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Entries in Strokes (9)

Wednesday
May292013

Arizona Twins Suffer Strokes at 26, Just Months Apart

Courtesy Barrow Neurological Institute(TEMPE, Ariz.) -- Kathryn Tucker, a senior care coordinator for an Arizona insurance company, had just gone to bed when she felt a sharp pain the back of her head on the right side before her vision went out and she went numb.

Her brother was at her Tempe, Ariz., apartment and got her to the hospital where doctors at first dismissed her symptoms as a migraine with aura. But Tucker, only 26, was having a stroke.

"I was absolutely terrified," said Tucker, who was sent home from the emergency room that day in July 2012 without medical intervention.

"I slept for three days straight," she said. "Then, when I woke up, my vision was horrible. Everything was distorted and one-dimensional. I could barely get around."

Her health deteriorated so she ended up going to an urgent care facility, where tests showed she had, indeed, had a stroke.

Nine months later to the day, her twin sister, Kimberly Tucker, suffered a stroke in exactly the same way, except on the left side. Kimberly Tucker had left school in Tucson to take care of her sister after her stroke. Then in April, their roles reversed.

The Tucker girls are fraternal twins and do not share the same DNA, and there is no family history of stroke, so doctors said there is no genetic cause. Both suffered a stroke on opposite sides of the occipital lobe, which sends visual input from the brain to the retinas.

"Honestly, it's rare for us to actually evaluate two sisters who've had strokes within months of each other," said Dr. Joni Clark, a vascular neurologist at Barrow Neurological Institute in Phoenix. "If they had a family history, it would not be a surprise. It's quite uncommon."

Stroke is a leading cause of death in the United States, killing nearly 130,000 Americans each year, according to the Centers for Disease Control and Prevention, which observes National Stroke Month in May.

About one-third of strokes are believed to occur in people younger than 65. For those younger than 45, the stroke risk has jumped 14 to 20 percent, according to Clark.

"We see this mainly among young people who have risk factors that you should see in elderly patients.

"Here at Barrow, we see a huge population of stroke patients -- and, in my own experience, which is anecdotal, I see a fair number of young people with stroke," said Clark. "The majority are spontaneous."

Obesity, which leads to diabetes, high blood pressure and high cholesterol, is a risk.

"You'd also be surprised how many young adults don't exercise," said Clark. "It's sad, because the rise is due to good, old stroke risk factors that shouldn't happen when they are young."

The twins also shared lifestyle traits that doctors said are linked to an increase in the incidence of strokes among young people. Both girls were smokers. They were also migraine sufferers and had been taking birth control pills.

It was discovered later that Kathryn Tucker had a PFO, or patent foramen ovale, a small hole in the heart that may have contributed to her stroke.

"There were several things that probably all together put Kathryn at risk," said Clark, who treated Kathryn Tucker, but not her sister.

Kathryn Tucker said her prognosis is "really good" now that she has stopped smoking and taking the pill.

The twins said they were also worried about their overuse of caffeinated energy drinks -- three to four a day, although there is no medical evidence linking those drinks to stroke.

"Don't think you are impervious to stroke," said Kimberly Tucker, who is still undergoing therapy. "We think we are invincible until we are not. This taught us a huge lesson that we are not guaranteed great health and we need to take care of our bodies."

Kimberly Tucker, unlike her sister, did not have a PFO and was an avid runner.

"On the day of my stroke I did a 5K run," she said. "I was feeling extra thirsty the whole time and went home to take a nap."

When she woke up, Kimberly Tucker felt a sharp pain on the left side of the back of her head.

"My vision closed in almost completely," she said. "I wasn't making a lot of sense and was not able to form complete thoughts. But I knew I was having a stroke."

Remembering what her twin sister had gone though, she immediately called 911, then her sister, who told her to take her blood thinners, a move that might have saved her life.

"I instantly knew I had a stroke because I was suffering from many of the same symptoms as my sister," says Kimberly Tucker. "The EMTs told me that the chance of both me and my sister having a stroke this young was that of being struck by lightning twice. They thought I was suffering from dehydration or heat stroke."

