Stroke Archive

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Q. I have had a dandruff problem for years. I have tried selenium and zinc shampoos, as well as ketoconazole shampoo. Nothing has worked. Are there other options?

A. Dandruff, which is a chronic skin condition known as seborrheic dermatitis of the scalp, can range from a minor irritant to a severe rash of the entire scalp.

In the journals

Low-dose aspirin therapy is standard treatment for people who have suffered a heart attack or stroke to protect them from a second one. But what about people who don't have cardiovascular disease, but do have specific risk factors, such as type 2 diabetes? A study published in the Feb. 14, 2017, Circulation found that low-dose aspirin therapy in fact did not lower this group's risk for heart attack or stroke.

The researchers recruited more than 2,500 people, ages 30 to 85, with type 2 diabetes and randomly assigned them to take either 81 mg or 100 mg of aspirin daily, or no aspirin, for three years. At the 10-year follow-up, they found that the aspirin therapy did not lower risk of either heart attack or stroke compared with taking no aspirin at all. The reason is not clear, but the researchers speculated that people with diabetes might not experience the expected anti-clotting action of aspirin.

Ask the doctor

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Q. I've been taking the blood thinner warfarin (Coumadin) for a few years. I know there are new kinds of blood thinners, but I've heard they have downsides. Should I stick with warfarin?

A. Here's what you need to know. Some medical conditions lead to blood clots. The most common one is the irregular heart rhythm called atrial fibrillation. About 20% of all strokes are caused by clots that result from atrial fibrillation — usually because of inadequate treatment with blood thinners.

Don't be surprised if your doctor doesn't rush you into treatment.

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Urinary tract infections (UTIs) can be tricky in older age. They're not always as easy to spot or treat as in youth. And the decades-long approach to treatment is changing. "We've been hasty in using antibiotics, and we're learning there are significant consequences that can range from side effects of medication to infections with antibiotic-resistant bacteria," says Dr. Helen Chen, a geriatrician at Harvard-affiliated Hebrew Rehabilitation Center.

About UTIs

UTIs can occur anywhere in the urinary tract. The most common places are the bladder (where urine is stored) and the urethra (the tube through which you urinate). Less common, but more serious, is infection of the kidneys, which filter waste and extra water from the blood and make urine. Infections may be triggered by sexual activity, catheters, kidney stones, decreased estrogen in the lining of the vagina, or urine that's pooled in the bladder.

News briefs

Red meat is associated with an increased risk for developing cardiovascular disease, diabetes, and some types of cancer. Now, a study published online Jan. 9, 2017, by the journal Gut suggests that eating red meat is associated with an increased risk for developing diverticulitis. This occurs when tiny pouches in the wall of the large intestine become inflamed, potentially causing cramps, diarrhea, constipation, and even rectal bleeding. We don't really know what causes diverticulitis, so researchers explored possible dietary links. They analyzed health and diet information reported by more than 46,000 men (ages 40 to 75) over 26 years. Men who ate the most red meat per week (about 13 servings) were 58% more likely to develop diverticulitis during the study period, compared with men who ate the least red meat per week (1.2 servings). The association was strongest for unprocessed red meat like steak. However, the risk for developing diverticulitis was 20% lower when people in the study substituted poultry or fish for a serving of unprocessed red meat each day. The findings don't prove that red meat causes diverticulitis, but other studies have suggested red meat may be a factor in diverticular disease.

Research we're watching

Following a Nordic diet — which features fish, whole grains, plus fruits and vegetables popular in Scandinavian countries — may help lower the risk of stroke, a new study suggests.

The study, published in the February 2017 issue of Stroke, included more than 55,000 Danish people from a national health registry, all of whom filled out questionnaires about their diets and other lifestyle habits. Researchers looked at how closely the participants followed the Healthy Nordic Food Index, which includes six food categories: fish, apples and pears, root vegetables (such as carrots and celery root), cabbages (which also include broccoli, cauliflower, kale, and Brussels sprouts), rye bread, and oatmeal.

In the journals

People who suffer from migraines have increased risks of stroke and hospital readmission within 30 days after having surgery, according to research published online Jan. 10, 2017, by BMJ.

The study included 124,558 patients (45% of whom were men), who had a history of migraines, either with or without aura (a period of symptoms, such as flashes of light or facial tingling, that precedes the migraine). The researchers monitored the condition of all the patients after either inpatient or outpatient surgery. They then looked at how many had strokes and how many were readmitted to the hospital over the following 30 days.

In preliminary research, sucralose and acesulfame potassium increased insulin levels, although more studies are necessary to determine whether they—or other artificial sweeteners—increase the risk of insulin resistance.

Despite the lack of a universally recognized therapy for nighttime leg cramps, a few approaches may be worth trying.

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Few things are more jarring to a night's sleep than shooting calf pains. If you have nocturnal leg cramps, you have lots of company. Although they can strike people at any time of life, they become more common with age. Among people over 60, almost half report having leg cramps, a third say they are awakened by cramps at night, and 15% report weekly episodes.

What causes leg cramps?

The risk of developing stress incontinence or urge incontinence increases along with BMI and body fat percentage. Stress incontinence is also associated with declines in grip strength.