Stroke Archive

Research we're watching

Aging brains often show signs of microscopic strokes, which result from damage to tiny blood vessels within the brain. Those that occur in the brain's outermost layer — called cortical cerebral microinfarcts (CMIs) — usually don't cause any symptoms. But they are more common in autopsies of people diagnosed with dementia. Now, new research suggests a link between blood markers for early heart disease and CMIs.

The study, published online Feb. 6, 2017, by JAMA Neurology, included 243 people who attended a memory clinic. All had brain scans to check for CMIs and blood tests that measured two substances associated with early signs of heart damage. People who had CMIs (nearly 29% of the participants) were much more likely to have heart disease than those who didn't have CMIs. Higher levels of both substances associated with heart damage were also linked to CMIs — even when the researchers left out people who already had obvious symptoms of heart disease.

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.

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.

Early treatment of the most common type of stroke, ischemic stroke, can limit brain damage and vastly improve outcomes. Ischemic stroke is the kind caused by atherosclerosis, which causes blood clots that block the blood supply to a part of the brain. Yet too few ischemic stroke patients receive important clot-busting drugs, which are most effective when given within three hours after symptoms start. Patients often arrive at the hospital after that window of opportunity has closed. They delay getting treatment because stroke symptoms may not be that pronounced or they are mistaken as coming from other, less serious problems.

As a result, doctors are looking for ways to make it easier for the layperson to identify a stroke. The Cincinnati Prehospital Stroke Scale is one such attempt. Some experts say it leaves out too many symptoms. Others say it will cause false alarms because it's not specific enough..

Most people with atrial fibrillation take anti-clotting drugs to prevent strokes. For those who cannot take these drugs because of a high risk of bleeding, a tiny, basket-like device implanted in the part of the heart that traps clots may be an alternative. 

Lacunar strokes, which account for about one-fifth of all strokes, occur in small arteries deep within the brain. Although these strokes may not cause symptoms, those that do may cause weakness in the face, arm, or leg on one side of the body. 

An abnormal heart rhythm — when your heartbeat is too slow, too fast, or irregular — may be a fleeting, harmless event. But it may also be a symptom of a more serious heart condition. One of these common abnormal heart rhythms, known medically as arrhythmias, is atrial fibrillation.

Atrial fibrillation

In atrial fibrillation (afib, for short), the heart's upper chambers, or atria, quiver instead of beating normally. The result is a fast, irregular heartbeat, which may lead to dizziness and fatigue but is often symptomless. A related condition is called atrial flutter.

In an observational study of 1.3 million women, excess weight was linked to an increased risk of strokes caused by blood clots but a lower risk of strokes caused by bleeding.