Thursday, 26 December 2013

Women and Stroke

What is stroke?
Stroke is defined as condition in which the brain function is interrupted rapidly due to the loss of blood supply as a result of the blockage of blood such as thrombosis and arterial embolism, or leakage of blood causes of the death of brain cells, according to the article of Mitochondria, oxidative metabolism and cell death in stroke by Sims NR, Muyderman H (September 2009). Stroke is caused by cholesterol build up in the arteries and high blood pressure. In other words, if cholesterol building up in the arteries is blocking the circulation of blood in any part of the body causing oxygen not to be delivered to the brain, resulting in some cells in the brain to die off and are unable reproduce,
Besides cancer and heart diseases, stroke is the third leading cause of death. Approximate 1/4 of all stroke victims die as a direct result of the stroke or it's complications.

Women and stroke
According to the statistic of the Heart and Stroke Foundation, strokes kill 45% more women than men in Canada. In the study, published in the journal Neurology, researchers from the University of California at Los Angeles monitored 17,000 people over a period of six years. They found the incidence of stroke rising faster among women than men.When women reach the age of 45, the risk of stroke begins to rise rapidly, it may be due to levels of estrogen has dropped significantly at age 45 and onward.

Types of stroke
1. Ischemic stroke
This is the most common type of stroke accounting for almost 80% of all strokes. The brain depends on its arteries to bring fresh blood from the heart and lungs. The blood carries oxygen and nutrients to the brain, and takes away carbon dioxide and cellular waste. If an artery is blocked then the brain cells may not receive enough oxygen. They then cannot make enough energy and will eventually stop working.

a) If blood clots from the inside of the arteries of the brain, we have thrombotic stroke.
Study shows that this type of stroke is responsible for almost 50% of all strokes. The most common problem is narrowing off the arteries in the neck or head.

b) If blood clotted in other parts of the body's arteries subsequently entering the brain, we have embolic stroke. In this case the clot was formed somewhere other than in the brain itself.
The clot then travels the bloodstream until they become lodged and can not travel any further. This naturally restricts the flow of blood to the brain and results in embolic stoke.

2. Hemorrhagic strokeHemorrhagic stroke occurs when a blood vessel bursts inside the brain, causing an increase of the fluid pressure on the brain and harms the brain by pressing it against the skull. Hemorrhagic stroke is associated with high blood pressure, which stresses the arterial walls until they break.

1. Sudden trouble in standing
Sudden trouble in standing is an early symptom of stroke as a result of circulation of blood that carries oxygen to suddenly deplete caused by narrowing of arteries and high blood pressure.

2. Dizziness and loss of balance
The brain coordinates information from the eyes, the inner ear, and the body's sense to maintain balance. If the cells of that part of the brain get damaged in result of depleted oxygen will cause dizziness and loss of balance.

3. Sudden confusion
A sudden onset of confusion means that something is potentially going wrong with the brain. Almost all conditions that affect the brain are life-threatening. It might be caused by a tumor or low levels of oxygen in the cells of the cerebral cortex in your brain that affect your ability to think with your usual speed or clarity. It might also be caused by lowered blood sugar, as is the case of diabetes.

4. Having trouble speaking and understanding
Having trouble speaking and understanding occurs when the brain cells in the area of the broca, wernicke and angular ayrus in the left hemisphere area begin to die because they stop getting the oxygen and nutrients they need to function.

6. Sudden severe headaches
Headache is a condition of pain in the head, sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints and may be frequent for many people but sudden severe headaches may be caused by an early symptom of heart disease as we mentioned in previous articles, by rupturing a brain vessel or depletion of oxygen in some parts of the brain.

7. Sudden trouble seeing
This may be an early indication of stroke when the oxygen in the blood supply to the part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into cells that control the vision area of the cerebral cortex in the brain.

8. Etc.

Risk Factors
1. Age
Human aging is the biological process that is unavoidable but controllable. Starting at age 40, the cells in our body begin this process causing the deterioration of some functions of our body. Most people of this age group already have some form of cholesterol building up in their arteries and high blood pressure resulting in an increased risk of stroke.

