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Cerebral Vascular Disease

Strengthening Cerebral Vasculature
The skin of thick-skinned berries such as cherries and grapes, the seeds of grapes, and the skin, leaf, and flower of the Hawthorne tree are all naturally rich sources of a potent antioxidant called oligomeric proanthocyan a i dins (OPC). These naturally occurring antioxidant flavonoids are tissue specific for strengthening the walls of arteries and thereby reducing the risk of recurring aneurysms and hemorrhagic strokes. In addition to antioxidant protection, OPCs also support collagen and help maintain elastin throughout the entire body. These two critical proteins are major components of all our connective tissues and organs. They are responsible for maintaining structural integrity as well as the elasticity of all the tissues throughout your body. This includes joints, blood vessels, skin, ligaments, tendons, muscles, and even the heart.

By maintaining healthy levels of structural collagen and elastin, our bodies are able to continue to function more efficiently and maintain their youthful strength and flexibility longer. OPCs attach to "reactive sites" on collagen molecules and protect them from free radical attack. This is one of the reasons they are so protective and so valuable for the circulatory system (Laperra et al. 1977; Thebaut et al. 1985; Blazso et al. 1997; Rohdewald 1998; Packer et al. 1999). As noted earlier, oligomeric proanthocyan i a dins are found in grape seeds, Hawthorne tree skin, leaf, and flowers, thick-skinned berries, and the inner rind of citrus fruit.

Conclusion
Hemorrhagic stroke is a medical emergency. The two types of hemorrhages involved are ICH and SAH.

• The primary risk factor for ICH is hypertension, because chronic hypertension weakens blood vessels. Other risk factors include drug and alcohol abuse, anticoagulant medications, age, gender, and race.
• The underlying cause for SAH is cerebral aneurysm (an abnormal dilation of a blood vessel in the brain). Risk factors for SAH include family history of aneurysm, age, gender, and race.

Symptoms for both types of hemorrhagic stroke are similar and include sudden onset of severe headache, loss of consciousness, nausea and vomiting, and partial or total paralysis. Diagnosis of the underlying cause of hemorrhagic stroke is by CT scan, MRI, and angiography. Surgical evacuation of the hematoma may be necessary. For SAH, treatment includes clipping or embolization of the aneurysm.

The medications Hydergine and piracetam may be beneficial to patients with hemorrhagic shock. The FDA has not approved Hydergine for the treatment of stroke, but it should be available through the hospital pharmacy, and patients or their surrogates should request its use. Piracetam may be beneficial in preventing permanent neurological damage following stroke. Piracetam is not currently available in the United States .

There is little research on natural supplements for hemorrhagic stroke. CDP-Choline and vitamin C may be of some benefit in facilitating recovery and preventing future strokes. Supplements like vinpocetine and phosphatidylserine that enhance neuronal energy metabolism could also help in the rehabilitation process. See the section on Cerebral Aneurysm for recommendations on maintaining healthy blood vessels.

