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Stroke (Ischemic, Thrombotic, Embolic, and Transient Ischemic Attack)
Updated: 08/01/2003
Amazingly, 42% of stroke patients wait as long as 24 hours before presenting for medical treatment. That's 21 hours too late! The delay in presenting at the emergency room results in a missed opportunity to effectively treat, and possibly reverse, the damage caused by thrombotic stroke. According to one published study, "Patients with milder symptoms, for whom treatment might be more effective, were less likely to arrive in time for therapy" (Stroke [USA], May 1997; 28[5]:1092).
Stroke is the third leading cause of death in developed countries. About 25% of sufferers die as a result of the stroke or its complications, and almost 50% have moderate to severe health impairments and long-term disabilities. Only 26% recover most or all normal health and function.
We often consider "heart attack" as a "life or death" health event. Strokes have been given less attention, but the new realization that the disease is an acute event has now led to stroke being referred to as a "brain attack." Thrombotic strokes are a major cause of brain attacks, and are caused in part by atherosclerosis, hypertension, and diseases that cause abnormal arterial blood clot formation (thrombosis) such as atrial fibrillation and heart valve replacement.
The time it takes to receive treatment is as important to stroke victims as it is for those suffering a heart attack! Not recognizing the symptoms of a stroke, or believing that stroke is untreatable, too many people fail to respond to the warning symptoms of stroke by seeking immediate medical attention.
Further contributing to stroke deaths is the belief by many health care providers that stroke is untreatable, leading to an attitude of "watchful waiting" with an onset of a stroke, instead of being focused on treating the stroke as a medical emergency. The National Stroke Association succinctly described this problem in 1999 as follows: "These outdated attitudes serve as the largest obstacle to the effective prevention and emergency treatment of strokes."
(See symptoms and emergency treatment of a stroke below. Your life may depend on it!)
The Underlying Causes
As with almost all cardiovascular disease, strokes are generally the result of several underlying diseases which work to stop or reduce the flow of blood to the brain, causing disability or death.
The majority of strokes occur when a blood clot blocks the flow of oxygenated blood to a portion of the brain. This type of stroke, caused by a blood clot blocking, or "plugging," a blood vessel, is called ischemic stroke. An ischemic stroke can be caused by a blood clot that forms inside the artery of the brain (thrombotic stroke), or by a clot that forms somewhere else in the body and travels to the brain (embolic stroke). In healthy individuals, blood clotting is beneficial. When you are bleeding from a wound, blood clots work to stop the bleeding. In the case of ischemic stroke, abnormal blood clotting blocks large as well as small arteries in the brain, cutting off blood flow, resulting in a clinical diagnosis of ischemic, thrombotic, or embolic stroke.
Ischemic strokes account for 83% of all strokes, and occur as either an embolic or thrombotic stroke. Thrombotic strokes represent 52% of all ischemic strokes. Thrombotic stroke is caused by unhealthy blood vessels becoming clogged with a buildup of fatty deposits, calcium, and blood clotting factors such as fibrinogen and cholesterol. We generally refer to this as atherosclerotic disease. Simplistically, what happens with a thrombotic stroke is that our bodies regard these "buildups" as multiple, infinitesimal, repeated injuries to the blood vessel wall. Our own bodies react to these injuries, and just as they would if we were bleeding from a small wound, respond by forming blood clots. Unfortunately, in the case of thrombotic strokes, these blood clots get caught on the plaque on the vessel walls and reduce or stop blood flow to the brain. That's when we suffer a brain attack.
Two types of thrombosis can cause a stroke: large vessel thrombosis and small vessel disease. Thrombotic stroke occurs most often in the large arteries, magnifying the impact and devastation of disease. Most large vessel thrombosis is caused by a combination of long-term atherosclerosis followed by rapid blood clot formation. Many thrombotic stroke patients have coronary artery disease, and heart attacks are a frequent cause of death in patients who have suffered this type of brain attack.
The second type of thrombotic stroke is small vessel disease, which occurs when blood flow is blocked to a very small arterial vessel. Little is known about the specific causes of small vessel disease, but it is often closely linked to hypertension and is an indicator of atherosclerotic disease.
