Stroke
And Brain Aneurysm
Introduction:
A stroke is a medical emergency where a person
suddenly changes from functioning normally to a person who may have a set of complaints
such as headaches, inability to move a body part and change in level of consciousness
(dizziness, confusion, all the way to possible unconsciousness or coma). In
a dense stroke there may be an inability to move the muscles of one body half.
Often the person may fall and if older, may break the more brittle bones (typically
a hip fracture or wrist fracture) as the person is off balance and falls.The obvious
thing to do for an onlooker is to call 9-1-1 to get an ambulance so that the patient
can be transported to the nearest hospital. There the physician will stabilize
the patient and arrange an emergency CT or MRI scan. Here is a simple test based
on three brain functions that anyone can do, if you suspect a person around you
may suffer from a stroke:
| Stroke and brain
aneurysm (recognize the symptoms) |
| *Ask the individual to SMILE. |
| *Ask him or her to RAISE BOTH ARMS. |
| *Ask the person to SPEAK A SIMPLE
SENTENCE. | If
he or she has trouble with any of these tasks, call 9-1-1 immediately and describe
the symptoms to the dispatcher. | | After
discovering that a group of non-medical volunteers could identify facial weakness,
arm weakness and speech problems, researchers urged the general public to learn
the three questions. They presented their conclusions at the American Stroke Association's
Annual meeting in February of 2004. Widespread use of this test could result in
prompt diagnosis and treatment of a stroke and prevent brain damage.
|
In the following I am describing
that there can be very different reasons for similar symptoms. For instance, the
underlying pathology in the above example could be a brain tumor that presses
onto the part of the brain that controls body motion. However, there might be
a closing off of the middle cerebral artery on one side through a blood clot dislodged
from heart valve disease (embolic stroke) or the middle cerebral artery may have
been narrowed down so badly that one day it suddenly closes off completely (ischemic
stroke).
This would be an example of an ischemic stroke on the basis
of arteriosclerosis (hardening of the arteries), which happens for instance prematurely
in a patient with diabetes mellitus, but which commonly happens also in old age.
Another mechanism for stroke is with poorly controlled high blood pressure, when
one of the small blood vessels may rupture and bleeding occurs in the brain tissue
with identical symptoms as above (hemorrhagic stroke). Finally, in more rare cases
a congenital pouch exists in one of the arteries of the brain, called brain aneurysm,
which tends to rupture as the person ages and suddenly leads to a subarachnoid
bleed (or hemorrhage). In the following I shall deal with the most common
conditions just mentioned (Ref. 9, p. 1538).
Other
Causes of Strokes A primary brain tumor (benign of
malignant) or a brain metastasis of a cancer elsewhere in the body (for instance
lung cancer, melanoma, breast cancer or prostate cancer) can also produce the
signs of a stroke. Clinically the first signs are often like an ischemic stroke.
However, the CT scan or MRI scan would show the typical findings of a metastasis
rather than an ischemic stroke. Also, in time this metastasis would increase in
size while the ischemic stroke heals with a scar. On the other hand a clot
from a diseased heart valve (for instance from prior rheumatic heart valve disease)
or a clot from an arteriosclerotic plaque at the bifurcation of the carotid artery
will produce the clinical picture of an ischemic stroke. Sometimes such underlying
diseases lead to a serious of mini strokes. Treatment with ASA or full anticoagulation
initially with heparin and later with Coumadin to thin the blood might have to
be done. If other medical illnesses such as diabetes mellitus or hypertension
are present, these conditions would have to be treated diligently and persistently.
It is important that the patient understands that a one-time treatment of these
conditions will not change the long-term risk. However, I want the patient to
understand also, that long-term control of hypertension and diabetes mellitus
will produce marvelous results. I know how difficult it is to be persistent. But
this is an area where the affected person becomes his or her own hero and the
gold medal in this Olympic event is the prolongation of your life!
Stroke
Prevention A chapter on strokes would not be complete, if
nothing would be mentioned about stroke prevention. Physicians are very limited
with what they can do when a stroke has happened as brain tissue has often been
lost and scarring sets in following a stroke. Looking at tooth decay it is certainly
important to think about the cause of plaque formation, tooth decay and eventual
tooth loss. After identifying the risk factors the next step is to cut out sugar
consumption, brush your teeth and floss them regularly. Many of you know that
and those of you who do this regularly likely still have their own teeth. What
does that have to do with prevention of strokes? The same preventative thinking
works in stroke prevention. I have mentioned earlier and in other parts of the
Net Health Book that there are preventable risk factors that lead to stroke. For
ease of reference I have listed them in tabular form here again (modified from
Ref.12).
| Risk factors
important for stroke prevention |
| Risk factors: | Comments: |
| Diabetes | premature
hardening of arteries, best prevented by close diabetic control |
| Dietary factors
| low fat, low refined carbohydrate diet,
which is good for your teeth is also good for your body |
| Inactivity | the
blood needs to circulate and HDL-cholesterol needs to be built up be regular exercise
(45 to 55 minutes of a brisk walk every day) |
| Hypertension | don't
get it and if you have it use medicine and life style changes to keep it under
close control | | Hyperlipemia | high
blood fats in your blood cannot be good for your heart or brain arteries. If you
have this, see your doctor and get medicine to control it closely. |
| Obesity | this
did not happen overnight. You tackle this by attacking inactivity, dietary factors
and mental attitute all at the same time. It can be done. Get support, cut out
the main offenders to get started. |
| Smoking | this
is an addiction to nicotine. It may go much deeper than you think. Smoking can
be an escape from stresses in life. Whichever way works for you, you need to get
off cigarettes and other addicting stuff. | Dr.
Philip A. Teal from the Vancouver General Hospital (Director of the British Columbia
Centre for Stroke and Cerebrovascular Disease) gave a talk at this conference
(Ref.12) entitled "Stroke Prevention." He stated that about 80%
of strokes are preventable through life style changes by paying attention to what
I summarized for you in the table above. He also said that they found in BC that
about 40 % of all strokes originated from diabetes, hyperlipidemia and high blood
pressure that were not adequately controlled and from smoking that had not been
stopped. In other words these were entirely preventable. The other 40% of preventable
causes are lifestyle decisions regarding food intake and inactivity. These BC
vital statistics are identical in the US and in many other parts of the world.
Many people have enough will power to change this on their own. Others need to
do it under the guidance of a YMCA
program or other equivalent program. Like brushing your teeth, limiting your sugar
intake and flossing your teeth, which are very simple steps to take, you need
to pay attention to your body, particularly the arteries that go to the brain
and heart. Whatever I suggested in the table above is good not only for your brain,
but also for your heart. It's a "two-for-one-deal". In those
patients where a transient ischemic attack has taken place urgent tests of the
carotid arteries are needed, as a high percentage may have severe narrowing of
the arteries predisposing them to the development of a stroke in the near future.
Carotid
endarterectomy can be done for this with a success rate of stroke
prevention in 70 to 80 % of patients (with proper selection of the patients who
will benefit). Those who had a stroke can do "secondary prevention"
by taking a baby aspirin daily to thin the blood and this can be combined with
extended release clopidrogel or dipyridamole. Ask you family doctor or specialist
about this. Risks and benefits of medications have to be assessed in each patient
according to the circumstances. As you know aspirin (ASA) can cause severe stomach
bleeding in a small number of patients. | |
