My father had a lacunar stroke — what does this mean?

Posted July 02, 2013, 2:00 am

My father just had a lacunar stroke. I’ve never even heard of this. What can you tell me about it?

The most common kind of strokes, called ischemic (iss-KEE-mick) strokes, occur when an artery supplying oxygen-rich blood to a part of the brain is blocked. This leads to the death of some brain cells. Many strokes are caused by blockages of the largest arteries in the brain.

A lacunar stroke involves smaller arteries deep in the brain that branch off the large arteries. Because the arteries are smaller, the amount of brain tissue they feed is smaller than the amount fed by the large arteries. Still, lacunar strokes can cause significant disability. (I’ve put an illustration of the areas of the brain affected by lacunar stroke below.)

 (Image courtesy of Staywell Krames.)

The smaller arteries deep in the brain are vulnerable because they branch directly off of a high-pressure main artery. As a result, high blood pressure can directly damage the walls of these arteries. High blood pressure also can damage the walls of larger arteries and help stimulate the growth of plaques of atherosclerosis, which can block blood flow.

The symptoms of lacunar stroke vary depending on the part of the brain that is deprived of its blood supply. Symptoms may affect the ability to feel things, to move, to see, to speak, and one’s balance and coordination. If a person has multiple lacunar strokes, this can affect emotional behavior and lead to dementia.

Full recovery is possible with early treatment. Ideally, doctors would be able to administer a clot-dissolving medication within three hours after symptoms start. If blood supply is interrupted for longer, there may be more brain damage. In this case, symptoms may last for many weeks or months, requiring physical rehabilitation. There may be permanent disability.

The first person I ever cared for after a lacunar stroke just noticed that his writing hand was suddenly clumsy. Fortunately, there were no other symptoms, and the clumsiness gradually improved with physical therapy.

What probably happens when people recover from the symptoms of a stroke is that some new brain cells grow to take the places of some of the cells that were killed. We used to think that this couldn’t happen, but now research has showed us that it can. Probably more important, other brain cells that are sitting around with not enough to do learn to take on the jobs of the brain cells that were killed by the stroke.

Your father must control his risk factors to prevent another stroke. He will probably need to take a daily aspirin or other blood-thinning medication. He should control his blood pressure and heart disease with lifestyle changes and medication. Exercising regularly, eating plenty of fruits and vegetables, and avoiding saturated fats and cholesterol will help. If he smokes, he should quit. If he has diabetes, he should control his blood sugar.

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Brain Injury May Raise Stroke Risk

Study of more than 1 million people found link but not cause and effect

By Barbara Bronson Gray

HealthDay Reporter

WEDNESDAY, June 26 (HealthDay News) -- People who have a traumatic brain injury may be more likely to suffer a stroke, a large new study suggests.

And while the chances of having a stroke are still small, incurring a traumatic brain injury (TBI) may be as big a risk factor as is high blood pressure, said study author Dr. James Burke.

While stroke risk is usually tied to older adults, about 20 percent occur in those under 65, said Burke, a research fellow in the neurology department at the University of Michigan Medical School. "Stroke is not typically associated with young people, and why younger people have strokes is not well understood."

But when younger adults do suffer a stroke, the effects can be daunting.

Dr. John Volpi, co-director of the Eddy Scurlock Stroke Center in Houston, recalled a patient who had a minor bike accident and seemed just fine. But after just a few days, the man -- who was only 45 -- had a stroke. "It was a slow recovery, getting back to walking and talking, and because he was an ophthalmologist, it took him a long time to be able to go back to work," Volpi said.

While study author Burke said stroke prevention has come a long way in the last 20 years or so, acute stroke treatment has seen only one significant advance, the administration of a powerful blood clot destroyer called tissue plasminogen activator (tPA).

Intravenous tPA is used in the first hours after a stroke to help break up blood clots associated with ischemic stroke, in which blood flow to part of the brain is blocked. Ischemic stroke accounts for about 87 percent of all cases, according to the American Heart Association.

"The next place to hit a potential home run [in preventing stroke] is to find other risk factors that could be playing a key role, especially in younger people," Burke said.

It is unclear how a traumatic brain injury might raise a person's stroke risk, he added. "TBI patients may have more headaches, more fear of seizures, diet changes, genuine brain rewiring, or they may be affected by the stress of TBI, or atherosclerotic plaques may be activated."

The study, published online June 26 in the journal Neurology , tapped several databases of adults in California who went to the emergency department or were discharged from a hospital between 2005 and 2009. More than 400,000 people with traumatic brain injury and more than 700,000 people with trauma but no brain injury were included in the study. The average age of all participants was about 50.

