Category Archives: Prevention

Diabetes

Diabetes is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism, and elevated levels of glucose (sugar) in the blood and urine.

Up to 15-33% of people that have had a stroke also have diabetes.

  • Increased risk seems to be greater for type 1 than type 2
  • Increased risk (16 times greater) in people aged 15-34 with type 1
  • In a 20 year follow up study (13,105 people) – type 2 diabetes increased the risk of stroke by 2 times in men, and 6.5 times in women

In general, diabetes increases the hardening of the arteries, and requires tighter control of cholesterol.

Increased stroke risk might also be due to a decreased healing ability associated with diabetes.

How can this be prevented?

  1. Healthy Eating – manage carbohydrate intake (approximately 45-60 g for women and 60-75 g for men every meal)
  2. Being Active – 150 minutes of exercise weekly, resistance training 2 times per week
  3. Taking Medication Properly
  4. Monitoring
    • Blood Glucose – 80-130 before meals, 90-160 at bedtime, Hb A1c 7% or less
    • Blood Pressure – less than 140/70
    • Cholesterol – HDL > 45 (men); HDL > 50 (women); LDL <100; TG <150; total < 200
  5. Reduce Risks
    • Stop smoking!
  6. Problem Solving
    • Know signs/symptoms of: low blood sugar, stroke, heart attack
    • If you are having problems reaching your goals regarding blood sugar, cholesterol, or high blood pressure, talk to your health care provider for help
  7. Stress Management
      • Yoga
      • Meditation
      • Therapy
      • Anything that helps you decompress (talking to a friend, reading, exercise…)

Diabetes Resources

Atrial Fibrillation

Atrial Fibrillation (or AFib) is an abnormal heart rhythm, and accounts for 20% of ischemic strokes. Treatment of Afib usually includes anticoagulation.

During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart.

Atrial fibrillation symptoms often include heart palpitations, shortness of breath and weakness.

AFib Resources

Preventing Strokes

R.W. FRELICK, M.D.

 

The most common type of stroke is cause by the lack of a blood supply to one or more vessels of the brain. A stroke is more likely to occur after the age of 50, but can even develop in children. It is often associated with a history of high blood pressure (hypertension), and / or a disturbance of the blood lipids (most commonly) measured by the level of cholesterol in the blood. Those lipids develop into plaques that can slowly grow to obstruct one of the main arteries to the brain, and/ or within one of the smaller end arteries to a localized area of the brain. These smaller arteries in the brain are called “end arteries” because they lack the rich capillary network found in most other parts of the body. An obstruction of one of these small end arteries can cause damage to a specific part of the brain such as speech or control of an arm.

 

Bleeding from a leak in one or more brain blood vessels can frequently be related to a small “bubble” called an aneurysm of a blood vessel which may be inherited. It may rupture at any age but more commonly after 50 years of age. Some may never leak. High blood pressures may be a factor. A brain tumor – whether a primary or secondary cancer starting in another part of the body- can also cause a stroke like attack.

 

Brain Attack/Stroke Risk Factors:

High blood pressures, increased weight (obesity), elevated cholesterol, increased blood sugars (diabetes), use of tobacco, excessive alcohol consumption and recreational drug use such as cocaine and amphetamines. The presence of multiple risk factors increases stroke risk. It is extremely important to keep the blood pressure under control. That is usually possible by taking prescribed blood pressure medications, avoiding salt, exercising and having the blood pressure checked regularly

 

The Surgeon General reported a few years ago that ap-proximately 300,000 Americans die each year from ill-nesses related to obesity. 60% of adults are overweight and childhood obesity is an epidemic.

 

People using warfarin (Coumadin) for an irregular heart rate called atrial fibrillation need to have their blood tests carefully and frequently checked to prevent bleeding. Hitting one’s head when falling is responsible for 24% of bleeding in the brain in older individuals (called intracranial hemorrhage).

 

Healthy Lifestyles

Adopting a healthy lifestyle can not only reduce the risk of a stroke, but of many other diseases. A diet low in saturated fats, excessive sodium (salt), and sugar has been shown to help prevent stroke and heart disease. Likewise the importance of 30 minutes of physical exercise at least 3 times per week has been scientifically shown to be an effective way to maintain a healthy life. Everyone should avoid smoking, exposure to second hand smoke, recreational drugs of all kinds and drinking more than two alcoholic beverages in anyone day.

