Stroke, Part II, Invite Health Blog

Written by Dr.Claire Arcidiacono, ND

For further questions or concerns email me at [email protected]†

Last week we began our conversation on the topic of strokes or CVA and even talked about TIAs. As I said last time this will be a 3 part blog.  We will be continuing with part 2 of this topic today. In this blog, we will review what actually causes a stroke? What are the risk factors you should be aware of and what are the most common complications after a stroke?†

What actually causes a stroke to occur? Well as you can most likely guess anything that affects blood flow to the brain can potentially cause a stroke to occur. In the case of hemorrhagic stroke, some causes include but are not limited to: hypertension, ruptured aneurysms, ruptured AV fistula, prior ischemic stroke and drug- induced bleeding. (1) An ischemic stroke is caused basically by blood clots or anything that blocks the flow of blood. For example in addition to blood clots blood flow can be blocked by cancer cells, fat, and even clumps of bacteria from infections such as infectious endocarditis.† (2)

Now as I’ve said anything that blocks blood flow to the brain is a risk factor for strokes. But what does this mean in terms of risk factors that we can reduce or even eliminate? What do we need to look out for? Obviously as I mentioned in my prior blog having a TIA is a huge risk factor for developing a stroke. Another one of the biggest risk factors for having a stroke is high blood pressure. (3) Unfortunately high blood pressure is very often asymptomatic. This means that you have high blood pressure but don’t know. That is why it is often referred to as a silent killer. In some cases of high blood pressure the presence of high blood pressure can be indicated by headaches, lightheartedness, vertigo or tinnitus. (4) In my clinical experience I have found it is important for anyone with these symptoms to monitor their blood pressure.  Another very common risk factor for a stroke is having high cholesterol. (5) Other risk factors that can increase stroke risk include having diabetes, kidney disease, and atrial fibrillation as well as being obese. Tobacco use can also increase stroke risk. (6) Having a brain aneurysm can increase the risk of a hemorrhagic stroke. (7)  Having atherosclerosis is another huge risk factor for having a stroke. (8) Using stimulants such as cocaine increase stroke risk greatly. (9)  Alterations in blood vessels that can increase stroke risk include,  cerebral amyloid angiopathy, cerebral arteriovenous malformations and intracranial aneurysm.(10) Head trauma can also increase the risk of a stoke by either weakening the blood vessels so that they rupture or by disrupting blood clotting in the brain. (11) Having chronic or long term inflammation has also been found to increase stroke risk. Certain chronic conditions such as Lupus, Rheumatoid arthritis, and sickle cell anemia can also increase the risk of strokes. Having a history of COVID -19 may also increase the risk of a stroke however, more research is needed on this topic.† (12)

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There are certain risk factors that increase risk of stroke especially in women. I would like to take a few minutes to review these particular risk factors.  One very common risk factor for women is the use of oral contraception pills. These pills have been found to increase the risk of blood clots and thus can increase the risk of a stroke. Pre-eclampsia which is high blood pressure during pregnancy can also increase the risk of a stroke.†(13)

Lastly if you have a family history of strokes or TIA you are more likely to have a stroke. Race also appears to affect the risk of stroke. For those of African American, Alaska Native, American Indian and Hispanic descent there is a higher risk than in those of a causation descent.† (12)

What are the most common complications after a stroke? 

The complications of a stroke can be physical, mental and/or emotional. In 75% of stroke survivors the physical disability is bad enough to decrease a person ability to work. (14) In some individuals this can also impact their ability to carry out activities of daily living. In up to 10% of individuals there is an increased risk of developing seizures. (15) Urinary incontinence occurs in approximately 15% of stroke survivors. (16) Sexual dysfunction occurs in up to 50% of people after a stroke. (17) Other physical changes can include but are not limited to muscle weakness, numbness, pressure sores, apraxia, as well as decreased appetite, vision and speech loss.† (18)

There may be anxiety, panic attacks, flat affect as well as mania, apathy and psychosis after a stroke. (19) There may also be changes in your ability to communicate. In up to 50% of stroke survivors there is depression. (20) In up to 20% of survivors there is emotional lability. (21) Cognitive changes after a stroke include perceptual disorders, aphasia, dementia, reduced attention span and decrease in memory. (22)Lastly there may be hemi spatial neglect, where a person is unable to process and perceive any stimulus on the opposite side that the stroke occurred on.†(23)

In our next blog we will review signs and symptoms of a stroke. We will also cover ways to help mitigate risk factors and how to help aid in the healing process after a stroke has occurred.†

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REFERENCES

Smith WS, English JD, Johnston SC (2012). “Chapter 370: Cerebrovascular Diseases”. In Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J (eds.). Harrison’s principles of internal medicine (18th ed.). New York: McGraw-Hill. pp. 3270–3299. ISBN 978-0-07-174889-6.