About 28 months after the injury, more than 11,000 people -- 1.1 percent -- had an ischemic stroke. But among those who had trauma but no brain injury, only 0.9 percent had a stroke. While that difference may seem small, it is significant because the overall risk of stroke for people this age is so tiny, Burke explained.

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Migraine With Aura May Be Linked to All Stroke Types

Study of women identifies important risk factor

By Robert Preidt

HealthDay Reporter

WEDNESDAY, June 26 (HealthDay News) -- Women who have migraine headaches with aura are at increased risk for stroke, a new study indicates.

Migraine with aura is a migraine that's preceded or accompanied by visual effects such as flashes of light or blind spots, or by tingling in the hand or face.

A study of almost 28,000 women in the United States found those who had migraine with aura were at greater risk for all types of strokes, according to the researchers, who are scheduled to present the findings Wednesday at a meeting of the International Headache Congress in Boston.

"Migraine with aura has been consistently linked with increased risk of ischemic stroke and there is also some evidence that it increases risk of hemorrhagic stroke," lead author Dr. Tobias Kurth, of Brigham and Women's Hospital in Boston, said in a congress news release.

An ischemic stroke is caused by blocked blood flow to the brain while a hemorrhagic stroke is caused by bleeding in the brain.

"In this study we sought to determine the importance of migraine with aura in stroke occurrence relative to other stroke risk factors," Kurth added.

The study included 1,435 women who had migraine with aura. None of the patients had heart disease at the start of the study.

During 15 years of follow-up, there were 528 strokes overall -- 430 ischemic strokes, 96 hemorrhagic strokes and two unknown types of strokes.

"For total, ischemic and hemorrhagic stroke, migraine with aura was a strong relative contributor," Kurth said in the news release.

About 36 million Americans suffer from migraine, more than the total number of Americans who have asthma or diabetes combined. Migraine costs the United States more than $20 billion in direct medical expenses, such as doctor visits and medications, and indirect expenses, such as missed work and lost productivity.

The data and conclusions of research presented at medical meetings are typically considered preliminary until published in a peer-reviewed medical journal.

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Drug Combo May Reduce Risk of Second Stroke: Study

After small or mini-stroke, aspirin plus Plavix tied to lower odds of another event

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, June 26 (HealthDay News) -- After suffering a stroke or a mini-stroke, patients are usually given aspirin to prevent clots that can cause another stroke. Now a new study suggests that adding the drug Plavix (clopidogrel) to the mix can reduce the risk of a second stroke by nearly a third over aspirin alone.

Both drugs target clotting agents in the blood, called platelets, preventing them from grouping together and forming clots. The drug combination is commonly used after a heart attack, but until now there hasn't been enough data to suggest it would work in stroke or mini-stroke, officially known as a transient ischemic attack (TIA).

"Giving two drugs that block platelets works a lot better than aspirin alone in people who have had a minor stroke or TIA," said researcher Dr. S. Claiborne Johnston, a professor of neurology at the University of California, San Francisco.

The trial was done in China, so whether the results would be the same in the United States isn't known. "They probably are, but we would like to see them confirmed," Johnston said.

To do so, a similar trial is under way in the United States with Johnston as the lead investigator. "We should have confirmation or no confirmation within a few years," he said.

Some doctors are treating stroke patients with this combination of drugs now, Johnston said. "This combination may be something [other] doctors can consider," he said.

The report was published June 26 in the online edition of the New England Journal of Medicine.

Most strokes are caused by blood clots that block blood vessels in the brain. These are called ischemic strokes. A TIA is also caused by a clot that dissipates in a short time. Both leave patients at risk for another stroke that could be more severe, the researchers said.

In the new phase 3 trial, more than 5,000 patients who had suffered a stroke or TIA within the previous 24 hours were randomly assigned to take either aspirin alone or aspirin plus Plavix for three months.

This three-month period is the most critical for repeat strokes, with 10 percent to 20 percent of people who have a TIA or minor stroke suffering a second stroke, the researchers said.

Within three months of starting the study, 8.2 percent of the patients taking the two-drug combo had another stroke, compared with 11.7 percent of those taking aspirin alone, the researchers found.

Dr. Rafael Alexander Ortiz, director of neuro-endovascular surgery and stroke at Lenox Hill Hospital in New York City, said these findings are important and, if confirmed, will change standard practice for some stroke patients.

