Stroke in Young Adults Becoming More Common

Richard Libman, MD

Stroke may be affecting people at a younger age, according to a recent study published in the journal Neurology. This is not the first study to suggest this unsettling trend and other research has found similar results.

The first question to ask is whether stroke in young people only appears to be more common because of improved diagnosis. Magnetic resonance imaging (MRI) has been more widely used for stroke diagnosis, and MRIs are much more sensitive than computed tomography (CT) scans to detect small strokes. So some of the increase in diagnosis of stroke in young people may be due to improved technology and not a true increase in incidence.

Still, stroke is often diagnosed by the judgment of a physician, not necessarily by the type of scan. So increased use of MRI may not fully explain the trend.

The most widely accepted explanation, although unproven, is the rise in obesity in children. One of the main complications of obesity is diabetes. Obesity itself is a risk factor for stroke, and diabetes is an extremely strong stroke risk factor. The rise in obesity and diabetes among children may set the stage for stroke in young adulthood.

This possibility is quite alarming, and should serve as a wake-up call to healthcare practitioners. We need to address children obesity sooner rather than later. Full Post - to Detail View

Can Chocolate Help Prevent Stroke in Men?

Richard Libman, MD

According to a recent study published in the journal Neurology, eating a moderate amount of chocolate each week may be associated with a lower risk of stroke in men. Study participants who ate the largest amount of chocolate, about one-third of a cup of chocolate chips, had a lower risk of stroke compared to the men who ate no chocolate.

Though it is tempting to recommend more chocolate consumption (at for least men), the usual caveats pertain to this kind of study design. While this is a prospective study, it is still observational and not randomized, so unmeasured differences between the groups of chocolate eaters may have influenced the outcome.

For example, men who are already healthier for various reasons might consider it “safer” to consume larger amounts of chocolate. They may have a lower stroke risk because they are already healthier in ways the study didn't measure, not because they eat more chocolate. So it would be premature to assume a direct relationship between eating chocolate and a lower risk of stroke. 

A randomized trial is the only way to establish whether chocolate is beneficial for stroke prevention. Regardless of there being many willing volunteers for a randomized trial of chocolate versus placebo, it's unlikely that researchers would conduct one.  

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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

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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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