2. Heredity
People with a family history of stroke have a greater chance of stroke than those do not have such a family history.

3. Race
Because of frequent high blood pressure in African Americans, they have a significantly higher risk of stroke than their Caucasian counterparts.

4. High blood pressure
High blood pressure causes hardening and thinning of arterial walls and makes our heart work harder to pump blood throughout our body resulting in heart diseases as well as increasing the risk of stroke.

5. Smoking
Smokers may be exposed to toxic cadmium, causing high blood pressure and heart diseases as well as contributing to a higher risk of stroke.

6. Excessive alcohol consumption
Drinking one cup of wine for women and 2 cups of wine for men might help to increase the circulation of blood as well as providing more oxygen for cells. However, excessive drinking not only damages the normal function of liver but also raises high blood pressure, increasing the risk of stroke.

7. Diabetes
Diabetes with unhealthy diet causes high levels of glucose in the bloodstream. Diabetics have a greater risk of stroke, because high levels of glucose damage the arterial wall as well as clotting the arteries and blood vessels.

8. Gender
Males have a 20% greater risk of stroke than females, but when women reach the age of 45, the risk of stroke begins to rise rapidly, it may be due to levels of estrogen has dropped significantly at age 45 and onward.

9. Atrial fibrillation
Risk of stroke increases by 5% for people with atrial fibrillation (poor blood flow)

Cause of stroke in women
There are similar causes of stroke and heart diseases, but in stroke the result is more severe. Any delay of rescuing will result in death of the victim. Here are some causes of stroke:
1. Unhealthy diet
A diet high in saturated and trans fats causes bad cholesterol to build up in your blood vessels in the brain, blocking oxygen needed for the cells thus increasing the risk of stroke. Also unhealthy diet causes high blood pressure making your heart work harder to pump blood to your body in result of heart diseases. High blood pressure also causes the blood vessels in your brain to harden and thin, increasing the risk of stroke.

2. Smoking
Smoking not only has a devastating effect on the health of the smoker but also to anyone that inhales its toxic fumes. Cigarettes contain high levels of cadmium that causes the blood to clot activity of cells in result of blocking blood flow and damaging the blood vessels in the brain.

3. Excessive drinking
Moderate drinking is good for your heart, but excessive drinking can raise levels of some fats in your blood causing cholesterol to build up in the arteries and blood vessels in the brain resulting in increase of the risk of stroke.

4. Diabetes
People with diabetes tend to develop heart disease or have strokes at an earlier age than other people. Diabetes with unhealthy diet causes high blood glucose levels that damage nerves and blood vessels, leading to complications such as heart disease and stroke, the leading causes of death among people with diabetes.

5. Obesity — a body mass index of 30 or higher
Study shows that even after adjusting for other stroke risk factors such as high blood pressure, diabetes, high cholesterol, smoking, cardiac diseases, moderate alcohol consumption, and physical activity; obesity is still associated with a greatest risk of stroke in men and women.
6. Use of birth control pills
Birth control pills contain estrogen and one of two other hormones, lynestrenol or norethisterone that increase the risk of blood clotting, which can lead to ischemic stroke especially in woman who smoke and who are older than 35.

7. Migraines
According to the article published in the journal Neurology, Dr. Kurth and his colleagues looked at 27,798 female health professionals ages 45 and older, including 3,568 who had migraines, from the Women's Health Study, researchers found that women with once-a-week-migraines with auras -- who made up 5 percent of the women with migraines -- were four times as likely to have had a stroke during the 12-year study as women without migraines, And women who had migraines with auras less than once a month (75 percent of the group) were more than twice as likely as migraine-free women to have a heart attack, and almost twice as likely to have had a heart procedure, such as bypass surgery. Overall, only 2.5 percent of women in the study had experienced a stroke, heart attack, or related problem.