 

Annual Physical Exams and Medical Follow-up

Everyone should have regular checkups by their primary health care provider as is appropriate for their age and gender. It is important to monitor weight, blood pressure, blood cholesterol and blood sugar. In addition to stroke risk factors, having mammograms, Pap smears and colonoscopy as recommended can help catch cancers early.

 

Take Action When Symptoms Occur! If you or someone with you experiences:

Sudden weakness or numbness

Sudden change in vision

Sudden difficulty in speaking

Sudden dizziness or severe headache

 

 

Call 911 immediately!

Do not wait for such symptoms to go away. It is very important to get to the hospital immediately when stroke symptoms begin. This can help limit injury and improve recovery from a stroke/brain attack.

Emergency Evaluation and Treatment of Stroke

ANTHONY MUNSON, M.D.

NEUROLOGIST,

CHRISTIANA CARE HEALTH SYSTEM

Neurologists have a saying when it comes to stroke treatment: “Time is Brain.” Like a heart attack, the key to good stroke treatment is early and rapid evaluation. In the last decade, we have seen amazing advances in the treatment of stroke, but most of these treatments can only be given in the first few hours. As such, I cannot emphasize enough the most important factor: Get to the hospital as soon as possible! If you suspect someone is having a stroke, do not wait, call an ambulance right away. Do not attempt to drive the person (or yourself) to the hospital. Try to note the time that the person’s symptoms began. When they arrive, tell the paramedics what happened, including the time, and any medical history you may know. If you are not the patient, follow the ambulance to the hospital (if possible), as the doctors may want to speak with you as well.

The focus in the emergency room will be on two things: determining if the patient is having a stroke, and then determining the appropriate treatment. If a stroke is felt likely, the next step is to find out if it is an ischemic (blockage) or hemorrhagic (bleeding) type of stroke. They will then use that information to determine how to treat that stroke. To get this information, the doctors and nurses will likely perform a series of procedures and tests in a very quick and efficient manner:

  • A physician will ask about the symptoms and any recent medical problems
  • An emergency room physician and likely a neurologist will look for signs of stroke on a physical examination
  • Blood will be drawn for certain laboratory tests
  • A CT scan (a type of X-ray) will be done to look for any signs of bleeding or early signs of the stroke

If there is bleeding found on the CT scan, treatment will likely consist of blood pressure control and watching closely for complications. They may call a neurosurgeon as well, although this is usually a precaution and most patients will not require any sort of surgery. They will admit the patient to the hospital so a close watch can be kept and any problems can be treated early.

If there is no bleeding and a blockage-type stroke is suspected, the next step will be to determine if the person is a candidate tor therapy with a “clot-buster” drug, usually a medication called tissue plasminogen activator, or tPA for short. This medication is designed to help break up the clot that is blocking blood flow to the brain, and therefore improve the chances of a good recovery. While it does not usually improve things right away, it has been shown that patients who receive this medication have less long-term problems from their stroke.

The medication does have some risk, however, and a small number of patients who receive the medication have bleeding problems that can actually make things worse. The physicians therefore have a list of things they look for to identify who would be less likely to have bleeding problems and more likely to benefit. The most important factor in this decision is the time since the stroke began. They will try to find out when the last time was that the patient was without symptoms. If the problems have been present for more than 4 1/2 hours, the risk of giving the medication will be too high. That is one of the reasons why it is very important to get to the emergency room as soon as possible. Patients on warfarin (Coumadin) (a strong blood thinner medication) are also at a higher risk of bleeding and in general will not be given the medication. Finally, patients who are already showing improvement are usually not given tPA, as they are more likely to do well even without the medication.

Another option available to restore blood flow from a blocked artery within the brain is to perform a procedure called a thrombectomy. This procedure removes the blood clot and is an option for the more severe strokes. This procedure also has specific criteria, time restrictions and complications similar to tPA yet can save your life so again calling 9-1-1 and getting to the hospital is so very important.

No matter what type of stroke or what happens in the emergency room, the patient will almost certainly be admitted to the hospital for further testing and to keep a close watch for problems.

View the pdf of this article.

Stroke Education

ANTHONY MUNSON, M.D.

