Stroke

What is a stroke?

Quick test for a stroke

Symptoms of a stroke

Silent stroke

Risk factors for strokes

Immediate treatment for a stroke

Prevention / remedies for strokes

References

What is a stroke?

A stroke (cerebrovascular accident or CVA) is the rapid loss of brain function due to a disruption of the blood supply to the brain. At the lesser level, a mini-stroke may have symptoms which last for hours before the symptoms resolve. At the other extreme, symptoms are life-changing and life-threatening. 20% of those who have a mini-stroke go on to have another more serious stroke within a year.

The lack of blood flow (ischemia) to the brain can be caused by:

• Blockage (thrombosis, embolism) of a vein or artery.
• Internal bleeding from the rupture of a blood vessel (haemorrhage). Usually caused by trauma or drugs.
• Sudden decrease in blood supply (from shock, heart failure, cardiac arrest or arrhythmia, for example).

A stroke is a medical emergency that can cause permanent brain damage or death. A stroke is a time-critical emergency. In many (but not all) cases, the sooner a clot-buster can be administered within a maximum four hour window, the better the outcome.

Strokes are the second leading cause of death worldwide, (5) after heart disease and before cancer.

A stroke is caused by the blockage of a blood vessel (vein or artery) by an embolus (a travelling particle or debris). The most common blockage is an atherosclerotic plaque. Other types of blockages can include a lump of fat, some bone marrow or broken bone, air, a cancerous tumour or clump of bacteria.

The cause of atherosclerotic plaques is chronic (continual) inflammation - simply your body's natural defence to a foreign invader such as a bacteria, toxin or virus.

Sickle-cell anemia can cause blood cells to clump up and block blood vessels, and can also lead to stroke.

Quick test for a stroke

Sometimes it is difficult to tell if someone has had a stroke or not. Here are quick and simple tests for a stroke:

• Ask the person to SMILE.
• Ask the person to TALK and SPEAK a simple coherent sentence.
• Ask the person to RAISE BOTH ARMS.
• Ask the person to stick out their TONGUE straight. If it goes to one side, that is an indication of a stroke.

If they have difficulty with any of these tasks, get emergency medical advice.

Symptoms of a stroke

Stroke symptoms usually start within seconds or minutes.

The symptoms can vary widely, depending on the part of the brain affected. Sometimes there are no symptoms (see silent stroke).

• Cannot move and hold arms above head, raise legs, turn head properly, walk straight. New muscle weakness.
• Weakness, numbness or loss of function on part of the face. One side of the face drooping.
• Inability to understand or formulate speech.
• Altered or lost smell, taste, hearing.
• Abnormal vision, blurred vision, inability to see on one side of the visual field. Drooping eyelid.
• Balance problems.
• Dizziness.
• Headache.
• Nausea, vomiting.
• Seizures.
• Altered breathing and heart rate.
• Confusion, loss of memory.

Silent stroke

A silent stroke has no outward symptoms, and the person is typically unaware that they have suffered a stroke. Silent strokes are estimated to occur at five times the rate of symptomatic strokes. (1, 2) The risk of silent stroke increases with age, but may also affect younger adults and children, especially those with acute anemia. (1, 3)

Risk factors for strokes

• High blood pressure. Hypertension accounts for 35-50% of stroke risk. (4)
• Poor diet, high in sugar, carbohydrates and omega-6 polyunsaturated fats. (8)
• Poor diet, low in saturated fats. A major 2019 meta-analysis demonstrated that a higher consumption of dietary saturated fatty acids (SFA) is associated with a lower risk of stroke, and every 10 g/day increase in SFA intake is associated with a 6% relative risk reduction in the risk of stroke. (9)
• Lack of physical activity, little exercise.
• Stress is a major risk factor for stroke. Unresolved stress, particularly stress caused by losses such as loss of job, loss of loved one, loss of money, loss of friends or connection, loss of position.
• Vitamin E deficiency. A good vitamin E status provides protection against suffering a stroke, lessens damage should a stroke occur, and significantly assists with recovery after a stroke. (10, 11, 12)
• Potassium deficiency.
• Obesity.
• Age. 95% of strokes occur in people aged over 45, and two-thirds in those over 65.
• Previous stroke.
• Diabetes.
• Poor blood lipid profile.
• Atrial fibrillation.
• Air pollution. short-term fluctuations in particulate air pollution can act as a trigger for stroke and heart attack. (6, 7) Over a longer period, particulate air pollution raises the risk of stroke, heart disease, depression and many other diseases, and is associated with increased mortality (including suicide).
• Cigarette smoking, pharmaceutical drugs (such as cough and cold medications containing sympathomimetics), alcohol, and illicit drugs such as cocaine and amphetamines.

Immediate treatment for a stroke

It is essential to get urgent treatment within minutes or hours of a stroke - the sooner the treatment starts, the better the outcome. In hospital, the blockage will either be broken down / dissolved with a "clot buster" (thrombolysis), or removed / repaired with surgery.

Stroke rehabilitation to recover lost brain function. Physiotherapists; speech, language, occupational and other physical therapists need to be involved immediately and extensively. The brain is highly plastic, and the sooner rehabilitation starts, the better the outcome. Continual rehabilitation at the limit of the person's ability pays dividends over the following weeks and months. Most return of function is seen in the first few months, though some people continue to improve for years, regaining and strengthening abilities like writing, walking, running, and talking. Continuing exercise and social interaction are essential.