1. The symptoms of intracerebral hemorrhage (ICH) include nausea and vomiting; sudden, severe headache; weakness; numbness; paralysis, particularly to one side of the body; and partial or total loss of consciousness. The symptoms of subarachnoid hemorrhage (SAH) include sudden, severe headache; nausea and vomiting; stiff neck; light intolerance; and partial or total loss of consciousness.
2. Diagnostic procedures for hemorrhagic stroke include CT scan, MRI, and cerebral angiogram. Treatment of hemorrhagic stroke consists of medication and surgical interventions, based on the underlying cause of the hemorrhage:
   1. For intracranial hemorrhage resulting from uncontrolled hypertension, the initial treatment is blood pressure control (see the Cardiovascular Disease protocol for more information about natural blood-pressure lowering supplements and the Hypertension protocol ).
   2. Persons taking anticoagulants (Coumadin and aspirin) should exercise extreme care to prevent ICH. If signs of major hemorrhage are present, these medications should be immediately discontinued. For more information about Coumadin and natural blood-thinners, see the Thrombosis Prevention protocol and the Thrombotic Stroke section.
   3. Smoking should be discontinued for those at risk of ICH. The detrimental effects of smoking on the cardiovascular system are well known.
   4. Amyloidosis can be due to several diseases, including multiple myeloma (amyloid light chains) and Alzheimer's disease (beta-amyloid). The Alzheimer's Disease protocol contains information on several natural supplements that reduce beta-amyloid deposition.
3. Hydergine, an antioxidant medication that protects brain cells, may be given in an acute situation. The recommended dosage is 10 mg given sublingually and 10 mg administered orally. Because the FDA has not approved Hydergine for this purpose, the patient or patient's advocate should request that the medication be given.
4. Piracetam, a nootropic medication, may be useful in the prevention of hemorrhagic stroke because it appears to protect brain cells from injury during the stroke event. The recommended dosage for piracetam is 4800 mg a day, administered orally.
5. CDP-choline may be useful in both preventing and reducing the neurological damage following hemorrhagic stroke. CDP-Choline Caps contain 250 mg of cytidine-5'-diphosphocholine. One capsule a day is recommended for healthy people over the age of 40. Those with neurological impairment should take 2 capsules daily.
6. Vitamin C has been shown to both lower the risk of hemorrhagic stroke and reduce the neurological damage following hemorrhagic stroke. An appropriate dosage of vitamin C depends on the dietary intake. A prophylactic dose of 2.5-6 grams daily is recommended. Up to 15 grams a day may be taken therapeutically. Large doses should be consumed with meals. Do not take high doses of vitamin C during an acute stroke.
7. For further protection from free-radical induced brain injury, consider taking 300 mcg-10 mg of melatonin (at night) and 100-200 mg of palm-oil derived tocotrienols (vitamin E) a day.

Cerebral Aneurysm

• Conventional Treatment
• Integrated or Alternative Therapies
• Medical Device Advances the Treatment of an Aneurysm
• Conclusion

Cerebral artery aneurysm, one of the cerebral vascular diseases, can be fatal. An aneurysm is a weakened portion of the heart or a blood vessel, usually an artery, that fills up with blood under pressure, causing it to balloon outward. Aneurysm can be caused by a hereditary weakness in the vessel wall, high blood pressure, atherosclerosis, direct injury, infection, and other diseases.

Approximately 30,000 people a year in the United States experience an aneurysm rupture, causing cerebral hemorrhage. It has been estimated that if five people were to experience a cerebral hemorrhage today, in 1 year: only one of those people would be alive and well; one would be disabled; and the other three would be dead.

Cerebral vascular hemorrhage may also produce delayed problems such as hydrocephalus ("fluid on the brain") and narrowing of the blood vessels because of the irritation of the blood on the blood vessels (known as vasospasm). Rebleeding, hydrocephalus, and vasospasm can happen days to weeks after the initial bleed. Aneurysms can and do grow. If they reach a certain size, usually more than 25 mm (1 inch), they may start applying pressure on the surrounding brain tissue and cause additional problems.

Cerebral aneurysm is very uncommon in patients under 20 years of age and is increasingly common in older patients. In people over 65, cerebral aneurysm may be found in as high as 5% of the population. It appears cerebral aneurysm is related to an absence of a muscular layer that makes up part of the blood vessels; over time, it stretches and thins and creates the aneurysm. Smoking appears to markedly increase the chance that one will develop a cerebral aneurysm.

Indications of the presence of an aneurysm depend on the location of the aneurysm. Aneurysm generally exhibits few symptoms and is discovered by accident on x-ray films or imaging scans performed for some other reason.

The rupture or hemorrhage of an aneurysm usually produces severe pain. The location of the aneurysm usually determines the amount of bleeding, shock, loss of consciousness, or if death will occur. In some cases, the aneurysm may leak blood, causing warning pain without the rapid deterioration and damage characteristic of a rupture. The threat of aneurysm goes beyond the immediate site damage it can cause. Blood clots often form in an aneurysm, creating danger of embolisms and clotting in distant organs or vessels.

Cerebral hemorrhagic problems occur when an aneurysm ruptures, causing internal bleeding. For example, aneurysm affecting the arteries supplying the brain can occur at any age, but occurs most often in people 60 years of age with a history of hypertension. The aneurysm may rupture, causing hemorrhage and blood leakage into the membrane surrounding the brain. A cerebral artery aneurysm is particularly important because it can lead to fatal subarachnoid hemorrhage which occurs underneath one of the layers of tissue lining the brain. This aneurysm frequently occurs from inherited vascular defects at the branch points of cerebral arteries.