In an embolic stroke, a blood clot forms somewhere in the body (usually the heart) and travels through the bloodstream to the brain. Once in the brain, the clot eventually travels to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke.
The other type of stroke is called hemorrhagic stroke and is not caused by a blood clot. A hemorrhagic stroke, also known as a cerebral hemorrhage, occurs when a blood vessel in the brain breaks or ruptures. This type of stroke occurs less frequently than ischemic stroke.
Risk Factors for Strokes
The top risk factors for thrombotic strokes are the presence of hypertension, atherosclerosis, excessive blood-clotting factors (such as homocysteine, fibrinogen, and LDL cholesterol), heart valve defects, diabetes, and aging.
High blood pressure. High blood pressure is the most prominent risk factor for stroke. In fact, stroke risk varies directly with blood pressure. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for strokes.
Increasing age. The chance of having a stroke more than doubles for each decade of life after age 55. While strokes are common among the elderly, substantial numbers of people less than 65 also have strokes.
Gender. Overall, men have about a 19% greater chance of a stroke than women. Among people under age 65, the risk for men is even greater when compared to that of women.
Heredity (family history) and race. The chance of a stroke is greater in people who have a family history of strokes. African-Americans have a much higher risk of death and disability from a stroke than Caucasians, in part because African-Americans have a greater incidence of high blood pressure.
Prior stroke. The risk of a stroke for someone who has already had one is several times that of a person who has not.
Cigarette smoking. In recent years studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking also greatly increases stroke risk.
Diabetes mellitus. Diabetes is an independent risk factor for stroke and is strongly correlated with high blood pressure. While diabetes is treatable, having it still increases a person's risk of a stroke. People with diabetes often also have high cholesterol and are overweight, increasing their risk even more.
Carotid artery disease. The carotid arteries in your neck supply blood to your brain. A carotid artery damaged by atherosclerosis (a fatty buildup of plaque in the artery wall) may become blocked by a blood clot, which may result in a stroke. If you have a diseased carotid artery, your health care provider may hear an abnormal sound in your neck, called a bruit, when listening with a stethoscope.
Heart disease. A diseased heart increases the risk of a stroke. In fact, people with heart problems have more than twice the risk of a stroke as those with hearts that work normally. Atrial fibrillation (the rapid, uncoordinated beating of the heart's upper chambers), in particular, raises the risk for stroke. Heart attack is also the major cause of death among survivors of a stroke.
Transient ischemic attacks (TIAs). TIAs are "mini-strokes" that produce stroke-like symptoms, but no lasting damage. They are strong predictors of a stroke. A person who has had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't.
WARNING: TIAs are extremely important stroke warning signs. Don't ignore them!
High red blood cell count. A moderate or marked increase in the red blood cell count is a risk factor for stroke. The reason is that more red blood cells thicken the blood and make clots more likely.
Heart disease risk factors related to stroke. Other secondary risk factors for a stroke are caused by increasing the risk of heart disease. These indirect factors include high blood cholesterol and lipids, physical inactivity, and obesity.
Other potential risk factors for stroke are:
Geographic location. Stroke is more common in the southeastern United States than in other areas. These are the so-called "stroke belt" states. The age-adjusted death rates from a stroke are much higher in these states than in the rest of the country.
Season and climate. Stroke deaths occur more often during periods of extremely hot or cold temperatures.
Socioeconomic factors. There is some evidence that people of lower income and educational levels have a higher risk for stroke.
Excessive alcohol intake. Excessive drinking (an average of more than 1 drink per day for women and more than 2 drinks per day for men) and binge drinking can raise blood pressure; contribute to obesity, high triglycerides, cancer, and other diseases; and cause heart failure, leading to stroke.
Certain kinds of drug abuse. Intravenous drug abuse carries a high risk of stroke from cerebral embolisms. Cocaine use has been closely related to strokes, heart attacks, and a variety of other cardiovascular complications. Some of them have been fatal even in first-time cocaine users.
*Source of risk factors: National Stroke Association, 1999.