NEUROLOGIST, MEDICAL DIRECTOR,

CHRISTIANA CARE STROKE PROGRAM

 

What is Stroke?

The brain is responsible for coordinating how we move, think, speak, hear, see, feel, and behave. To function properly, brain cells must have a continuous supply of oxygen and other nutrients from the blood. When the blood supply is disrupted, even for a few minutes, areas of the brain may be damaged and a person may suddenly lose some of the functions controlled by that region of the brain. This sudden loss of function is referred to as a stroke.

 

Blood is continuously pumped from the heart to the brain via several artery groups. Within the brain, these arteries branch into smaller and smaller arteries and then into tiny thin-walled vessels (called capillaries) which supply the oxygen and nutrients that the brain tissue needs. It is when this continuous blood supply is disrupted that brain cells die and a stroke results.

 

A stroke is the result of a sudden blockage caused by a clot, narrowing of an artery, or bursting of a blood vessel. It is this distinction that defines the main types of stroke. The two main kinds of strokes are known as ischemic and hemorrhagic.

 

Ischemic Stroke

Ischemic is the most common type of stroke and constitutes an estimated 80 percent of all strokes. An ischemic stroke results when a blood vessel leading to the brain becomes blocked. This type of stroke may occur for three main reasons:

 

1.) A blood clot (or thrombus) forms inside an artery in the brain, blocking the flow of blood. Referred to as thrombotic stroke, this is the most common type of ischemic stroke. Blood clots form most often in arteries damaged by atherosclerosis, a disease in which rough fatty deposits, or plaque, build up on the walls of the artery. These deposits can crack and expose substances that induce clots to form.

 

2.) A clot forms in the blood, but unlike thrombotic stroke, it originates somewhere other than the brain. This type of stroke is referred to as an embolic stroke and occurs when a piece of clot (an embolus) or plaque fragment breaks loose and is carried in the bloodstream to the brain. An embolus can form in many places in the body, including the heart and the arteries of the neck that transport blood to the brain. The embolus travels through the arteries, which branch off into smaller vessels. When it reaches a point where it can go no further, it plugs the vessel and cuts off the blood supply to the area of the brain that is supplied by that vessel.

 

Note: Both thrombotic and embolic strokes are referred to as ischemic because the blood supply has been blocked to the brain area. You may hear of the term cerebral infarction in connection with thrombotic and embolic types of stroke. Cerebral refers to the brain. An infarct is an area of tissue death due to a blockage of blood flows, such as a blood clot. It is also a result of ischemia, which refers to an inadequate blood (and therefore oxygen) supply to a certain part of the body.

 

3.) Blood flow decreases to the brain which can result from poor overall blood flow in the body due to heart damage or dysrhythmia (irregular heart rhythm that makes pumping inefficient or ineffective). This type of ischemic stroke is called hypoperfusion or watershed and is less common than the other two types.

 

Hemorrhagic Stroke

The second main type of stroke is hemorrhagic and occurs when a blood vessel in or around the brain ruptures or leaks. This rupture not only denies the blood from reaching its destination, it also causes a leakage of blood into the brain or the area surrounding the brain. When this happens, the cells nourished by the artery are unable to obtain their normal supply of nutrients and stop functioning properly. Blood begins to accumulate and clot soon after the rupture of the artery, causing a disruption of brain function and potentially increased pressure on the brain itself. Cerebral hemorrhage is most likely to occur in people who suffer from a combination of atherosclerosis and high blood pressure.

 

Transient Ischemic Attack (TIA)

About one-third of all strokes are preceded by one or more transient ischemic attacks (TIAs) or what are sometimes referred to as “mini-strokes.” TIAs can occur days, weeks, or even months before a stroke and are caused by temporary interruptions in the blood supply to the brain. The symptoms resemble those of a stroke but last a relatively short time and completely resolve.

 

Because TIAs are temporary, it is easy to ignore them or to believe the problem has disappeared. However, the underlying problem that caused the TIA continues to exist. Therefore, attention must be paid to these symptoms and a TIA should be viewed as early warning of a potentially serious stroke in the future.

 

If you or someone you know experiences a TIA, it is important to seek the assistance of a health care professional. Call your doctor immediately or go to the closest emergency department, even if the symptoms seem to be getting better or have resolved.