"This is great news in terms of a positive outcome," said Ortiz, who was not involved with the study.

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Hard Physical Labor May Boost Risk of Heart Disease, Stroke: Studies

THURSDAY, April 18 (HealthDay News) -- Demanding physical work may boost a person's risk of heart disease, two new studies suggest.

"Physicians know that high stress can be associated with increased risk of heart disease," said one expert not connected to the study, Dr. Lawrence Phillips, a cardiologist at NYU Langone Medical Center in New York City. "These two studies suggest that, in addition to normal life stressors, the physical demands a person experiences in the workplace can independently increase their risk as well."

"The reason for this [labor-linked risk] is unclear, but might be related to higher stress levels," Phillips said.

In one study, researchers looked at 250 patients who had suffered a first stroke and 250 who had suffered a first heart attack or other type of heart event. They were compared to a control group of 500 healthy people.

Stroke and heart patients were more likely to have physically demanding jobs than those in the control group, researchers found. After adjusting for age, sex and a number of lifestyle and health factors, they concluded that having a less physically demanding job was associated with a 20 percent lower risk of a heart event or stroke.

The findings suggest that people with physically demanding jobs should be considered an important target group for prevention of cardiovascular disease, said study author Dr. Demosthenes Panagiotakos, an associate professor of biostatistics and epidemiology at Harokopio University in Athens, Greece.

The results seem to conflict with recommendations that people should exercise to reduce their risk of heart trouble. But Panagiotakos said the increased risk of stroke and heart events among people with physically demanding jobs may be due to mental stress, while exercise helps reduce stress. He also said people with physically demanding jobs tend to have lower incomes, which might limit their access to health care.

The study suggests that leisure-time exercise might be important to "balance out" the physical stress encountered in laborious jobs, said Dr. Tara Narula, associate director of the cardiac care unit at Lenox Hill Hospital in New York City. She was not connected to the study.

"This delicate interaction between work and leisure-time activity warrants further research in order to appropriately guide public health," she said.

The study was presented at a meeting of the European Society of Cardiology, taking place this week in Rome.

In a second study presented at the same meeting, researchers looked at more than 14,000 middle-aged men who did not have heart disease and were followed for about three years on average. The investigators found that physically demanding work was a risk factor for developing coronary heart disease.

They also found that men with physically demanding jobs who also did moderate to high levels of exercise during their leisure time had an even greater risk (more than four-fold higher) of developing coronary heart disease.

Phillips, who also is an assistant professor in the department of medicine at NYU Langone, said the finding was a bit surprising. "This is a new finding that was not previously seen," he said. "Further studies to support this finding will be needed. As with many areas of medicine, a one-size-fits-all approach to leisure exercise might not work."

Study author Dr. Els Clays, of the department of public health at the University of Ghent, in Belgium, weighed in on the study in a society news release.

"From a public health perspective, it is very important to know whether people with physically demanding jobs should be advised to engage in leisure-time activity," Clays said.

"The results of this study suggest that additional physical activity during leisure time in those who are already physically exhausted from their daily occupation does not induce a 'training' effect but rather an overloading effect on the cardiovascular system," Clays said.

On the other hand, the study did find that men with less physically demanding jobs were 60 percent less likely to develop heart disease if they exercised during their leisure time.

"Further studies will be needed to find out the cause of increased heart disease in those people who have high physical job demands," Phillips said.

Both studies could point only to an association between hard physical labor and increased heart risk, not a cause-and-effect. Studies presented at a medical meetings typically are viewed as preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Lawrence Phillips, M.D., assistant professor, department of medicine, Leon H. Charney Division of Cardiology, NYU Langone Medical Center, New York City; Tara Narula, associate director, cardiac care unit, Lenox Hill Hospital, New York City; European Society of Cardiology, news release, April 18, 2013

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Hard Physical Labor May Boost Risk of Heart Disease, Stroke: Studies

Researcher says higher mental stress, lower income could be factors

By Robert Preidt

HealthDay Reporter

THURSDAY, April 18 (HealthDay News) -- Demanding physical work may boost a person's risk of heart disease, two new studies suggest.

"Physicians know that high stress can be associated with increased risk of heart disease," said one expert not connected to the study, Dr. Lawrence Phillips, a cardiologist at NYU Langone Medical Center in New York City. "These two studies suggest that, in addition to normal life stressors, the physical demands a person experiences in the workplace can independently increase their risk as well."

"The reason for this [labor-linked risk] is unclear, but might be related to higher stress levels," Phillips said.