Later, doctors discovered Kimberly Tucker had arrhythmia, which may have been a contributing factor to her stroke.

Today, both girls are doing well after occupational and speech therapy, though they still have some visual deficits and are not allowed to drive.

"I still notice some weakness when I am tired," Kathryn Tucker said. "Otherwise, I am fine, physically back to normal."

"We are super close," said Kimberly Tucker of her twin. "I think we always have been close, but this definitely brought us closer. Honestly, she is the only person who understands because we are going through it together."

Copyright 2013 ABC News Radio

Thursday
Oct112012

Stroke Patients Are Getting Younger, Study Finds

iStockphoto/Thinkstock(NEW YORK) -- Having a stroke may not be just a concern for the elderly.  New research shows young adults are having strokes at a faster rate, and people under 55 make up an increased percentage of all strokes.

In a new study, published in the journal Neurology, researchers looked at more than 1 million American adults and found that the rate of first stroke in patients age 20 to 54 had jumped from 12.9 percent in 1993 and 1994 to 18.6 percent in 2005.

Though the study authors did not look into what is causing the upsurge in young strokes, they say the study results may be a reflection of an increase in risk factors such as hypertension, diabetes and smoking in younger patients.

When compared with data from the National Examination Survey for 1999-2000 and 2005-2006 prevalence rates for the leading risk factors for higher among patients in the same age range, MedPage Today reports.

The authors noted, according to MedPage, "the prevalence of stroke risk factors, including hypertension, diabetes, [coronary heart disease] and current smoking are all elevated in the younger stroke population compared with the population survey."

Stroke is fourth leading cause of death in the U.S., and can come with lasting effects, including paralysis and speech impairment, according to the Centers for Disease Control and Prevention.

Copyright 2012 ABC News Radio

Tuesday
Oct022012

Beta Blockers May Not Prevent Heart Attacks and Strokes

iStockphoto/Thinkstock(NEW YORK) -- New research suggests that beta-blocker pills don't prevent heart attacks, strokes or cardiac deaths in patients with heart disease, but doctors are torn over whether there's enough in the study to make them want to stop prescribing the drugs. Beta blockers have been a standard heart medication for decades.

The study, published in the Journal of American Medical Association, looked at nearly 45,000 patients with prior heart attacks, coronary artery disease or risk factors for coronary artery disease, and found that those on beta blockers didn't show significantly lower rates of heart attack, stroke or cardiac death than those not on the medication.

"This is a very compelling study that has the potential to shake up the conventional wisdom that exists regarding the role of beta blockers in the management of patients with cardiovascular disease," said Dr. Randal Thomas, a cardiovascular specialist at the Mayo Clinic. "At a minimum, it will lead to new studies that address this issue once again."

Beta blockers work by blocking adrenalin receptors in the brain that become activated when the body is stressed. Beta blockers are used to treat heart disease, high blood pressure, anxiety and other conditions.

Some doctors say they are glad beta blockers are being questioned because their use had been "written in stone" for so many years, but others say using a non-randomized data sample is not as reliable as a randomized drug trial.

While the authors attempted to account for differences between the patient groups that might have had an impact on their health, they did not have access to information on why some patients were prescribed these drugs and some were not, said Dr. Richard Besser, the chief heath and medical editor at ABC News.

Dr. Melvin Rubenfire, who directs cardiovascular medicine at the University of Michigan, said he'd been hoping for a study like this, but it won't change his prescribing habits because he uses beta blockers only in specific cases. Rubenfire also weans patients off the pills 18 months after they have a heart attack if they experience adverse side effects, such as fatigue and erectile dysfunction.

Rubenfire said the existing data wasn't enough to determine which patients would benefit from beta blockers, and what kinds of beta blockers are better than others. Beta blockers include at least six brand names, including Sectral, Tenormin and Zebeta.

Even study coauthor Christopher Cannon, a professor at Harvard Medical School, said he will continue to prescribe beta blockers to his patients, adding, "I would not make too much of this" because the study is only observational.