If your physician suspects an aneurysm or the possibility of hemorrhage, he or she will probably recommend ultrasound testing, computed tomography scanning (CT scan), magnetic resonance imaging (MRI), or angiography of the area to determine the size and severity and to predict the possibility of rupture and subsequent hemorrhage.

Conventional Treatment
If an aneurysm is large and the risk of rupture is significant, surgery may be necessary.

When an aneurysm ruptures, emergency surgery is necessary to stop the bleeding. Surgical intervention into cerebral aneurysm or hemorrhage may be difficult or impossible because of the constraints of access to the damaged or threatened areas of the brain.

Hypertensive drugs may also be prescribed in an attempt to lower blood pressure and reduce the chances of additional aneurysm or cerebral hemorrhage (see the Cardiovascular Disease protocol for more information on natural ways to reduce blood pressure).

Integrated or Alternative Therapies
Researchers speculated in a 1998 issue of Life Sciences Journal that "an acute systemic oxidative stress condition might influence the rupture of intracranial aneurysm." Vitamin E was specifically identified by investigators to act as an antioxidant by scavenging free radicals and thus reducing the conditions that precipitate these cerebral vascular ruptures (Marzatico et al. 1998). We recommend taking 400-800 IU of vitamin E daily to reduce the risk of aneurysm ruptures. Vitamin C at 2000-5000 mg a day is suggested, along with 300 mg a day of the flavonoid proanthocyan i a din (from grape seed or pine bark) for further protection against underlying factors that cause cerebral vascular disease.

Magnesium is crucial for arterial structure, and it is suggested that 1500 mg a day of elemental magnesium be taken along with 1000 mg a day of calcium and 500 mg a day of potassium.

Mechanisms that regulate cerebral circulation have been intensively investigated in recent years, and this research is increasingly focused on the effects of nitric oxide. Nitric oxide is an important regulator of cerebral vascular tone. Nitric oxide maintains the cerebral vasculature in a dilated state. Arginine, a natural supplement, specifically enhances nitric oxide synthesis. Persons with cerebral vascular disease may consider taking 4-5 grams of arginine 3 times a day to better maintain the health of vessels.

Activation of potassium channels appears to be a major mechanism for dilatation of cerebral arteries. Agents that increase the intracellular concentration of cyclic adenosine monophosphate (cAMP) produce vasodilatation. Supplementation with 500 mg a day of potassium and 5-20 mg a day of Hydergine may enhance vasodilatation in cerebral vascular disease, helping to restore vessels to a healthier state.

Additionally, alcohol consumption poses a risk for development of hypertension (high blood pressure), strokes, and sudden death through the depletion of magnesium from the body. The dietary intake of magnesium modulates the hypertensive actions of alcohol (Altura et al. 1999). Experiments indicate that chronic ethanol ingestion results in the contraction of the cerebral arteries and capillaries, a contraction that causes increased cerebral vascular resistance. Chronic ethanol ingestion increases the reactivity of intact microvessels to vasoconstrictors and results in decreased reactivity to vasodilators. However, pretreatment of animals with magnesium prevents ethanol from inducing a stroke and prevents the adverse cerebral vascular changes from taking place. Magnesium influences the response of cerebral arteries to several other natural or synthetic stimulators (agonists) and has been shown to decrease cerebral vascular resistance. Contractility of cerebral arteries is dependent upon the actions and interactions of calcium and magnesium (Altura et al. 1994).

It is clear from published studies that magnesium can induce healthy vascular tone in all types of vascular smooth muscle. Magnesium appears to act on voltage-, receptor-, and leak-operated membrane channels in vascular smooth muscle. Standard channel blocker drugs do not have this uniform capability. Calcium channel-blocking drugs, however, can block calcium infiltration into brain cells, lower cerebral vascular resistance, relieve cerebral vasospasm, and lower arterial blood pressure.

