they can 
occur at any time in a person’s life, depending on how they take care of themselves. 
As medicine advances, it is key for the public to understand the urgency of paying 
attention to their health in order to combat and prevent strokes from occurring.  
 
 
II. Literature Review 
A. Background: Strokes can be predicted with a better understanding overall  
B. First Main Point: Attention to the Body   
1. Monitoring the BP in patients with an ambulatory monitor can 
predict a stroke and alert patients (Wang) 
2. Women who are susceptible to atrial fibrillation are at higher risk 
(​"Women more likely to suffer stroke due to atrial fibrillation--but
undertreatment persists: deficiencies in atrial fibrillation care may translate
into poorer stroke outcomes for women.") 
3. Strokes are commonly missed due to an overlook of basic symptoms 
(​Arch) 
 
C. Second Main Point: Understanding of the Signs and Risk Factors  
1. Cases are misdiagnosed in younger age groups because of a lack of 
knowledge (Cejas) 
2. Many are uninformed leading to more time in between the stroke 
and treatment, leading to worse aftermath (​Chhabra) 
3. Promotion of more information will allow for an educated public 
who can get treated more effectively (Hickey)  
4. Older black men are at the highest risk of stroke (Howard) 
 
D. Third Main Point: Treatment After Stroke   
1. Cardio such as brisk walking can decrease the chance of stroke 
recurrence (​"Know the latest in stroke prevention and treatment: new
research highlights the dangers of calcified coronary arteries and the
benefits of brisk walking after a stroke.") 
2. Physical activity decreases stroke risk (​Lee) 
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3. Knowing effective methods of working with patients who have 

suffered stroke is beneficial to their recovery (​"Studies from University of
Pittsburgh Add New Findings in the Area of Stroke (Clinical Predictors of
Engagement in Inpatient Rehabilitation Among Stroke Survivors With
Cognitive Deficits: An Exploratory Study).") 
 
III. Data Collection Methods  
A. I plan on conducting a survey to collect my data this year. My survey will include 
between 15-20 questions that are either multiple choice or entry based. These 
questions will touch on topics such as age, gender, symptoms, information a 
patient had about strokes prior to having one, family history, their own medical 
history, and any out of the ordinary changes in behavior that gave reason to come 
to the hospital.  
B. I plan to make my survey digitally, so that I can carry any given device in order 
to question the patients. After collection I hope that my mentor and I can analyze 
the overlaps to determine the most frequent symptoms or history that correlates 
with a stroke. I want to make it online so it is quick for the patient to complete, 
while still giving me the information needed to fully analyze. After each patient 
submits I will review their responses and group them according to any overlaps 
with other patients.  
C. My mentor, Dr. Henggeler, and I will work together to create a series of questions 
that are easy for the patient to understand and answer. They will only cover the 
most important factors necessary to come to conclusions.  
1. After identifying a patient having suffered a stroke, I will ask the 
patient, if their status allows, if they are comfortable answering a few 
questions about their experiences leading up to the stroke  
2. I will assure the patient that their responses are anonymous, 
ensuring that their patient information is confidential 
3. If willing to do so, the patient will answer the survey I provide them 
4. I will continue to collect data from any other patient who is willing 
to participate  
5. I will later analyze their responses and compare to those of other 
patients  
6. Lastly I will compile a list of trends that we discover as the data is 
being collected.  
 
IV. Results and Analysis  
 
A. I predict that if patients monitor their health more closely and work with their 
doctors, there will be a decrease in stroke activity, and lower rates of mortality 
because they are being caught earlier.  
B. Due to patients being monitored, strokes can be predicted faster, and more 
efficiently, so they can be treated quicker. This will allow for less mortality, and 
hopefully fewer patients left with a disability. Doctors who are aware that their 
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patients have a BP issue can recommend they be monitored so that the data will 
display whether they are at risk.  
C. These results will be useful because monitoring the BP of patients will allow for a 
statistic that doctors can refer to with new patients. This means that for future 
patients doctors can recommend a period of monitoring for those who match the 
history of others. In theory, this will allow for more prevention of future stroke 
patients. They will know they are at risk ahead of time and will take action to 
prevent the chances of a stroke before it occurs.  
 