8. Pre-eclampsia
In the article of Preeclampsia and Stroke: Risks during and after Pregnancy by Cheryl Bushnell and Monique Chireau, researchers indicated that although women with cerebrovascular manifestations of preeclampsia are thought to be out of danger when the baby is delivered, accumulated data show that women with preeclampsia are at risk for stroke and cardiovascular disease well after the postpartum period and child bearing years....... From a clinical perspective, preeclampsia should be regarded as a risk factor for stroke in pregnancy as well as a harbinger of future cerebrovascular disease, although there are many gaps in our knowledge about who is at risk and when, as well as how to best prevent preeclampsia and stroke in women.

9. Estrogen and progestin HRT
In a sudy of Hormone replacement therapy and stroke, by Billeci AM, Paciaroni M, Caso V, Agnelli G., researchers concluded that there seems to be no indication for hormone replacement therapy in the prevention of stroke in women. Further studies are needed to discover why estrogen have different effects on the heart and brain. Conventional risk-factors which could increase the risk of estrogen therapy need to be identified and as well as more restrictive inclusion and exclusion criteria such as coagulation parameters and intimal thickness should be adopted before new randomized trials are started.

10. Etc.

Diagnosis and tests
After recording you family history and a complete physic exams, including the neurological examination and blood pressure reading. The neurological examination is done in your doctor office to check for any sign of stroke including, awareness, speech, language, and memory function, eye movements, movement in the face arms and legs, reflexivity, walking and balancing, etc.
1. Blood test
Blood test is usually the first test that your doctor orders to check for levels of cholesterol, blood coagulation disorder and levels of glucose.

2. X-ray computed tomography scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the bleeding inside the brain.

3. Magnetic Resonance Imaging (MRI)
MRI (magnetic resonance imaging is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of narrowing or blockage of blood vessels in the brain and surrounding areas.

4. Transcranial Doppler (TCD)
It is a test that measures the velocity of blood flow through the brain's blood vessels by using the ultrasound probe to emit a high-pitched sound wave in to the testing areas, then measure the bounces off wave by the same probe. The blood flow velocity frequency is recorded and analysis. The change of freduency of the blood flow can provide a clear evidence of emboli, stenosis, vasospasm from a subarachnoid hemorrhage.

5. Etc.

A. How to avoid
1. A healthy Diet
Uncontrolled diet that is high in saturated fat and trans fat results in cholesterol building up in the arteries and blood vessels obstructing the flow of blood and damaging brain cells because of lack of oxygen causing stroke. If we can consume less of processed foods, fatty animal meats and avoid artificial chemicals and consume more healthy vegetables and fruits, we can reduce the risk of stroke.

2. Put on a happy face
Study shows that people with depression have an increased risk of stroke. Experts also found that people with elevated levels of depression will increase the risk of stroke by 73%.

3. Exercise
Regular moderate exercise will help to improve circulation of blood flow and lessen the risk of stroke that is caused by clogged blood vessels by 30% because regular walking helps to lower high blood pressure and increase levels of HDL.

4. Quit Smoking
Cigarettes contain toxic chemicals cadmium together with heavy metals that cause blood clotting in the arteries resulting in increased high blood pressure and risk of heart diseases as well as stroke.

5. Reduce intake of alcohol
Excessive drinking increases high blood pressure, thus increasing the likelihood of stroke.

6. Etc.

B. Nutritional Supplements
1. B-complex
Three B-vitamins: folate, B-6, and B-12 can lower homocysteine, an amino acid that is found naturally in the body and study shows that the higher the level of homocysteine in the blood, the higher the risk of stroke.

2. Beta-carotene
Beta-carotene is an antioxidant that may reduce oxidative stress to brain cells. Such stress occurs when highly volatile forms of oxygen damage cell structure. Study shows that beta- carotene helps to reduce the risk against cerebral infraction and stroke.

3. Vitamin E
Vitamin E is an antioxidant that helps to reduce arterial clotting.

4. Selenium
Selenium is a powerful agent that helps to keep tissues and arteries elastic. It also helps to reduce the stickiness of the blood and decreases the risk of clotting, in turn lowering the risk of heart attack and stroke. Selenium increases the ratio of HDL (good) cholesterol to LDL (bad) cholesterol.