1. Kumar V (2009). Robbins and Cotran Pathologic Basis of Disease, Professional Edition (8th ed.). Philadelphia: Elsevier. ISBN 978-1-4377-0792-2.
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3. Fisher ND, Williams GH (2005). “Hypertensive vascular disease”. In Kasper DL, Braunwald E, Fauci AS, et al. (eds.). Harrison’s Principles of Internal Medicine (16th ed.). New York: McGraw-Hill. pp. 1463–1481. ISBN 978-0-07-139140-5.
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5. “Who Is at Risk for a Stroke?”. www.nhlbi.nih.gov. March 26, 2014. Archived from the original on 27 February 2015. Retrieved 27 February 2015.
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8. Osterweil N (26 December 2006). “Methamphetamine May Trigger Ischemic Stroke”. Medpage Today.
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11. https://www.nhlbi.nih.gov/health/stroke/causes
12. https://www.stroke.org.uk/what-is-stroke/are-you-at-risk-of-stroke/women-and-stroke
13. Coffey CE, Cummings JL, Starkstein S, Robinson R (2000). Stroke – the American Psychiatric Press Textbook of Geriatric Neuropsychiatry (Second ed.). Washington DC: American Psychiatric Press. pp. 601–17. ISBN 9780880488419.
14. Reith J, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS (August 1997). “Seizures in acute stroke: predictors and prognostic significance. The Copenhagen Stroke Study”. Stroke. 28 (8): 1585–9. doi:1161/01.STR.28.8.1585. PMID 9259753.
15. Thomas LH, Coupe J, Cross LD, Tan AL, Watkins CL (February 2019). “Interventions for treating urinary incontinence after stroke in adults”. The Cochrane Database of Systematic Reviews. 2019 (2): CD004462. doi:1002/14651858.CD0
16. Stratton H, Sansom J, Brown-Major A, Anderson P, Ng L (May 2020). “Interventions for sexual dysfunction following stroke”. The Cochrane Database of Systematic Reviews. 2020 (5): CD011189. doi:1002/14651858.CD011189.pub2. PMC 7197697. PMID 32356377.
17. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C (December 1997). “Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project”. BMJ. 315 (7122): 1582–7. doi:1136/bmj.315.7122.1582. PMC 2127973. PMID 9437276.
18. an KM (2014). “Disorders of emotional communication after stroke”. In Schweizer TA, Macdonald RL (eds.). The behavioral consequences of stroke. New York [u.a.]: Springer. pp. 119–33. doi:1007/978-1-4614-7672-6_7. ISBN978-1-4614-7671-9.
19. Senelick RC, Rossi PW, Dougherty K (1994). Living with Stroke: A Guide for Families. Contemporary Books, Chicago. ISBN 978-0-8092-2607-8. OCLC 40856888.
20. Coffey CE, Cummings JL, Starkstein S, Robinson R (2000). Stroke – the American Psychiatric Press Textbook of Geriatric Neuropsychiatry (Second ed.). Washington DC: American Psychiatric Press. pp. 601–17. ISBN 9780880488419.
21. Kuźma E, Lourida I, Moore SF, Levine DA, Ukoumunne OC, Llewellyn DJ (November 2018). “Stroke and dementia risk: A systematic review and meta-analysis”. Alzheimer’s & Dementia. 14 (11): 1416–1426. doi:1016/j.jalz.2018.06.3061. PMC 6231970. PMID 30177276.
22. Murray ED, Buttner N, Price BH (2012). “Depression and Psychosis in Neurological Practice”. In Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.). Bradley’s neurology in clinical practice. Vol. 1 (6th ed.). Philadelphia: Elsevier/Saunders. pp. 100–01. ISBN 978-1-4377-0434-1.

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