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STOKE AND CEREBROVASCULAR DISEASE

By Dr. Keith E. Lewis
May 22, 2008

Cerebrovascular disease including stroke is the third leading cause of death in the United States and the leading cause of disability among older Americans. Cerebrovascular disease occurs when the blood vessels supplying the brain with oxygenated blood are damaged or their function is compromised. If blood flow is severely restricted depriving the brain of adequate oxygen even briefly, stroke can occur. It has been estimated that every 45 seconds, another American suffers from a stroke, often with debilitating consequences or even death. One in four men and one in five women over the age of 45 will suffer a stroke.

There are two main kinds of strokes. The most common, an Ischemic stroke, occurs when the artery in the brain is blocked by blood clot usually because of Atherosclerosis which is a deposition of plaque inside the artery walls. Alternatively, a hemorrhagic stroke can occur when inflammed arterial wall weakens and bursts. A stroke is a serious medical emergency that requires immediate medical attention. Time is a critical factor in stroke management. Some experts now refer to strokes as brain attacks.

Many thousands of clinical trials have been performed over the past several years trying to better understand stroke and ways to prevent stroke. It has now been identified that endothelial dysfunction is a fundamental process of cardiovascular and cerebrovascular disease along with the prime risk factors for endothelial function, such as high blood pressure smoking. Researchers are pursuing the therapies aiming at stroke prevention by improving our health strategies. The endothelium is the linings of our blood vessels, this is where inflammation occurs and that is where plaque formation occurs. By preventing or reducing inflammatory process and plaque formation, we significantly reduce the potential for stroke.

Stroke is a very slow forming condition without any early warning signs of dysfunction or problems unlike the heart. Typically before a heart attack, we will have some symptoms which may be chest pain or tingling in the arm, shortness of breath, however, the brain lacks pain receptors and these temporary episodes of ischemia do not cause any pain, so warning signs are very, very limited. Strokes are so feared because of their debilitating effects. Many strokes have been shown to reduce cognitive function. Major strokes have life-altering or life-threatening consequences.

Common effects with stroke: Paralysis and weakness, aphasia which is the inability to speak, write, or understand spoken or written language, spacial perception, thinking and memory. Stroke can damage areas of the brain that control memory, learning, awareness, and mental health changes or challenges which will include depression, personality changes, and trouble controlling emotions are common after stroke because of the debilitating emotional effect of the trauma.

To briefly sum up at this point, stroke is the third most common cause of death in Americans caused by blood clots blocking the flow of blood supply and oxygen to the brain, or by hemorrhage in blood vessels of the brain. One in four men and one in five women over the age of 45 will suffer stroke. The most common risk factor is high blood pressure.

An Ischemic stroke occurs when the blood flow to the brain is disrupted because of a blood clot. A hemorrhagic stroke occurs when the blood flow to the brain is disrupted by ruptured artery. Ischemic strokes account for about 80% of all strokes. Ischemic strokes are closely associated with Atherosclerosis and underlying endothelial dysfunction in the arteries or inflammation in the arteries. Any treatment that improves endothelial health may help lower the risk of stroke

Stroke results in more long-term disabilities in the United States than any other disease. If a stroke is suspected, it is essential to get emergency medical care as soon as possible. Preventative measures can reduce the risk of having a stroke or a second stroke.

There are several warning signs of stroke:

     1.    Sudden weakness, numbness, or paralysis of the face, arm, and leg particularly on one side of
             the body.
     2.    Sudden confusion or loss of speech or understanding of language.
     3.    Sudden loss of vision in one or both eyes.
     4.    Sudden severe headache with no apparent cause.
     5.    Sudden dizziness, loss of balance or coordination, or trouble walking.

Today there are many stroke screening technologies that are available not only to diagnose stroke but to also predict the possibility or potential for stroke. Advanced CT scanners give us unprecedented views of arteries. Carotid ultrasound will evaluate the health of carotid arteries. There are a number of blood tests that also measure vascular health. It may help identify people with risk for stroke. These include homocysteine, C-rective protein, fibrinogen, interleukin-6. In addition to the more well known tests that we typically find our family physician performing, are cholesterol and triglycerides. Folic acid and other B vitamins help decrease homocysteine concentrations. It has also been found that vitamin B in general helps reduced the inflammatory maker C-Reactive Protein.

What can we do to resist or prevent the incidence of stroke? Of course, lifestyle modification which would include diet is extremely important as well as exercise but the following nutritional supplements appear to be very helpful in protecting the endothelium or the lining of the blood vessels: L-arginine is a basic amino acid found in many proteins and is essential to the growth and maintenance in all vertebrates. There is evidence that L-arginine plays major role in maintaining stroke. The L-arginine helps lower blood pressure by serving as a precursor to Acetyl L-carnitine is a derivative of carnitine.

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