"All it can do is raise up an idea for us researchers to consider for further study," he said.

Cannon said this research shows that it's unclear whether beta blockers add more benefit than the other therapies developed in the decades since beta blockers became a standard of practice for treating patients with heart disease. Since patients are often taking several drugs, it's hard to pinpoint how much one agent helps compared with another.

Dr. Steven Nissen, who chairs the department of cardiovascular medicine at the Cleveland Clinic Foundation, said the medicine might not be ideal for all of the patients it's prescribed to, but a new randomized, controlled trial will be necessary to change guidelines for prescribing beta blockers.

"Abandonment of this type of therapy for post-MI [post-heart attack] patients based upon an observational study is not warranted," he said.

For the time being, the study raises questions, said Dr. Harlan Kumhulz, a professor of medicine, epidemiology and public health at Yale University.

"The question it raises is about how long after having a heart attack should patients remain on beta blockers?" Kumhulz said, noting that beta-blocker patients didn't have better outcomes than the other patients did after the first year. "The study cannot definitively answer that question -- but raises doubts about the need to continue to take them for the rest of a patient's life."

Copyright 2012 ABC News Radio

Tuesday
May082012

Elderly Women with Common Heart Condition at Higher Risk for Stroke

Pixland/Thinkstock(MONTREAL) -- Elderly women diagnosed with atrial fibrillation, a common type of irregular heartbeat, are at higher risk of stroke than elderly men with the same heart condition, regardless of the use of a common blood thinner to prevent strokes, according to a new study published in the Journal of the American Medical Association.

People with AF have a much higher risk of stroke compared to the general population, but it's still unclear why older women with the condition are more likely to suffer a stroke, the authors wrote. One factor, they suggested, could be that women with atrial fibrillation may need to take more warfarin.

Canadian researchers compared patterns of warfarin use and later stroke incidence between more than 80,000 men and women 65 and older who were admitted to a hospital with atrial fibrillation.

Both men and women stuck to their prescribed warfarin regimen well, but stroke rates were significantly higher in women even though they were more likely to fill prescriptions for warfarin. Women who had stroke were also more likely to be 75 or older.

"Thus, women older than 75 years represent the most important target population in patients with AF, and the effectiveness of novel anticoagulants in this population in real-world practice will need to be closely monitored," wrote the authors, led by Meytal Avgil Tsadok of McGill University Health Center in Montreal, Quebec, Canada.

Preventing stroke using blood thinners can be effective, but doctors say it does carry serious risks.

"About 65 to 70 percent of strokes can be prevented using warfarin, but any anticoagulant presents a bleeding risk," said Dr. James O'Keefe, a cardiologist and clinical researcher at Mid America Heart Institute in Kansas City, Mo. O'Keefe was not involved in the study.

"The decision to give patients with a-fib blood thinners is a balancing act," said Dr. Lawrence Phillips, an assistant professor of medicine at NYU Langone Medical Center. "We have to carefully weigh the risk of getting a stroke against the risk of bleeding." Phillips was also not involved with the study.

While stressing the relationship between warfarin dosage and increased stroke hasn't been firmly established, the authors believe the study suggests older women's stroke risk may need to be addressed differently.

"These results suggest that current anticoagulant therapy to prevent stroke might not be sufficient for older women, and new strategies are needed to further reduce stroke risk in women with AF," they wrote.

"I think that the more research that comes out that talks about higher stroke risk in women, the more we're going to think about being aggressive in treating them with blood thinners," said Phillips.

There are newer blood thinners available now, and O'Keefe said these could someday be used in place of warfarin to prevent strokes.

"This is a very dynamic area. We don't really understand why older women have a higher risk of stroke than older men. We also don't know if these newer agents -- Pradaxa and Xarelto -- might be more effective."

Copyright 2012 ABC News Radio

Friday
Apr202012

Low-Fat Dairy Foods May Reduce Your Risk of Stroke

Creatas/Thinkstock(STOCKHOLM) -- About 700,000 Americans suffer strokes every year, according to the American Heart Association. But a new study found that if you choose low-fat dairy foods, you may be reducing your risk of stroke.
 