5. Pycnogenol
Pycnogenol helps to keep collagen elastic and soften the blood platelets, making blood flow more efficiently.

6. Co enzyme Q-10
Co enzyme is a strong antioxidant that not only protects low density lipoprotein LDL against oxidants, but also helps for getting oxygen to the cells.

7. Lecithin
Lecithin is a fat-like substance called a phospholipid that helps to remove bad cholesterol and other lipids from the body. It also protects the arteries and organs from the build up of fatty tissue that can lead to stroke or heart attack.

8. Melatonin
Melatonin is a neurohormone produced in our body by the pineal gland. It is a powerful antioxidant that easily penetrates the blood-brain barrier and is used to treat thrombotic stroke.

9. Vitamin C
Vitamin C helps to strengthen the arterial wall, lowering the risk of heart diseases and stroke.

10. Etc.

C. Herbs
1.Ginkgo biloba
The herb is extracted from the leaves of the ginkgo biloba tree and was first used medicinally in China more than 4,000 years ago. Ginkgo biloba has the ability to increase the oxygen content to the brain and other bodily tissues, improving circulation of blood and improving cerebral tolerance to hypoxia. Study shows that taking Ginkgo and other blood thinner medications together may increase the risk of heart diseases and stroke. Be sure to consult with your doctor before taking ginkgo biloba.

2. Hawthorn
Hawthorn contains cardiotonic amines, polyphenols, and is a source of Vitamins C, B, and many other nutrients that help in relaxing and dilating arteries, increasing the flow of blood and oxygen to and from the heart and maintaining healthy blood pressure resulting in lowered risk of stroke.

3. Garlic
Garlic contains high amounts of antioxidants and elements that help to improve blood circulation. It is dangerous to take garlic extract together with blood thinner medications as we mentioned in a previous article.

4. Cayenne
Cayenne contains an active ingredient called capsaicin that has the abilities to lower blood pressure and cholesterol levels as well as preventing heart diseases and stroke.

5. Blueberries
Blueberries are one of the richest food sources of natural antioxidants readily available, having more than twice the levels of other berries that helps to prevent heart disease, stroke and internal bleeding.

6. Pigweed
Pigweed is an excellent plant-source of calcium. It helps lower one-third of the risk of succumbing to heart attack. Personally, I believe these results also apply to ischemic strokes, because they are biologically so similar to heart attack.

7. Willow bark
Willow bark has been shown in several studies to reduce the risk of ischemic stroke by about 18 percent. Study shows that willow bark has the aspirin's ability to prevent heart attacks, and also shows a slight increase in risk of hemorrhagic stroke from taking willow bark daily but the increase was small and not statistically significant.

8. Ginger
This is another herb proven to have anti-clotting abilities and has the same function as garlic.

9. Etc.

D. Chinese acupuncture and herbs
1. Acupuncture
Acupuncture is the most popular treatment modality for stroke patients in China, used effectively on 85% of the stroke patients there. The recently acceptance of acupuncture by western medical practitioners allows one more effective method in curing diseases especially stroke. Study shows that acupuncture helps to facilitate nerve regeneration, decrease blood viscosity, as well as helping surviving nerve cells find new pathways, effectively bypassing damaged parts of the brain resulting in decreased risk of stroke.

2. Ginkgo biloba (bai guo ye).
Ginkgo biloba improves mental functioning as well as preventing blood cells from forming blood clots in the brain. Study shows that ginkgo improves blood circulation and lowers plasma cholesterol concentrations that help to lower the risk of stroke.

3. GastrodiaGastrodia was listed in the ancient Shennong Bencao Jing (ca. 100 A.D.) and was later classified by Tao Hong as a superior herb, meaning that it could be taken for a long time to protect health and prolong life, as well as for treating illnesses. Gastrodia is used by Chinese herbalist in treating stroke and chronic weaknesses of Qi that eventually blocks the flow of blood to the brain.

