| You have had a stroke. Hopefully, you went to | | | | blood-sugar levels as close to normal as is |
| the hospital when you developed your symptoms | | | | humanly possible. |
| of weakness, numbness, altered speech or visual | | | | Quitting smoking is also pivotal in preventing |
| impairment. Your hospital care enabled you to limit | | | | another stroke, and it is never too late in the |
| the damaging effects of the loss of circulation to | | | | game to benefit from this difficult but important |
| a portion of your brain. You've made it through | | | | change. Consumption of more than two standard |
| the acute phase of stroke management. Now | | | | drinks of alcohol per day also increases the risk of |
| what? | | | | stroke and should be avoided. If you are obese, |
| You will want to obtain the best achievable | | | | then it is in your best interests to lose weight |
| outcome from the impairments you already have. | | | | through a combination of calorie reduction and |
| If you have "motor" impairments (weakness or | | | | sensible exercise. |
| clumsiness) you can rest assured that | | | | The carotid arteries are a pair of pulsating blood |
| randomized, controlled trials -- the gold-standard | | | | vessels in the front of the neck that carry blood |
| method for determining a treatment's | | | | to much of the brain. If your hospital studies |
| effectiveness -- have shown that physical therapy | | | | showed that a carotid artery is 70-99% |
| can improve your level of functioning. If you have | | | | narrowed (severe stenosis) and your recent |
| speech impairment, then speech therapy might be | | | | stroke was downstream from this blood vessel, |
| beneficial, though this has never been proved by | | | | then you are much less likely to have another |
| means of randomized, controlled trials. | | | | stroke if you have a surgical clean-out |
| While it is important to focus on rehabilitation | | | | (endarterectomy) by an experienced surgeon |
| following a stroke, there are also other issues to | | | | whose complication rate is less than 6%. If you |
| attend to. As a survivor of a stroke you are at | | | | have severe narrowing, but because of some |
| increased risk for another. | | | | medical or surgical problem the surgery is |
| Researchers at the Mount Sinai School of Medicine | | | | considered too risky, then insertion of a stent into |
| and Columbia University in New York studied 655 | | | | the narrowed artery can serve as a substitute |
| people who suffered first ischemic strokes. | | | | for endarterectomy. |
| (Ischemic strokes are due to plugged blood | | | | If the carotid artery on the same side of the |
| vessels and not bleeds, and comprise 85-90% of | | | | stroke is 50-69% narrowed (moderate stenosis), |
| all strokes.) Publishing their results in a March 2006 | | | | then an endarterectomy can be considered, but |
| issue of the journal "Neurology," the investigators | | | | the benefit of surgery in these circumstances is |
| found that in the first five years following the | | | | much less clear-cut. If the narrowing is less than |
| stroke there was an 18% likelihood of another. | | | | 50% (mild stenosis), then you are better off |
| Over the same time period the research subjects | | | | leaving the artery alone. |
| also had a 5% likelihood of a heart attack. | | | | The above recommendations are based on |
| Can you improve your odds? Absolutely! The | | | | studies in people with atherosclerosis (hardening of |
| process of using information from the first stroke | | | | the arteries) which is the most common cause of |
| to help prevent another is called "secondary | | | | strokes and, for that matter, heart attacks. But |
| stroke prevention." The idea is that if there is | | | | not every stroke is caused by atherosclerosis. |
| something that can and should be done to reduce | | | | That's why medical testing is important in stroke |
| one's risk, now is the time to do it. There is no | | | | patients -- so that treatment can be tailored to |
| point in waiting for yet another attack to occur | | | | individual circumstances. |
| before getting started. | | | | What about blood-thinners? If you have atrial |
| A blue-ribbon panel from the American Stroke | | | | fibrillation (a specific pattern of irregular |
| Association and American Heart Association | | | | heartbeats) then you are at particular risk to |
| reviewed the state of knowledge concerning | | | | have a stroke due to a blood clot being thrown |
| secondary stroke prevention for patients with | | | | into the circulation from the heart. In this case |
| ischemic strokes and published their results in a | | | | warfarin (Coumadin) is the blood-thinner of choice. |
| March 2006 issue of the journal "Circulation." They | | | | If for some reason the warfarin cannot be |
| found that use of blood-pressure-lowering | | | | tolerated or is considered too risky, then aspirin is |
| medications has a powerful effect in reducing the | | | | a second-best choice. |
| risk of a second stroke -- ranging from 24-43% | | | | If your stroke was due to atherosclerosis, then |
| in better studies -- and this benefit might even | | | | studies support the use of an "anti-platelet" drug. |
| extend to patients who have normal blood | | | | Platelets are the building blocks from which blood |
| pressure to start with. | | | | clots are made, and anti-platelet drugs interfere |
| If you have diabetes, then it is especially | | | | with the ability of the platelets to clump together |
| important to control high blood pressure. Using a | | | | to form a clot. Antiplatelet drugs of first choice |
| medication from the groups of drugs known as | | | | include aspirin by itself, aspirin in combination with |
| "angiotensin converting enzyme inhibitors" (ACEIs) | | | | extended-release dipyridamole (Aggrenox), and |
| and "angiotensin receptor blockers" (ARBs) will not | | | | clopidogrel (Plavix). |
| only help control blood pressure, but will additionally | | | | It's important to realize that patients who address |
| help protect the kidneys. If you have diabetes, | | | | every risk factor for a second stroke are likely to |
| then it is also important to consider use of | | | | have the best outcome and the lowest chances |
| cholesterol-lowering medication, especially from | | | | of another attack. Handling some risk factors and |
| the class of drugs known as "statins." Statins can | | | | not others is better than doing nothing at all, but |
| additionally benefit people without diabetes and | | | | in fighting off a second stroke, you want to use |
| even those without elevated cholesterol levels. Of | | | | every weapon in your arsenal. |
| course, in diabetes it is also important to keep the | | | | |