Howard LeWine, M.D.

World Stroke Day: stroke is common, disabling, and often preventable

Today is World Stroke Day. It offers a good reminder of the profound impact that stroke has on individuals and communities.

A stroke occurs when something interrupts blood flow to part of the brain. That something could be a clot lodged in a blood vessel. That causes an ischemic stroke. It could also be a break in a blood vessel. That leads to a hemorrhagic stroke. The type of stroke is important, since they require different types of treatment.

Nearly 800,000 Americans have strokes each year; about 90% of these are ischemic strokes. Worldwide, one in six adults will have a stroke during their lifetime. Although most survive, stroke is a leading cause of disability in the United States and many other countries.

A report published last week in The Lancet documents a troubling trend: more and more young people are experiencing strokes. Between 1990 and 2010, the number of strokes among people aged 20 to 64 years increased 25%. This age group now accounts for one-third of strokes worldwide.

Other findings:

  • The incidence of stroke (the number of new cases a year) decreased by 12% in high-income countries, but increased by 12% in low-income and middle-income countries.
  • Stroke-related deaths decreased 37% in high-income countries and 20% in low-income and middle-income countries.
  • In 2010, nearly 17 million had strokes worldwide, up 40% since 1990. Most of the increase was in low-income and middle-income countries.

Prevention is key

Some stroke survivors recover fully and regain their previous levels of function. Others don’t. Keys to full recovery include rapid identification of stroke symptoms, immediate evaluation and treatment, early rehabilitation, and support.

Here are some signs that you or someone you are with is having a stroke:

  • sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
  • sudden confusion, trouble speaking, or understanding
  • sudden trouble seeing in one or both eyes
  • sudden trouble walking, dizziness, loss of balance or coordination
  • sudden severe headache

If you notice any of these warning signs it is important to get to an emergency room as quickly as possible—ideally in a hospital with a stroke center (you can find a stroke center here).

While it’s important to talk about early identification and treatment, it’s just as important to talk about prevention. Many strokes—perhaps the majority of them—are preventable. Here’s how:

  • Know your personal risk factors for stroke, including high blood pressure, diabetes, obesity, high blood cholesterol, atrial fibrillation, and a history of having a transient ischemic attack or previous stroke
  • Control or manage these conditions by working with your health-care providers
  • Be active. Exercise or engage in physical activity every day.
  • Choose a healthy diet rich in vegetables and fruits, whole grains, and unsaturated fats.
  • If you drink alcohol, keep it moderate. That means no more than two drinks a day for men or one a day for women.
  • Avoid cigarette smoke—yours or someone else’s.

Comments:

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  2. Dean R

    What would probably make even more sense would be to prevent the neuronal cascade of death in the first week. Less dead and damaged neurons would directly result in better recoveries. Dr. Michael Tymianski, of the Toronto Western Hospital Research Institute in Canada mentions 1000 failed drugs that worked in rodents but failed in human trials. These probably need to be looked at again since it has now been proven that rodent inflammation is not the same as human inflammation. In my next stroke I have 31 possibilities that I will insist my doctor provide to me. Things like;
    blood pressure cuffs in the ambulance ride

    1. Statins.
    2. Fish oil.
    either by injection
    or a feeding tube
    3. Leg compressions
    4. anti-depressants – real ones
    5. music listening
    6. Sensation overload
    7. Coffee -
    8. CerAxon
    9. Peptide application
    10. Action observation
    11. bFGF administered intravenously
    12. Viagra -
    13. Training in lucid dreaming.
    14. Eptifibatide
    15. dietary olive leaf extract
    16. ebselen – neuroprotective treatment? within 48 hours
    17. diabetes drug linagliptin
    18. Etazolate, an α-secretase activator
    19. Glibenclamide – administered intravenously 6, 12, and 24 hours after reperfusion
    20. Paeoniflorin (PF) – PF treatment for 14 days
    21. administration of nontoxic carbon particles
    22. Ibuprofen
    23. Ceria nanoparticles
    24. Head-of-Bed Optimization of Elevation
    25. antibiotic minocycline
    26. neurotransmitter precursor levodopa
    27. Inhalation of nitric oxide
    28. old flu drug amantadine
    29. Melatonin
    30. opiate antagonists
    All these have some research already backing them even if they have not been in human clinical trials. Its worth it to my brain to take some chances to save my neurons from dying from glutamate poisoning, excitotoxicity,Capillaries that don’t open due to pericytes, Inflammatory action leaking through the blood brain barrier.

  3. Dean R

    You didn’t mention the specific preventions ideas of
    Potassium 21% Why eat three bananas a day?
    Marijuana buds 50% A Marijuana Bud A Day Keeps The Stroke Away
    Dietary magnesium 8% Higher magnesium intake associated with reduced ischemic stroke risk
    Mediterranean diet 30% – Mediterranean Diet Proven Key In Avoiding Heart Disease And Stroke

    lycopene – tomatoes 55% -Tomatoes Linked to Lower Stroke Risk

    Fish 6% – Does Eating Two Fish a Day REALLY Keep the Chance of Stroke Away?

    Chocolate eating 17% Eating small bar of chocolate cuts risks of stroke in men

    Walking 43% – Walking wards off stroke for women
    Speed walking 50% – Speed Walking Halves Stroke Risk
    Dietary fiber 7% –
    The generic prevention ideas are not really listened to.

    • John McBurney MD

      Great comments Dean. As a neurologist is the SE US i.e. the stroke belt who takes “stroke call” and a fellow in Integrative medicine I think you have pretty much identified the issues and the solutions .

      I applaud Dr. LeWine for his excellent efforts in bringing the issues of stroke in the young to light. But I think we have failed miserably as a profession to leverage the benefits of interventions such as the Mediteranean diet in prevention of stroke.

      I don’t know about cannabis…but…after seeing Sanjay Gupta’s CNN documentary “Weed” and reading the review of cannabis in the Weil Integrative Oncology book I believe that the endocannabinoid system is an overlooked potential source for the relief of human suffering.

      John

  4. Carlos Reyes

    Thank you.