In one study, researchers looked at 250 patients who had suffered a first stroke and 250 who had suffered a first heart attack or other type of heart event. They were compared to a control group of 500 healthy people.

Stroke and heart patients were more likely to have physically demanding jobs than those in the control group, researchers found. After adjusting for age, sex and a number of lifestyle and health factors, they concluded that having a less physically demanding job was associated with a 20 percent lower risk of a heart event or stroke.

The findings suggest that people with physically demanding jobs should be considered an important target group for prevention of cardiovascular disease, said study author Dr. Demosthenes Panagiotakos, an associate professor of biostatistics and epidemiology at Harokopio University in Athens, Greece.

The results seem to conflict with recommendations that people should exercise to reduce their risk of heart trouble. But Panagiotakos said the increased risk of stroke and heart events among people with physically demanding jobs may be due to mental stress, while exercise helps reduce stress. He also said people with physically demanding jobs tend to have lower incomes, which might limit their access to health care.

The study suggests that leisure-time exercise might be important to "balance out" the physical stress encountered in laborious jobs, said Dr. Tara Narula, associate director of the cardiac care unit at Lenox Hill Hospital in New York City. She was not connected to the study.

"This delicate interaction between work and leisure-time activity warrants further research in order to appropriately guide public health," she said.

The study was presented at a meeting of the European Society of Cardiology, taking place this week in Rome.

In a second study presented at the same meeting, researchers looked at more than 14,000 middle-aged men who did not have heart disease and were followed for about three years on average. The investigators found that physically demanding work was a risk factor for developing coronary heart disease.

They also found that men with physically demanding jobs who also did moderate to high levels of exercise during their leisure time had an even greater risk (more than four-fold higher) of developing coronary heart disease.

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Your Stroke Risk Can Shrink With 7 Lifestyle Changes

Controlling blood pressure is most important, large U.S. study found

By Robert Preidt

HealthDay Reporter

THURSDAY, June 6 (HealthDay News) -- Certain lifestyle changes could greatly reduce your stroke risk, according to a new study.

Researchers calculated stroke risk among nearly 23,000 black and white Americans aged 45 and older. Their risk was assessed using the American Heart Association's Life's Simple 7 health factors: be active, control cholesterol, eat a healthy diet, manage blood pressure, maintain a healthy weight, control blood sugar and don't smoke.

During five years of follow-up, 432 strokes occurred among the participants. All seven factors played an important role in predicting stroke risk, but blood pressure was the most important, according to the study, which was published June 6 in the journal Stroke.

"Compared to those with poor blood pressure status, those who were ideal had a 60 percent lower risk of future stroke," study senior author Dr. Mary Cushman, a professor of medicine at the University of Vermont in Burlington, said in a journal news release.

Cushman and her colleagues also found that people who didn't smoke or quit smoking more than a year before the start of the study had a 40 percent lower stroke risk.

For the study, the researchers categorized the participants' Life's Simple 7 scores as inadequate (zero to four points), average (five to nine points) or optimum (10 to 14 points). Every one-point increase was associated with an 8 percent lower stroke risk. People with optimum scores had a 48 percent lower risk than those with inadequate scores, and those with average scores had a 27 percent lower risk.

Overall, blacks had lower scores than whites, but the association between scores and stroke risk was similar for blacks and whites.

"This highlights the critical importance of improving these health factors since blacks have nearly twice the stroke mortality rates as whites," Cushman said.

Each year, about 795,000 people in the United States have a stroke, which is the No. 4 killer and a leading cause of long-term disability in the country, according to the American Heart Association.

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More Dietary Fiber Might Help Thwart Stroke: Study

Title: More Dietary Fiber Might Help Thwart Stroke: Study
Category: Health News
Created: 3/28/2013 4:36:00 PM
Last Editorial Review: 3/29/2013 12:00:00 AM

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Depression May Boost Stroke Risk in Middle-Aged Women, Too

Although risk is still low, Australian study found it nearly doubled for depressed women in their 40s and 50s

By Steven Reinberg

HealthDay Reporter

THURSDAY, May 16 (HealthDay News) -- Women in their 40s and 50s who suffer from depression are almost twice as likely to have a stroke as women who aren't depressed, according to a large, long-running Australian study.

This is not the first study to link depression with an increased risk for stroke, in both men and women. Exactly how depression is associated with stroke is unclear, as is whether treating it reduces the risk, experts say.