Prevention / remedies for strokes

• Vitamin E sufficiency, particularly of alpha-tocotrienols. The best food sources of tocotrienols are Malaysian red palm oil, annatto, and to a lesser extent tree nuts, legumes and whole grains. (10, 11, 12)
• Diet. Get sufficient saturated and omega-3 fats in your diet, and avoid polyunsaturated omega-6 fats made from grains and legumes.
• Exercise and regular movement (Not sitting around for long periods).
• No sugar, no refined carbohydrate, ketogenic diet..
• Natural blood thinners. The most effective natural blood thinner is cayenne pepper.
• Vitamin B3 (niacin). Fish, beef, chicken, turkey and spirulina are the best food sources of niacin. In a more urgent situation, niacin can be purchased as a supplement, and may be useful at 500 mg per day in an extended-release form. Niacin is a powerful antioxidant which acts upon cholesterol, and in particular niacin decreases small, dense, oxidised forms of cholesterol. It provides cardiovascular protection by preventing white blood cells forming atherosclerotic accumulation. Niacin decreases triglyceride levels. It decreases vascular oxidation through its anti-inflammatory effects. Niacin decreases C-reactive protein, which is a strong predictor of heart attack, stroke and peripheral vascular disease.
• Vitamin B1. (13)
• High blood pressure (hypertension) reduction.
• Potassium sufficiency to help keep your blood vessels elastic and blood pressure normal.
• Weight control.
• Methylene blue.
• Garlic.
• See details of remedies recommended by Grow Youthful visitors, and their experience with them.

References

1. Herderschee D, Hijdra A, Algra A, Koudstaal PJ, Kappelle LJ, van Gijn J. Silent stroke in patients with transient ischemic attack or minor ischemic stroke. The Dutch TIA Trial Study Group. September 1992, Stroke 23 (9): 1220-4. PMID 1519274.

2. Leary MC, Saver JL. Annual incidence of first silent stroke in the United States: a preliminary estimate. 2003, Cerebrovasc. Dis. 16 (3): 280-5. PMID 12865617.

3. Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. January 2002, Stroke 33 (1): 21-5. PMID 11779883.

4. Whisnant JP. Effectiveness versus efficacy of treatment of hypertension for stroke prevention. 1996, Neurology 46 (2): 301-7. PMID 8614485.

5. Mathers, CD; Boerma, T; Ma Fat, D. Global and regional causes of death. 2009, British medical bulletin 92: 7-32. PMID 19776034.

6. Anoop S V Shah, Kuan Ken Lee, David A McAllister, Amanda Hunter, Harish Nair, William Whiteley, Jeremy P Langrish, David E Newby, Nicholas L Mills. Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ 2015;350:h1295, Published 24 March 2015.

7. Melinda C Power, Marianthi-Anna Kioumourtzoglou, Jaime E Hart, Olivia I Okereke, Francine Laden, Marc G Weisskopf. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ 2015;350:h1111, Published 24 March 2015.

8. Matthew P. Pase, Jayandra J. Himali, Alexa S. Beiser, Hugo J. Aparicio, Claudia L. Satizabal, Ramachandran S. Vasan, Sudha Seshadri, Paul F. Jacques. Sugar and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia. Stroke. 2017;STROKEAHA.116.016027. Published 20 April 2017.

9. Zhou-Qing Kang, Ying Yang, Bo Xiao. Dietary Saturated Fat Intake and Risk of Stroke: Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Retrieved online 1 October 2019. Nutr Metab Cardiovasc Dis. PMID: 31791641 DOI: 10.1016/j.numecd.2019.09.028.

10. Yogheswaran Gopalan, Ibrahim Lutfi Shuaib, Enrico Magosso, Mukhtar Alam Ansari, Mohd Rizal Abu Bakar, Jia Woei Wong, Nurzalina Abdul Karim Khan, Wei Chuen Liong, Kalyana Sundram, Bee Hong Ng, Chinna Karuthan, Kah Hay Yuen. Clinical Investigation of the Protective Effects of Palm Vitamin E Tocotrienols on Brain White Matter. 03 Apr 2014, Stroke;45:1422-1428.

11. Kabir MI, Adnan M, Rahman MM. Natural Sources of Tocotrienols: A Note on Absorption. J In Silico In Vitro Pharmacol (2017). 3:20. doi: 10.21767/2469-6692.100020.

12. Gabsi S, Gouider-Khouja N, Belal S, Fki M, Kefi M, Turki I, Ben Hamida M, Kayden H, Mebazaa R, Hentati F. Effect of vitamin E supplementation in patients with ataxia with vitamin E deficiency. Eur J Neurol. 2001 Sep;8(5):477-81. doi: 10.1046/j.1468-1331.2001.00273.x. PMID: 11554913.

13. Costantini A, Giorgi R, D'Agostino S, Pala MI. High-dose thiamine improves the symptoms of Friedreich's ataxia. BMJ Case Rep. 22 May 2013;2013:bcr2013009424. doi: 10.1136/bcr-2013-009424. PMID: 23704441; PMCID: PMC3669970.