Ministrokes

A ministroke.    What is it? It is similar to a stroke because it is caused by a blockage of blood flow to part of the brain.  The blockage is only for a short period of time, which is why it is called a ministroke.  After a short time the blood flows again, unlike a stroke where the blood flow remains blocked or reduced.

A healthy lifestyle may help you avoid mini strokes, from which many suffer.  As a senior, you have lived long enough to know that there are no guarantees in life.  The best we can do is to make prudent decisions and thus increase our chances of a beneficial outcome, right?

This truism was forcefully brought home to me about a year ago (at the time of this writing) when my younger brother, thirteen months my junior, had what the doctors believe was a TIA, or a transient ischemic attack, more commonly known as a mini stroke.

The irony is this, he has been very careful his entire adult live about his lifestyle choices.  He has jogged at least five times a week for forty years.  He is also a vegetarian.  Yes, he has a few more pounds than he would like, but only a few.

So, Where Are You Going With This?

With this as a background, I’d like to share with you an article I found recently in a magazine called Adventist World.  In the magazine is an article titled Ministrokes, A worldwide problem.

My thanks to adventistworld.org for giving me permission to share this article with you.

I hope you will find it as helpful and informative as I did.

Ministrokes A worldwide problem

By Allan R. Handysides and Peter N. Landless

My mother has had two episodes that the doctor says were ministrokes, or transient ischemic attacks. We are worried that she might have a major stroke. Is there anything we can do that will protect her?

Stroke is a major cause of death worldwide and a leading cause of incapacity in its victims. When stroke and transient ischemic attacks (TIAs) are lumped together, they may exceed the rate of coronary vascular effects.

An ischemic stroke occurs when the blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes brain cells begin to die. A stroke or TIA (in which the blockage is temporary) has a 12.8 per­cent risk of recurring within a week. Some have estimated up to 80 percent of stroke recurrences could be avoided if patients were managed appropriately.

Not all strokes occur for the same reason. A clot or a plaque blockage in the blood vessels is most often the cause of the interruption in blood flow. About 15 percent of ischemic strokes, however, are the result of a blood-vessel rupture in the brain, with about 5 percent (1 in 20) related to bleeding around the brain.

To identify the cause of the TIA, or ministroke, doctors need to determine:

  1. Is this related to problems in the heart, such as atrial fibrillation?
  2. Is it related to large artery dis­ease, such as carotids?
  3. Is there small artery disease, as with diabetes?
  4. Is this related to other problems, such as clotting disorder, drugs, or mechanical problems?

In order to get this information, most patients will undergo magnetic resonance imaging (MRI) investiga­tion, which is more sensitive than computed tomography (CT) for defin­ing strokes. Other forms of imaging will permit diagnosis of blood-vessel damage. Even with this testing, how­ever, doctors are sometimes unable to determine the cause of strokes.

For your mom, and all such patients, aggressive risk-factor management and lifestyle modification are essential. Reg­ular exercise, abstinence from smoking, and weight control are critical.

The following 10 factors have been identified as playing a role in 90 per­cent of stroke risk factors:

  1. high blood pressure
  2. smoking
  3. overweight
  4. poor diet
  5. lack of exercise
  6. diabetes
  7. alcohol consumption
  8. stress and depression
  9. cardiac irregularities
  10. genetically determined abnor­mal cholesterol levels

In addition to lifestyle changes, solid evidence supports the lowering of blood pressure, the lowering of choles­terol, and medications to lower platelet adhesiveness. Data is not available to define an optimal blood pressure, but absolute lowering of systolic pressure has shown improved outcomes. A 28 percent lower risk of stroke over four years was seen in those taking an angio­tensin-converting enzyme (ACE) inhibi­tor to lower blood pressure. Whether the specific medication or the lowered blood pressure is most responsible is debatable, but most of the evidence sup­ports it is the lowered blood pressure.

Lowering cholesterol with a statin has shown a 25 percent reduction in the risk of stroke, with the greatest effects being seen in persons whose cholester­ols were lowered the most significantly.

Aspirin in very low doses (80 mil­ligrams per day) seems as effective as high doses when taken regularly, and although other antiplatelet drugs have slightly better effects, their side effects offset these benefits.

Careful evaluation of your mom is required, followed by lifestyle change. If her blood pressure is elevated, it must be normalized. Cholesterol lev­els, too, need to be brought to normal. Antiplatelet treatment is of lesser ben­efit, but may be recommended.

Exercise along with a low-fat veg­etarian diet that includes whole, unpro­cessed foods and lots of fresh fruits and vegetables offer the best chance of a longer life. The implementation of such a lifestyle also permits the celebration of God’s goodness in giving us life and health as His gracious gifts.

Allan R. Handysides, a board-certified gynecolo­gist

Peter N. Landless, a board-certified nuclear car­diologist


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