"Although the absolute risk of stroke is low in mid-aged women, depression does appear to have a large adverse effect on stroke risk in this age group," said lead researcher Caroline Jackson, an epidemiologist in the School of Population Health at the University of Queensland.

"Our findings, however, suggest that depression may be a stronger risk factor for stroke in mid-aged women than was previously thought," she said.

Despite the growing body of evidence on depression and risk of stroke, depression is generally not included in guidelines for primary stroke prevention, which appears to be an important omission that should be addressed, Jackson noted.

The report was published May 16 in the journal Stroke.

One expert said this latest finding adds to the growing pile of evidence on the link.

"This large study among Australian women adds further evidence supporting the association between depression and stroke risk," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine.

Other studies have also demonstrated the effects of depression on stroke risk, he added. "Although we are not clear about the mechanisms, depression is frequent and needs to be more readily recognized and appropriately treated," Sacco said.

To see how much depression influenced the risk of stroke, Jackson and her colleague Gita Mishra, a professor of life course epidemiology at the University of Queensland, collected data on more than 10,000 women aged 47 to 52 who took part in the Australian Longitudinal Study on Women's Health.

Women in the survey answered questions about both physical and mental health every three years from 1998 to 2010.

Among these women, about 24 percent said they suffered from depression. Over the study period 177 women had a stroke for the first time.

Analysis by Jackson and Mishra found depressed women were 2.4 times more likely to have a stroke than women who weren't depressed.

After eliminating some of the other factors that increase the risk of stroke, depressed women still were 1.9 times more likely to have a stroke, compared to women who were not depressed, they found.

Risk factors included: age; socioeconomic status; lifestyle habits such as smoking, alcohol and physical activity; and high blood pressure, heart disease, being overweight and diabetes.

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Coffee and Green Tea May Help Lower Stroke Risk

By Nicky Broyd
WebMD Health NewsReviewed by Sheena Meredith, MD

March 15, 2013 -- Green tea and coffee may help lower your risk of having a stroke, especially when both are a regular part of your diet, according to new research.

The study looked at the green tea and coffee drinking habits of more than 82,000 Japanese adults, ages 45 to 74, for an average of 13 years. Researchers found that the more green tea or coffee people drink, the lower their risk of having a stroke.

The results have been published in Stroke: The Journal of the American Heart Association.

Tea and coffee are the most popular drinks in the world after water, suggesting that these results may apply in other countries, too.

Previous limited research has shown green tea's link to lower death risks from heart disease, but it has only touched on the association with lower stroke risks. Other studies have shown inconsistent connections between coffee and stroke risks.

The new study found:

People who drank at least 1 cup of coffee daily had about a 20% lower risk of stroke compared to those who rarely drank it.People who drank 2 to 3 cups of green tea daily had a 14% lower risk of stroke, and those who had at least 4 cups had a 20% lower risk, compared to those who rarely drank it.People who drank at least 1 cup of coffee or 2 cups of green tea daily had a 32% lower risk of intracerebral hemorrhage, compared to those who rarely drank either beverage. Intracerebral hemorrhage happens when a blood vessel bursts and bleeds inside the brain. About 13% of strokes are due to this condition.

Researchers adjusted their findings to account for age, sex, and lifestyle factors like smoking, alcohol, weight, diet, and exercise. Green tea drinkers in the study were more likely to exercise than non-drinkers.

Dale Webb, DPhil, director of research and information at the U.K.'s Stroke Association, says in an email: "We welcome this study, which suggests that the benefits of antioxidants in coffee and green tea may offset the potential harm from caffeine. The results demonstrate higher consumption of green tea and coffee might reduce the risks for stroke, especially for intracerebral haemorrhage.

"We would like to see further research to understand the underlying biological mechanisms for these findings."

It's unclear how green tea affects stroke risks. A compound group known as catechins may provide some protection, as they have an antioxidant anti-inflammatory effect.

Some chemicals in coffee include chlorogenic acid, which is thought to cut stroke risks by lowering the chances of developing type 2 diabetes.

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Eye-Tracking Tool Might Quickly Spot Stroke

By Amanda Gardner

HealthDay Reporter

TUESDAY, March 5 (HealthDay News) -- The key to correctly diagnosing when a case of dizziness is just vertigo or a life-threatening stroke may be surprisingly simple: a pair of goggles that measures eye movement at the bedside in as little as one minute, a new study contends.

"This is the first study demonstrating that we can accurately discriminate strokes and non-strokes using this device," said Dr. David Newman-Toker, lead author of a paper on the technique that is published in the April issue of the journal Stroke.

