Your health issues in the news.  The risks, causes, and prevention of some types of stroke

Your health issues in the news. The risks, causes, and prevention of some types of stroke Antonio M. Gordon, Jr., MD Last month I invited you to write to me with your questions and issues on health. Remember I pointed out that the hardest of all the things to do for these monthly columns is the selection of the topic. Ideally, the topic should be just for you! I am inviting you again, the reader of these columns in the COOPA Guardian, to feel free to drop a line or two with a keyword, or a clue regarding the issues that you would like to see written about here. I would like to know who you are but your name and identity will never appear in the column associated with anything. Here is where to write: Dr A Gordon, PO Box 523096, Miami, Florida 33152. In the next few months we are going to set up a special mailbox for our readers in Pembroke Pines. Look for the new address soon! Again, thank you for taking the time to just jot down a word, a line, or a sentence or two. I rather am guided by you needs and question that some other obscure factor. The issues regarding stroke prevention can be approached from these questions. First, what is the meaning of stroke? Second, what types of strokes may be prevented? Third, what are some of the symptoms of having a stroke? And fourth, what should be if any of these symptoms arise?  Although physicians use the word stroke and there is a medical journal named "Stroke", the word itself is considered a lay term. It  denotes, in general, a sudden neurological or nervous system related disorder  associated with a hemorrhage and/or the blood supply to the brain or any part of the brain. Further delineation of the term takes us directly to the various types of strokes. There are in general two main types: the hemorrhagic type in which a bleeding or hemorrhage has occurred inside the skull that protects the brain and the ischemic or thrombotic type of stroke resulting from a blockage or obstruction to the blood flow to a particular area of the brain. The latter type of stroke accounts for one in ten of all strokes. The hemorrhagic strokes account for the balance. Note that is imperative and of immediate importance to tell one main type from the other. That is important to perform an evaluation of the patient when any symptom of stroke arises. If the process is hemorrhagic one would not favor the use of blood clot busters, anticoagulants, and blood thinners.  Therefore, from the outset, the patient and the community must be alerted to seek help early in order to get the most out of the available therapies. Strokes may be prevented if the patient has had a warning set of signs that have brought his risks for a stroke to the forefront of his clinical situation. Otherwise, one would look at people in their "golden years", suffering from high blood pressure, and having evidence on clinical examination of thickening of the blood vessels known as arteries. The term for this finding is "endothelial injury'" meaning that the inside of the blood vessels are not exactly smooth and able to allow the blood to freely flow through them without clotting. The symptoms of having a stroke may be different depending on the part or area of the brain that has been threatened with an injury or actually injured. There may be difficulties with speech, with generating the speech and thinking on what to say. There may problems with vision, lack of vision, or double vision. The face may be twisted or asymmetrical suddenly. The patient may have tingling, weakness, tremor or lack of coordination of an extremity or part of the extremity. There may be headaches, nausea, generalized weakness and finally seizures. These are not all of the symptoms that may be associated with a stroke, but they are common ones reported. After the initial examination, the physician may order a number of tests to check for these problems. A carotid Doppler study is entirely noninvasive and may give reliable information of the status of the main blood vessels taking arterial blood to the brain. Any patient who is suspect of blockage of the internal carotid arteries or vertebral artery must be offered a special magnetic test to evaluate his cerebral circulation more closely. A patient with severe obstruction of the internal carotids may be helped through an invasive procedure or vascular surgery. These procedures are accompanied by intensive medical therapy in order to obtain a maximum benefit from the risks taken. The possible benefits from these interventions in the elderly, past the 75th birthday, remain a matter of debate and each physician must weigh the benefit and risk of a particular patient before embarking on any preventive procedure. These issues are more clearly delineated for patient who do have warning signs and symptoms. However, in these patients, the risk reduction is appreciable but not complete. For example, the risk reduction of a 73-year-old man with 90% obstruction of the internal carotid artery may be of the order of 28%. Obviously, those who benefit are at best one out of three patients. In the background for all of this information is still the fact that primary prevention of these vascular disorders always goes back to genetics, blood pressure control, optimal diabetes management, and lipid and cholesterol control.