V. Conclusion 
 

The most important aspect of medicine is knowledge, and application of that knowledge. 

It is important that all medical workers have the knowledge necessary to promote the importance 

of a stroke, and the public having knowledge on them. When a patient has the necessary 

knowledge, they can begin to ask their primary physician questions, in order to decide on an 

action plan that can be set to prevent future strokes. While there are methods of treatment 

post-stroke, no method will be as effective as those which will prevent it from ever occurring. 

This is why it is so important to stress to the public and medical community that monitoring is a 

key component to treatment. If it can be established ahead of time that a given patient is 

potentially at risk to have a stroke, methods to prevent it should be set. Doctors should be 

emphasizing the need to know more and the practice of monitoring to combat strokes. 
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References

Arch, Allison E., et al. "Missed Ischemic Stroke Diagnosis in the Emergency Department by

Emergency Medicine and Neurology Services." ​PDF​ , www.ahajournals.org › doi › pdf ›

STROKEAHA.115.010613. Accessed 9 Dec. 2019.

Cejas, Luciana León, et al. "Misdiagnosis of Acute Ischemic Stroke in Young Patients ." ​PDF​ ,

2019 , www.medicinabuenosaires.com/PMID/31048273.pdf. Accessed 5 Dec. 2019.

Chhabra, Manik, et al., "Assessment of Knowledge on Risk Factors, Warning Signs, and Early

Treatment Approaches of Stroke among Community Adults in North India: A Telephone

Interview Survey." ​The US National Library of Medicine National Institutes of Health​,

NCBI , 7 Oct. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6779547/. Accessed 24

Nov. 2019.

Hickey, Anne, et al., "Does stroke health promotion increase awareness of appropriate

behavioural response? Impact of the face, arm, speech and time (FAST) campaign on

population knowledge of stroke risk factors, warning signs and emergency response." ​US

National Library of Medicine National Institutes of Health​ , NCBI , 11 Jan. 2018,

www.ncbi.nlm.nih.gov/pmc/articles/PMC6460411/. Accessed 22 Nov. 2019.

Howard, George, et al. "Self-Reported Stroke Risk Stratification: Reasons for Geographic and

Racial Differences in Stroke Study." ​Stroke​, U.S. National Library of Medicine, May

2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493147/. Accessed on 30 Nov.

2019.
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"Know the latest in stroke prevention and treatment: new research highlights the dangers of

calcified coronary arteries and the benefits of brisk walking after a stroke." ​Heart

Advisor​, May 2013, p. 6+. ​Gale General OneFile​,

https://link.gale.com/apps/doc/A329303686/GPS?u=glen20233&sid=GPS&xid=4d088a7

c. Accessed 13 Dec. 2019.

Lee, Chong Do, et al. "Physical Activity and Stroke Risk ." ​AHA/ASA Journals​ , 18 Sept. 2003,

www.ahajournals.org/doi/full/10.1161/01.STR.0000091843.02517.9D. Accessed 12 Dec.

2019.

"Studies from University of Pittsburgh Add New Findings in the Area of Stroke (Clinical

Predictors of Engagement in Inpatient Rehabilitation Among Stroke Survivors With

Cognitive Deficits: An Exploratory Study)." ​Women's Health Weekly,​ 9 Aug. 2018, p.

6411. ​Gale General OneFile​,

https://link.gale.com/apps/doc/A549012409/GPS?u=glen20233&sid=GPS&xid=da94cd2

8. Accessed 11 Dec. 2019.

Wang, Guangyu, et al. "An Ambulatory Blood Pressure Monitor Mobile Health System for Early

Warning for Stroke Risk: Longitudinal Observational Study." ​JMIR mHealth and

uHealth​ , JMIR Publication , 30 Oct. 2019. Accessed 14 Nov. 2019.

"Women more likely to suffer stroke due to atrial fibrillation--but undertreatment persists:

deficiencies in atrial fibrillation care may translate into poorer stroke outcomes for

women." ​Focus on Healthy Aging,​ Sept. 2016, p. 1+. ​Gale In Context: High School​,

https://link.gale.com/apps/doc/A461695338/GPS?u=glen20233&sid=GPS&xid=34082e9

2. Accessed 07 Dec. 2019.