Some 100,000 strokes are misdiagnosed as something else each year in the United States, resulting in 20,000 to 30,000 deaths or severe physical and speech impairments, the researchers said.

As with heart attacks, the key to treating stroke and potentially saving a person's life is speed. Magnetic resonance imaging (MRI), the current gold standard for assessing stroke, can take up to six hours to complete and costs $1,200, said Newman-Toker, who is an associate professor of neurology and otolaryngology at Johns Hopkins Hospital in Baltimore.

Sometimes people don't even get as far as an MRI, and may be sent home with a first "mini stroke" that is followed by a devastating second stroke, he added.

The new study findings come with some significant caveats, however.

For one thing, the study was a small one, involving only 12 patients.

"It is impossible for a small study to prove 100 percent accuracy," said Dr. Daniel Labovitz, director of the Stern Stroke Center at Montefiore Medical Center in New York City, who was not involved with the study. About 4 percent of dizziness cases in the emergency room are caused by stroke.

The other caveat is that the device is not yet approved in the United States for diagnosing stroke. The U.S. Food and Drug Administration only recently gave it approval for use in assessing balance. It has been available in Europe for that purpose for about a year.

The device -- known as a video-oculography machine -- is a modification of a "head impulse test," which is used regularly for people with chronic dizziness and other inner ear-balance disorders.

"There are 500 otolaryngologists and 4 million dizzy patients in the U.S. alone," Newman-Toker said. "We [otolaryngologists] can't see everybody and [emergency room physicians] can't easily be trained to develop expertise in eye movement interpretation."

"Now we have a device that can do it for them," he added.

The test is simple to perform: Wearing a pair of goggles hooked up to a webcam and special software, the patient is asked to focus on one spot on the wall while the doctor moves the patient's head from side to side.

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High-Antioxidant Diet May Not Prevent Stroke, Dementia, Study Finds

By Carina Storrs

HealthDay Reporter

WEDNESDAY, Feb. 20 (HealthDay News) -- Antioxidants are celebrated as "brain foods" and "super foods," but a new study suggests that not all diets high in antioxidants reduce the risk of dementia and stroke.

The study involved more than 5,000 people in the Netherlands who were 55 years and older. Researchers determined each participant's antioxidant score, based on questionnaires about the foods they typically ate, and kept track of whether they developed dementia or had a stroke over the next 14 years.

"We asked, 'Is the [measure] of total antioxidant levels the important predictor for dementia and stroke, irrespective of what foods are contributing?'" said Elizabeth Devore, an instructor in medicine at Harvard Medical School in Boston and lead author of the study.

Although the study did not find lower rates of dementia and stroke among people with antioxidant-rich diets, similar research in other populations has come to different conclusions. For example, a study of older Italian adults found that higher antioxidant levels were linked to lower stroke risk.

The difference between the Dutch and Italian groups could lie in the types of antioxidants they eat, Devore said.

Almost 90 percent of the variability in antioxidant levels among the Dutch participants was due to coffee and tea consumption, whereas the antioxidants in the Italian cohort came largely from eating fruits and vegetables.

"There's a lot of [studies] to suggest that higher fruit and vegetable intake is associated with lower risk of stroke," Devore said. "It is possible that, though the Italian study did report diet antioxidant score, that is really being driven by those specific foods."

"It is not about total antioxidant level, it is about specific antioxidant-rich foods," Devore added.

The research in the Dutch population was published Feb. 20 in the online issue of the journal Neurology.

"It's a little bit hard to interpret the finding that total antioxidant capacity of the diet does not have a role, because of the abundance of evidence showing that oxidative stress [on cells] has a role in these diseases," said Gene Bowman, a nutritional epidemiologist at Oregon Health and Science University, in Portland.

However, "it may be that the antioxidants that they're capturing aren't the ones that are the big players," Bowman said.

Still, the idea of looking at total antioxidant capacity instead of individual antioxidant-rich foods is a new and important approach, he said.

"We've already had large observational studies showing us that certain antioxidants are linked to less stroke and dementia risk, but when giving these antioxidants in clinical trials to reduce risk for less stroke and dementia, the results have been disappointing," Bowman said.

The current study included almost 5,400 people who did not show signs of dementia and almost 5,300 people who had never had a stroke.

