Stroke — Who is at risk? (Page 27)

Article: Lucy Adoma Yeboah (10-03-2008)

ON Monday, February 25, 2008, the Daily Graphic carried a British Broadcasting Corporation (BBC) report with the headline, “Daytime dozing — early warning sign of stroke,” which made many readers sit up.
I could say that for a fact because five people, friends and family members, who are aware of my interest in health issues, called me to read that story.
According to the BBC report, which was based on a study conducted by a group of US researchers, regular unintentional daytime dozing may be an early warning sign of stroke in elderly people.
It continued that for those who had a habit of nodding off, the risk of stroke was two to four times higher than for those who never fell asleep in the day.
At an International Stroke Conference, the team advised doctors to check out older people who found they were dropping off in front of the TV.
As part of the research, the study asked 2,000 people how often they dozed off in different situations.
The situations included while watching TV, sitting and talking to someone, sitting quietly after a lunch without alcohol and stopping briefly in traffic while driving.
The risk of stroke over the next two years was 2.6 times greater for people who reported "some dozing" compared to those with no dozing. Among those who reported "significant dozing" the risk was 4.5 times higher.
The researchers also found the risk of heart attack or death from vascular disease was 1.6 per cent higher for moderate dozers and 2.6 per cent higher for significant dozers.
Study leader, Dr Bernadette Boden-Albala, Assistant Professor of Neurology at Columbia University, New York, said: "Those are significant numbers. We were surprised that the impact was that high for such a short period of time."
Previous research has shown that people who suffer from sleep apnoea— short periods when breathing stops during sleep— have an increased stroke risk.
It could be that daytime sleepiness is a sign of sleeping poorly at night because of sleep apnoea.
"Given what's known now, it's worth assessing patients for sleep problems," Dr Boden-Albala said.
"If patients are moderately or significantly dozing, physicians need to think about sending them for further evaluation."
She added that other studies had shown people were not getting enough sleep, making them consistently tired.
"But the real question is: 'What are we doing to our bodies?'. Sleepiness obviously puts us at risk of stroke."
Dr Heinrich Audebert, Consultant Stroke Physician at Guy and St Thomas's Hospital in London said the findings seemed reasonable.
"Sleep apnoea is a risk factor for stroke and in Mediterranean countries the siesta is associated with a little bit of an increased daytime risk of stroke," he said.
After reading this piece, it became evident that it is important if we spend a little of our time to learn about stroke and how it could be prevented.
What is a stroke?
According to health experts, a stroke is the sudden death of brain cells due to a problem with the blood supply. When blood flow to the brain is impaired, oxygen and important nutrients cannot be delivered. The result is abnormal brain function. Blood flow to the brain can be disrupted by either a blockage or rupture of an artery to the brain. A stroke is also referred to as a cerebrovascular accident or CVA.
Signs of Stroke
According to a report posted on the Internet by a group of University of North Carolina researchers, three commands sometimes used by doctors to begin assessing whether a person may be experiencing a stroke can also be useful for people who are not doctors, so as to help themselves or others who might be at risk.
The report said non-health professionals can ask a potential stroke victim to smile, raise both arms or make a simple sentence to determine whether he was suffering from the disease or not.
These three commands, known as the Cincinnati Prehospital Stroke Scale (CPSS), are used by health professionals as a simple first step in the assessment process for signs of stroke. If a person has trouble with any of these simple commands, the person should immediately be sent to hospital with a description of the situation, noting that you suspect the individual is having a stroke.
Another report from the US National Institute of Neurological Disorders and Stroke also states that major signs of stroke are the sudden onset of: Numbness or weakness of the face, arm or leg, especially on one side of the body, the loss of voluntary movement and/or sensation may be complete or partial. These may also be associated with tingling sensation in the affected area.
What causes a stroke?
According to health experts, the blockage of an artery in the brain by blood clot (thrombosis) is the most common cause of a stroke. The part of the brain that is supplied by the clotted blood vessel is then deprived of blood and oxygen. The cells of that part of the brain die as a result.
Typically, a clot forms in a small blood vessel within the brain that has previously been narrowed due to the long–term damaging effects of high blood pressure (hypertension) or diabetes. The resulting strokes are called lacunar strokes because they look like little lakes.
In other situations, usually because of hardening of the arteries (atherosclerosis), a blood clot can obstruct a larger vessel going to the brain, thereby preventing blood supply to the brain through the neck.
Another type of stroke may occur when a blood clot or a piece of atherosclerotic plaque (cholesterol and calcium deposits on the wall of the inside of the heart or artery) breaks loose, travels through open arteries, and lodges in an artery of the brain. When this happens, the flow of oxygen–rich blood to the brain is blocked and a stroke occurs.
This type of stroke is referred to as an embolic stroke.
A cerebral haemorrhage occurs when a blood vessel in the brain ruptures and bleeds into the surrounding brain tissue. A cerebral haemorrhage (bleeding in the brain) can cause a stroke by depriving blood and oxygen to parts of the brain. The accumulation of blood from a cerebral haemorrhage can also press on parts of the brain and cause damage.
A subarachnoid haemorrhage is caused by the rupture of a blood vessel that is usually located between the outside of the brain and the inside of the skull. The blood vessel at the point of rupture is often previously abnormal, such as from an aneurysm, which is an abnormal ballooning out of the wall of the vessel. Subarachnoid haemorrhages usually cause a sudden, severe headache and are often complicated by further neurological problems, such as paralysis, coma, and even death.
Overall, the most common risk factors for stroke are high blood pressure and increasing age. Diabetes and certain heart conditions, such as atrial fibrillation, are other common risk factors.
When strokes occur in younger individuals who are less than 50 years old, less common risk factors are often involved. These risk factors include drugs, such as cocaine or amphetamines, ruptured aneurysms, and inherited (genetic) predisposition to blood clotting.
Another example of a genetic predisposition to stroke occurs in a rare condition called homocystinuria, in which there are excessive levels of the chemical homocystine in the body. Another rare cause of stroke is vasculitis, a condition in which the blood vessels become inflamed.
Another report have it that there appears to be a very slight increased occurrence of stroke in people with migraine headache.
What are the treatable risk factors?
Health experts state that some of the most important treatable risk factors for stroke are: High blood pressure, also called hypertension.
This health condition is considered by far the most potent risk factor for stroke. If one’s blood pressure is high, it is important his or her doctor works out an individual strategy to bring it down to the normal range.
To reduce the risks, one needs to maintain proper weight. Avoid drugs known to raise blood pressure. Cut down on salt. Eat fruits and vegetables to increase potassium in diet. Exercise more: A doctor may prescribe medicines that could help lower blood pressure.
Controlling blood pressure will also help one avoid heart disease, diabetes, and kidney failure.
Avoid cigarette smoking: Cigarette smoking has been linked to the build-up of fatty substances in the carotid artery, the main neck artery supplying blood to the brain. Blockage of this artery is the leading cause of stroke in Americans. Also, nicotine raises blood pressure; carbon monoxide reduces the amount of oxygen one’s blood can carry to the brain; and cigarette smoke makes one’s blood thicker and more likely to clot.
Another risk factor, diabetes, causes destructive changes in the blood vessels throughout the body, including the brain. Treating diabetes can delay the onset of complications that increase the risk of stroke.