WARNING: Recognizing stroke symptoms and realizing that the symptoms require immediate emergency treatment can save your life!
Symptoms of stroke are:
- Sudden trouble standing or walking, dizziness, loss of balance or coordination.
- Sudden numbness of the face or weakness of arm or leg, especially on one side of the body.
- Sudden confusion, trouble speaking or understanding.
- Sudden trouble seeing in one or both eyes.
- Sudden, very severe headaches with no known cause.
WARNING: Any of the above signs may be only temporary and may last only a few minutes.
Stroke Symptoms Source: Mayo Medical Clinic, 1999 and The National Stroke Association, 1999.
Aggressive Stroke Therapy
A revolutionary improvement has occurred in the treatment of ischemic strokes, yet health care providers still do not treat stroke as aggressively as they do heart attack. Many therapies that are proven to work are not made available to the acute stroke patient presenting in the emergency room.
Development of computerized tomography (CT) and Doppler ultrasonography has made radical changes in early diagnosis of ischemic and hemorrhagic strokes. These advances have resulted in declines in stroke mortality. In the 1980s, the development of MRI imaging further improved evaluation of persons with cerebrovascular disease.
Then in the 1990s came conclusive evidence that specialized stroke centers for more immediate and intensive treatment, combined with educating the public that time to treatment decreases mortality and improves outcome for stroke, further decreased the incidence of death associated with all types of strokes. Oral anticoagulants and aspirin, as well as natural supplements, are demonstrated to be very effective in diminishing the risk of a stroke.
The FDA approved the use of a tissue plasminogen activator (t-PA) in June 1996 to treat strokes. t-PA had already been approved to dissolve clots that occurred in the coronary arteries (acute heart attack), but the FDA delayed approving t-PA to treat ischemic stroke for many years. Millions of cases of death and permanent paralysis occurred because of the FDA's delay in approving t-PA in treating stroke caused by abnormal blood clotting in the brain's arteries. Physicians affiliated with the Life Extension Foundation were using t-PA in emergency rooms to treat ischemic stroke years before the FDA gave its official seal of approval.
Insist that t-PA be Administered
upon Diagnosis of Ischemic Stroke
t-PA (sold under the brand name Activase) should be administered immediately (or within 3 hours) after a stroke in order to dissolve the clot that is preventing blood from reaching a portion of your brain. t-PA stands for tissue plasminogen activators. It is a natural clot-dissolving substance produced by the body and can literally blow open a blood clot in the brain that causes the acute ischemic brain damage characteristic of a stroke.
In the latest study, 30% more stroke victims were able to regain full use of their faculties after receiving t-PA. Even today, patients may encounter severe resistance from emergency room physicians who are reluctant to administer it, even if a patient's life is at stake. In some cases, surgery may be needed to remove any blockage of blood vessels going to the brain since it is important to get the blood circulating to the brain.
While t-PA can dissolve the blood clot that causes a blood-vessel blockage, there are other complications that occur during ischemic stroke that have to be addressed if permanent brain damage is to be prevented. Any interruption in blood flow causes an oxygen imbalance that results in massive free radical damage. It is critically important to have antioxidants in your bloodstream when t-PA is administered to reduce the free radical damage that will occur when blood flow is restored.
The most potent antioxidant that a hospital pharmacy normally stocks for the treatment of strokes is Hydergine. You should insist that the emergency room doctor administer 10 mg of Hydergine sublingually, and another 10 mg of Hydergine orally in liquid form. Hydergine is a powerful antioxidant that reduces free radical damage. Hydergine will increase the amount of oxygen delivered to the brain, enhance the energy metabolism of brain cells, and protect brain cells against both the low- and high-oxygen environments that ischemic stroke victims often encounter.
Hydergine is used routinely in Europe and the rest of the world as a treatment for stroke, but most emergency room physicians in the United States are reluctant to prescribe it because the FDA does not recognize its value in preventing brain-cell death. Paralyzed stroke victims consume billions of health care dollars every year, and the reason most ischemic stroke victims are permanently paralyzed is that the FDA has stopped patients from being treated with medications to prevent brain-cell death. |