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Surgical Delivery of Drug Shows Promise Against 'Bleeding' Stroke

Title: Surgical Delivery of Drug Shows Promise Against 'Bleeding' Stroke
Category: Health News
Created: 2/7/2013 2:36:00 PM
Last Editorial Review: 2/8/2013 12:00:00 AM

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One in Every 12 Stroke Survivors Contemplates Suicide, Study Finds

Title: One in Every 12 Stroke Survivors Contemplates Suicide, Study Finds
Category: Health News
Created: 2/7/2013 2:36:00 PM
Last Editorial Review: 2/8/2013 12:00:00 AM

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Southern Diet Might Explain the 'Stroke Belt'

Title: Southern Diet Might Explain the 'Stroke Belt'
Category: Health News
Created: 2/7/2013 4:35:00 PM
Last Editorial Review: 2/8/2013 12:00:00 AM

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Stroke During Childhood May Raise Risk for Epilepsy, Study Says

Title: Stroke During Childhood May Raise Risk for Epilepsy, Study Says
Category: Health News
Created: 2/7/2013 12:35:00 PM
Last Editorial Review: 2/8/2013 12:00:00 AM

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Smoking Pot May Raise Stroke Risk in Young Adults

By Mary Brophy Marcus

HealthDay Reporter

WEDNESDAY, Feb. 6 (HealthDay News) -- Smoking pot may double a young adult's risk for stroke, new research suggests, but experts point out the study is small and not conclusive.

Scientists from New Zealand presented their data Wednesday at the American Stroke Association annual meeting, in Honolulu.

"Sixteen percent of stroke patients had positive cannabis screens, compared with only 8 percent of control participants," said study author Dr. Alan Barber, a stroke neurologist and professor of clinical neurology at the University of Auckland.

"We think the relationship between cannabis and stroke is certainly plausible," Barber said. "We know [from other studies] cannabis reduces the time to angina, that it's associated with myocardial infarction [heart attack] and heart rhythm problems. It can also cause vasoconstriction. If you constrict arteries in the brain, you can have reduced blood flow.

"We believe the association is not just a chance one, but worthy of further investigation," he added.

Barber's study involved 160 stroke patients and 160 healthy participants, all between 18 and 55, an age range during which people rarely suffer a stroke, he said.

Of the stroke patients, 150 had been admitted to the hospital for an ischemic stroke -- the most common kind of stroke, in which blood flow is blocked to the brain. The other 10 had been admitted for a transient ischemic attack (TIA or "mini-stroke"). All were given urine tests that screened for evidence of marijuana use.

Barber said the ingredients in marijuana show up in urine tests for three or four days if you only use it occasionally, but urine will test positive for the drug for 30 to 40 days in daily users.

The 160 control group patients had come to the hospital as internal medicine admissions with non-stroke diagnoses and did not know they were involved in the study. Their urine samples had been tested for other reasons and were about to be discarded.

"As a consequence, the controls were anonymous -- we only could know age, sex and ethnicity," Barber explained.

The results after the drug screens: Twenty-five (more than 15 percent) of the stroke patients had positive cannabis screens and were also more likely to be male (84 percent) and tobacco smokers (88 percent). Of the control urine samples, thirteen (8 percent) were positive for marijuana.

"There was a doubling for the risk of stroke," Barber said.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Two experts said the study is worthwhile, but doesn't lead to any concrete conclusions.

"It's not a strong study, not one you can hang your hat on, but it's better than others we've got," said Dr. Daniel Labovitz, director of the Stern Stroke Center at Montefiore Medical Center, in New York City.

View the original article here

Distress Tied to Higher Risk of Stroke

Dec. 13, 2012 -- Older adults with high levels of distress are more likely to have certain kinds of strokes than those who aren’t as troubled, a new study shows.

Distress is a combined measure of stress, depression, negativity, and dissatisfaction with life.

“It’s really trying to capture more than negative mood. A lot of studies have looked a depression and how it relates to heart disease or stroke risk, and in this case what we really wanted to get at was a general tendency to have a negative outlook on life,” says researcher Susan A. Everson-Rose, PhD, MPH, associate director of the Program in Health Disparities Research at the University of Minnesota in Minneapolis.

For the study, researchers surveyed more than 4,000 adults over age 65 in the three neighborhoods in Chicago. The majority of people who took part were women and African-American. Their average age was 77.

Each person in the study gave a detailed medical history. They also answered questions about their income, education, daily functioning, and mental outlook.

After an average of seven years, 452 people in the study were hospitalized for strokes, and at least 151 people died of one.

After researchers accounted for other known risk factors for stroke, like smoking, high blood pressure, chronic health conditions, weight, and age, they found that high levels of distress were associated with having an increased risk for having a hemorrhagic stroke, or a stroke caused by bleeding in the brain, rather than the more common stroke caused by a blood clot.

