Stroke Archive

Q. I just discovered that I have a hole in my heart that my doctor called a patent foramen ovale, which was found during an ultrasound. What are the pros and cons of having it repaired?

A. All people start off with an oval, flap-like opening (called a foramen ovale) between the right and left upper chambers of their hearts. This small hole usually closes during infancy. But in about one in four people, it stays open and is known as a patent foramen ovale (PFO). Most people with the condition have no symptoms and never know they have it unless it's discovered by accident, as happened to you.

Well-educated people who report memory problems may face a higher risk of stroke.

Minor memory slips—such as losing your keys or forgetting an acquaintance's name—are common as we age. However, people who express concern about their memory may have a heightened risk of stroke, particularly if they're highly educated, according to a study in the January 2015 Stroke.

Q. I recently heard the term "silent stroke." If a stroke is silent, how is it diagnosed?

It isn't news that five lifestyle factors—following a healthy diet, getting regular exercise, controlling weight, never having smoked, and drinking alcohol in moderation—can reduce your risk of stroke. However, a report from Sweden in the Nov. 4, 2014, issue of Neurology has shown that combining healthy habits may reduce your risk even further.

Researchers analyzed answers from questionnaires from 31,696 women with an average age of 60 who were free of heart disease and cancer when they entered the study in 1998. They determined how many of the healthy factors each woman had. They followed the participants until 2008. During that period there were 1,554 strokes.

Women can cut their risk of stroke by more than 50% with healthy lifestyle practices, such as eating right, never smoking, drinking moderately, staying active, and keeping body mass index below 25.

Q. In a previous issue, you discussed abdominal aortic aneurysms. My uncle was just diagnosed with a thoracic aortic aneurysm. How is this type of aneurysm different?

A. An aortic aneurysm is a weakened area in the wall of the aorta that causes it to bulge or dilate. The aorta—which has a diameter the size of a garden hose—is the vessel that carries blood away from the heart to the rest of the body. The section that curves out of the heart, the thoracic aorta, is shaped like a candy cane. The part below, the abdominal aorta, passes straight down through the center of the body.

Eating more white beans, sweet potatoes, leafy greens, and other foods high in potassium may lower your risk of having a stroke. As described in a study published online Sept. 4, 2014, in the journal Stroke, researchers tracked 90,000 postmenopausal women between the ages of 50 and 70 for an average of 11 years. Women who got the most potassium in their diets were 16% less likely to have an ischemic stroke than those who consumed the least potassium. Ischemic strokes, the most common type of stroke, result from a blockage in a blood vessel supplying the brain.

Women with normal blood pressure who ate the most potassium had a 27% lower risk of ischemic stroke compared with women who ate the lowest amount of potassium. But potassium intake didn't seem to affect stroke risk among women
with high blood pressure. One possible explanation for that finding: a high-potassium diet may be more helpful before high blood pressure—a leading risk factor for stroke—sets in.

The options include surgery, stenting, or medications. Which is right for you?

The buildup of fat, cholesterol and other deposits on artery walls can block the flow of oxygen-rich blood to organs and tissues throughout the body. When clogs develop in the coronary arteries, the result can be a heart attack. But when obstructions develop in the carotid arteries of the neck, the main hazard is brain attack (stroke). Plaque in a carotid artery can cause a stroke by blocking blood flow to part of the brain, or by breaking loose and completely blocking a smaller vessel in the brain. Symptoms of a pending stroke usually call for treatment to reduce the risk.

Two pairs of blood vessels in the neck (the cervical arteries) carry blood to the brain. A tear in the lining of one of these vessels, called a cervical artery dissection, is rare, occurring in just one to three in 100,000 people per year. Still, it's one of the most common causes of stroke in people under the age of 50. The tear can occur spontaneously, after some sort of injury to the neck, or even during sports such as weight lifting or golf.

Now, the American Heart Association (AHA) warns of another possible cause: the quick, thrusting neck movements some chiropractors and other health care professionals use to treat neck pain. The technique, known as cervical manipulative therapy, has been linked to cervical dissections in younger people, according to an AHA statement published in the October 2014 Stroke. It's not clear whether the neck therapy causes the problem or if the pain from a tear might prompt people to seek out such treatment. But people at risk of cardiovascular disease should be extra cautious about getting cervical manipulative therapy.

Longer monitoring for irregular heart rhythms could be useful for people in danger of a brain attack.