Magnesium can also cause significant vasodilatation of intact cerebral arteries. Although magnesium is three to five orders of magnitude less potent than the standard calcium channel-blocking drugs, it possesses unique and potentially useful effects in maintaining healthy cerebral vascular circulation. Those with cerebral vascular disease, and especially those who consume alcohol, should take 1500 mg a day of elemental magnesium.

Nimotop (nimodipine) is an FDA-approved calcium channel-blocking drug specific to cerebral circulation and brain-cell activity. It has been shown to work better in the restoration of cerebral circulation than any other calcium channel-blocking drug yet tested. The normal dose is 30 mg of Nimotop taken 3 times a day.

Medical Device Advances the Treatment of an Aneurysm
By using the device known as the Guglielmi coil, physicians can now correct an aneurysm that is not approachable surgically, either because of its position in the brain or because of other factors that present a high risk.

The coil is an extremely fine wire made from platinum--one of the softest metals--at the end of a longer stainless steel wire. Several coils, depending on the size of the aneurysm, are inserted inside the bubble-like aneurysm through a catheter (a long, narrow tube) threaded through the patient's blood vessels. When the coil is in the correct position--verified by a blood vessel X-ray called an angiogram--it is given a positive electrical charge. The charge causes the steel wire to dissolve at the point of a junction with the platinum coil and the positively charged coil attracts blood cells to form a clot within the aneurysm.

The coils and resulting blood clot fill up the aneurysm, essentially sealing it off. Eventually, the lining of the blood vessel grows over the "neck" of the aneurysm and the aneurysm is essentially healed.

Conclusion
Cerebral vascular disease can be life - threatening. Aneurysm and the subsequent rupture-causing hemorrhage are caused by inherited vascular defects and may be unavoidable. Aneurysm is often precipitated by atherosclerosis and hypertension. High blood pressure increases the risk of aneurysm. Reduction of high blood pressure is imperative in reducing the risk of cerebral vascular disease. Natural supplements combined with lowered blood pressure can reduce the risk and/or damage caused by cerebral vascular disease.

Refer to the Age-Associated Mental Impairment protocol for additional suggestions about restoring cerebral circulation. See the Cardiovascular Disease protocol and the Hypertension protocol for more information on hypertension, cholesterol reduction, and atherosclerosis.

The following nutrients and drugs should be considered:

1. To maintain cerebral vasculature, thus lowering the risk of a cerebral aneurysm or hemorrhagic stroke, the following supplements should be considered:
   1. Magnesium, 1500 mg daily.
   2. Arginine, 4-5 grams daily.
   3. Calcium, 1000 mg daily.
   4. Grape seed extract, two 200-mg capsules daily.
2. To enhance vasodilation and improve the health of vessels, consider the following:
   1. Potassium, 500 mg daily.
   2. Hydergine, 5-20 mg daily. (Hydergine may be obtained by prescription or from offshore pharmacies.)
3. Antioxidants scavenge free radicals and protect against underlying factors that lead to cerebral vascular disease:
   1. Gamma E Tocopherol with Sesame Lignans, 1-2 softgels daily.
   2. Vitamin C, 2000-5000 mg daily.

For more information

Contact the National Institute of Neurological Disorders and Stroke, (800) 352-9424.

Product availability

Vinpocetine, low-dose aspirin, CDP-Choline Caps, Policosanol Tabs, Certified Ginkgo Extract, vitamin E succinate, Gamma E Tocopherol w/ Sesame Lignans  Super EPA/DH w/Sesame Lignans, R-dihydro-lipoic acid, selenium, green tea extract, liquid emulsified vitamin A, beta-carotene, No Flush Niacin, pregnenolone, DHEA, Super Carnosine, L-theanine, Mineral Formula for Men, Mineral Formula for Women, magnesium, calcium, arginine, potassium, vitamin C, Grape Seed Extract with Resveratrol, TMG, vitamin B6, Methylcobalamin (B12 sublingual tablets), folic acid + B12, melatonin, and Kyolic Reserve Garlic can be ordered by calling (800) 544-4440 or by ordering online. You may also ask for a list of offshore suppliers of Hydergine, Piracetam, and Aminoguanidine. Coumadin is a prescription medication.