Researchers say they were surprised by that finding.  

“Everything I knew about how measures of distress or depression link to heart disease and stroke went through [clotting] mechanisms. I’m really curious about what the biological mechanisms might be, but that’s really a task for future studies,” Everson-Rose says.

People in the study with the highest levels of distress also had roughly twice the risk of dying of a stroke compared to those with little distress.

The study doesn’t prove that distress causes strokes. Instead, it shows relationships between distress and health that are probably more complicated than simple cause and effect.

Gabor Toth, MD, a vascular neurologist at the Cleveland Clinic in Ohio, says it would be nice to find out more about how distress and stroke are related.

“It may just be that you don’t take care of yourself when you’re under a lot of stress and don’t eat well,  you smoke more. But at the same time, there could be some kind of hormonal, metabolic changes in the body that are brought on by stress that put you at a higher risk for stroke,” says Toth, who wasn’t involved in the research. 

Whatever the connection may be, researchers say understanding that distress and poor health can go hand in hand is important.

“It’s really recognizing this general negativity, these emotions around distress, and realizing that they can have a physical impact,” Everson-Rose says. “It’s important to pay attention to them and find ways to alleviate the distress. Emotional states can have strong effects.”

The study was funded by the National Heart, Lung, and Blood Institute. It’s published in the journal Stroke.

View the original article here

Distress Tied to Higher Risk of Stroke

ByBrenda Goodman, MA
WebMD Health News Reviewed byBrunilda Nazario, MD

Dec. 13, 2012 -- Older adults with high levels of distress are more likely to have certain kinds of strokes than those who aren’t as troubled, a new study shows.

Distress is a combined measure of stress, depression, negativity, and dissatisfaction with life.

“It’s really trying to capture more than negative mood. A lot of studies have looked a depression and how it relates to heart disease or stroke risk, and in this case what we really wanted to get at was a general tendency to have a negative outlook on life,” says researcher Susan A. Everson-Rose, PhD, MPH, associate director of the Program in Health Disparities Research at the University of Minnesota in Minneapolis.

A Visual Guide to Understanding Stroke

Tracking Distress in Older Adults

For the study, researchers surveyed more than 4,000 adults over age 65 in the three neighborhoods in Chicago. The majority of people who took part were women and African-American. Their average age was 77.

Each person in the study gave a detailed medical history. They also answered questions about their income, education, daily functioning, and mental outlook.

After an average of seven years, 452 people in the study were hospitalized for strokes, and at least 151 people died of one.

After researchers accounted for other known risk factors for stroke, like smoking, high blood pressure, chronic health conditions, weight, and age, they found that high levels of distress were associated with having an increased risk for having a hemorrhagic stroke, or a stroke caused by bleeding in the brain, rather than the more common stroke caused by a blood clot.

Researchers say they were surprised by that finding.  

“Everything I knew about how measures of distress or depression link to heart disease and stroke went through [clotting] mechanisms. I’m really curious about what the biological mechanisms might be, but that’s really a task for future studies,” Everson-Rose says.

People in the study with the highest levels of distress also had roughly twice the risk of dying of a stroke compared to those with little distress.

More Research Needed

The study doesn’t prove that distress causes strokes. Instead, it shows relationships between distress and health that are probably more complicated than simple cause and effect.

Gabor Toth, MD, a vascular neurologist at the Cleveland Clinic in Ohio, says it would be nice to find out more about how distress and stroke are related.

“It may just be that you don’t take care of yourself when you’re under a lot of stress and don’t eat well,  you smoke more. But at the same time, there could be some kind of hormonal, metabolic changes in the body that are brought on by stress that put you at a higher risk for stroke,” says Toth, who wasn’t involved in the research. 

Whatever the connection may be, researchers say understanding that distress and poor health can go hand in hand is important.

“It’s really recognizing this general negativity, these emotions around distress, and realizing that they can have a physical impact,” Everson-Rose says. “It’s important to pay attention to them and find ways to alleviate the distress. Emotional states can have strong effects.”

The study was funded by the National Heart, Lung, and Blood Institute. It’s published in the journal Stroke.

View Article Sources

SOURCES:

Henderson, K. Stroke, Dec. 13, 2012.

Susan A. Everson-Rose, PhD, MPH, associate director, Program in Health Disparities Research, University of Minnesota, Minneapolis.

Gabor Toth, MD, vascular neurologist, Cleveland Clinic, Cleveland, Ohio.

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