May 02, 2012

May is Stroke Awareness Month: Know the Signs!

David Langer, MD

A stroke is an injury to the brain caused by the obstruction of blood flow to a brain artery-usually by a blood clot or a direct bleed into the brain itself. It can be due to weakness in the vessel wall commonly caused by high blood pressure or cerebral aneurysm.

Stroke is the third leading cause of death and the number one cause of disability in the United States. Stroke or "brain attack" can occur in all ages and nearly one quarter of strokes occurs in people under age 65.

The warning signs of stroke include motor weakness, sensory change (i.e. numbness or tingling of the face, arm or leg), speech difficulty or visual disturbance. Pain is present only in patients with the hemorrhagic form of stroke (a bleed in the brain) which represents only 15 percent of all strokes.

For the most part, the treatment of hemorrhagic stroke remains conservative with therapeutic options to reverse brain injury being very limited. Treatment is surgical only when a blood clot in the brain becomes life threatening. Surgery or catheter-based neurointerventional procedures are often used in patients who suffer bleeds from cerebral aneurysms to prevent a second hemorrhage.

Neurointerventional treatments are becoming more common in treating patients with ischemic stroke-strokes caused by vessel blockage. Along with intravenous clot-busting drugs (called tPA), intra-arterial delivery of these same drugs, as well as new technologies such as intravascular suction catheters and sophisticated mechanical devices, are increasingly being used for patients who either fail medical therapy or who present outside the three-hour time window reserved for the administration of intravenous tPA. Full Post - to Detail View

September 09, 2011

Stents: Not a Promising Anti-Stroke Treatment

Jeffrey Katz, MD

Patients whose narrowed arteries put them at risk for a stroke have a better chance at avoiding stroke via medications rather than artery-opening stents, according to a study just published online by the New England Journal of Medicine. Furthermore, the authors of the study noted that while the risk of early stroke after stenting is high, the risk of stroke with aggressive drug therapy alone is lower than expected.

This finding should help doctors decide what to do. As it stands now, stents are appropriate for less than 10 percent of stroke patients, so unless better stents are developed, intracranial stenting is not a growth industry.
 

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July 20, 2011

Olive Oil Associated with Lower Risk of Ischemic Stroke

Richard Libman, MD

Previous studies have shown that a Mediterranean-style diet has been associated with protection against dementia, as well as stroke. However, the exact components of the Mediterranean diet which may be protective have not been clarified by the studies. 

We know that olive oil, an important component of a Mediterranean diet, has previously been shown to be associated with a lower risk of heart attacks. A recent study published in Neurology, reported that olive oil was associated with a lower risk of ischemic stroke  (a blood clot in the brain). 
 
In the study, French researchers from the University of Bordeaux and the National Institutes of Health and Medical Research looked at the medical records of 7, 625 people ages 65 and older from three cities in France. Participants had no history of stroke. Olive oil consumption was categorized as “no use,” “moderate use,” and “intensive use.” After five years, there were 148 strokes. The study found that those who regularly used olive oil for both cooking and as a dressing had a 41 percent lower risk of stroke compared to those who never used olive oil in their diet. Most of the study participants used extra virgin olive oil.
 
This is most encouraging and may be useful in the general population to decrease the risk of stroke. A major caveat, however, exists with this type of study in that it is an observational study, not a randomized trial. For this reason, it is subject to multiple sources of bias, both measured and unmeasured, which can potentially give false results. As such, the study findings should not be taken as the final answer, but should stimulate further research. Full Post - to Detail View

July 15, 2011

Not Enough Who Suffer Ischemic Stroke Get Clot-Busting Drug

David Langer, MD

Stroke remains one of the leading causes of death and disability in the United States. Unfortunately, the treatment of stroke remains problematic due to the difficulties involved in getting patients diagnosed and treated in a timely fashion. The clot-busting drug tPA remains the only Food and Drug Administration (FDA)-approved drug for acute ischemic stroke (AIS) which is caused by a blood clot in the brain. In order for tPA to be effective, it should be administered within the first three hours after the initial onset of stroke symptoms.

Recently, researchers from the University of Cincinnati reported in the American Heart Association’s Stroke journal that 3.4 percent to 5.2 percent of Americans who suffered from an ischemic stroke in 2009 received tPA compared to 1.8 percent to 2.1 percent in 2005. While this finding is a sign of improvement, it is still very low. As such, we must continue to improve our treatment of stroke patients. Time remains a critical element in stroke management.

Current efforts both in basic science, as well as in system-based work flows in stroke management, are ongoing in efforts to improve the outcome of stroke patients. The goal is to preserve the brain, while improving identification of stroke and treatment.

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June 10, 2011

Examining the "Stroke Belt"

Richard Libman, MD

National patterns of racial and regional differences in stroke incidence are similar to those for stroke mortality; however, the magnitude of these differences in incidence appears smaller, according to a study appearing in a recent issue of the Annals of Neurology. Known as REGARDS (the REasons for Geographic And Racial Differences in Stroke), the national study further elaborates on the geographic variation in the incidence of stroke, stroke risk factors and cognitive impairment, a condition that includes problems with memory, language or other mental functions.

It has been known for some time that the "stroke belt" is a geographical region with a significantly higher incidence of brain attacks. Stroke by itself is a major contributor to cognitive impairment and dementia. Furthermore, such risk factors for stroke as high blood pressure and diabetes are independent risk factors for cognitive impairment. In the REGARDS study, living in the stroke belt was also a risk factor for cognitive impairment.

The important message is that careful analysis of what makes the stroke belt different from other areas of the country can lead to more insight into what is causing the cognitive impairment, and, hopefully, result in effective preventive measures and treatment.
 

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