4. Cinnamon bark
True Cinnamon is one form of the common spice. As we discussed before, cinnamon helps to lower blood sugar by mimicking insulin, activating insulin receptors and working with insulin in the cells to reduce blood sugar by up to 20%. Also cinnamon has some antioxidant benefits that helps to find new pathways for surviving nerve cells after stroke.

5. Angelica
Angelica can help to warm up the chest-yang to remove obstruction of blood flow in the heart vessels as well as brain vessels.

6. Dragon's Blood
Dragon's Blood is used for increased power, purification, protection, consecration, and the development of strong ritual energy. It also helps to relieve pain in the heart due to blood stagnation and stimulate blood circulation to the brain resulting in decreased risk of stroke.

7. Etc.

Depending to the location of the occurrence
A. Ischemic stroke
1. Thrombolysis
The aims of thrombolysis is to resolve the blood clot to improve the blood flow to prevent further damage to tissue and organs in the body as the medicine break down the blood clot by stimulating fibrinolysis through infusion of a protein involved in the breakdown of blood clots called tissue plasminogen activator.

2. Mechanical thrombectomy
As it name, it is the mechanical to remove the blood clot directly by inserting a catheter, a long, into the large arteries in the thigh, then directing it into the blood vessels supplying blood the brain to dissolve the blood clot thus effectively restoring blood flow., by applying a with a corkscrew-like clot-removing device. The mechanical thrombectomy is used when the patient for what ever reason can not tolerate the thrombolysis.

3. Anticoagulation
According to the study of Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation by Hart RG, Pearce LA, Aguilar MI, researchers found that Adjusted-dose warfarin and antiplatelet agents reduce stroke by approximately 60% and by approximately 20%, respectively, in patients who have atrial fibrillation. Warfarin is substantially more efficacious (by approximately 40%) than antiplatelet therapy.

4. Etc.

B. Hemorrhagic stroke
Since Hemorrhagic stroke involves bleeding within the brain, which damages nearby brain tissue, therefore the use of anticoagulant can make the matter worse. In most cases, it requires neurosurgical evaluation to locate before the cause before it can be treated effectively such as occupational therapy, physical therapy, speech therapy, etc.

Care and rehabilitation
A. The impotant of care and rehabilitation of stroke patient
1. In a study of The Care and Rehabilitation of Stroke Patients One Year Following the Event N. Bentur, M. Davis, J. Brodsky, J. Gindin, B. Habot, Z. Haklai, A. Shemesh, researchers found that
significant differences among wards and hospitals, and highlight the need to develop criteria, standards, and clinical guidelines for the diagnosis and treatment of stroke patients. The brevity of the hospital stay and the small quantity of community rehabilitation services, along with the complexity of stroke, emphasize the need to determine the best discharge destination. The findings of this study were discussed by the National Geriatric Council and served as a basis for discussions in the Ministry of Health. The Ministry has instructed the health plans and hospital directors not to send individuals who need rehabilitation to long-term care institutions, so that patients can maximize their functional potential after stroke. The finding that rehabilitation services in the community are limited, emphasizes a need to examine the reasons for barriers to these services, as well as how to expand them and develop alternative patterns of rehabilitation in the community. The study also identified a need to examine National Health Insurance Law regulations on the rehabilitative services that the health plans are obligated to provide. Thought should be given to the health plans’ activity in this area, so as to ensure that services are appropriate.

2. In a study of The efficacy of self-care education on rehabilitation of stroke patients. Sahebalzamani M, Aliloo L, Shakibi A, researchers found that Self-care education of stroke survivors can improve patient's performance, and change them from a dependent to an independent person.

3. Etc.

B. Post-Stroke Rehabilitation. Clinical Practice Guideline
I will leave this article, for a link where you can find the charter 16 - Post-Stroke Rehabilitation by The Agency for Health Care Policy and Research (AHCPR) was established in December 1989 under Public Law 101-239 (Omnibus Budget Reconciliation Act of 1989) to enhance the quality, appropriateness, and effectiveness of health care services and access to these services.
Since this publication is dated in may -1995, and is provided for historical reference only and the information may be out of date or incorrect.

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