In what they call the largest stroke study yet, researchers followed almost 75,000 adults aged 45 to 83 for an average of 10 years. All were free of heart disease, stroke and cancer when the study began.
 
Writing in the journal Stroke, the authors, led by Susanna Larsson of the division of nutritional epidemiology at the National Institute of Environmental Medicine at Stockholm's Karolinska Institute, report that those who drank low-fat milk and ate low-fat yogurt and cheese had a 12 percent lower risk of stroke when compared with those who ate full-fat dairy food.
 
Low-fat dairy food is part of a dietary approach to stop hypertension. High blood pressure is a major risk factor for stroke.  In the U.S., the researchers noted that about one-third of adult men and women over 18 have high blood pressure -- a "major controllable risk factor" for stroke.  But only half of Americans affected by high blood pressure have the condition under control, they add.
 
Though the study was conducted in Sweden, Larsson's team of researchers say that typical North American dairy consumption is very similar to that of northern Europeans, underscoring the study's relevance to the U.S. population.
 
Copyright 2012 ABC News Radio

Wednesday
Mar142012

Hole in the Heart: Closing It No Better than Meds to Stop Strokes

iStockphoto/Thinkstock(CLEVELAND) -- As many as 26 percent of us have holes in our hearts.

This hole, found in the wall between the heart's two upper chambers, is called a patent foramen ovale, or PFO, and most of the time it isn't a cause for concern. But sometimes, a PFO can be the cause of a stroke.

In about 40 percent of strokes, patients don't have heart arrhythmias, blood clots or any other identifiable cause. In these patients, PFOs may be to blame.

The question of whether or not doctors should close PFOs in patients who have had strokes has been a hot-button issue for cardiologists and neurologists treating stroke patients for years. But a new study called the CLOSURE trial suggests that closing PFOs may be no better in preventing future strokes than treating patients with medication, a treatment route that is less costly and without the inherent risks of a medical procedure.

The study, published Wednesday in the New England Journal of Medicine, looked at 909 patients between the ages of 18 and 60 who had a PFO and had suffered a stroke without another apparent cause, called a cryptogenic stroke. About half of the patients went on medical therapy. The other half took medication and had their PFOs closed -- doctors threaded a catheter through a vein to the heart and plugged the hole with a small device called a STARFlex.

When researchers compared the two groups, they found that the risk of having another stroke was almost equal for both groups. Within two years of the procedure, 2.9 percent of the patients with closed PFOs had a stroke, compared with 3.1 percent of patients taking medication alone.

Dr. Anthony Furlan, the study's lead author and chairman of neurology at University Hospitals Case Medical Center in Cleveland, said the evidence just isn't there to support a PFO closure procedure over simply giving patients medication.

"We're not saying there are no patients who should have the hole closed, but we are saying the selection criteria have to be radically refined," he said. Ideally, a patient would be under age 45 and have a very large hole in their heart and a heart defect called an atrial septal aneurysm.

So if both treatments are equally effective, what's wrong with closing PFOs? Furlan said the procedure is costly and poses some risks for patients. According to the study, 13 patients had major vascular complications in the two years after their procedures, and 23 had atrial fibrillation, a heart arrhythmia that can be dangerous if left untreated. Only three patients taking medication alone had atrial fibrillation.

Many doctors welcomed the results of the CLOSURE trial, saying it provides real evidence about the choices doctors can give their patients.

"It has been taught and practiced for years that closing PFOs in patients with cryptogenic strokes is helpful," said Dr. Colin Barker, an assistant professor of cardiovascular medicine at the University of Texas Health Science Center. "This study shows the lack of benefit of this intervention."

"Hopefully it will significantly reduce the number of PFO closures that are being done off-label," said Dr. Amie Hsia, medical director of the Stroke Center at MedStar Washington Hospital Center in Washington, D.C.

But the study is drawing fire from other doctors who say the trial had several flaws.

Although the study included more than 900 patients, some doctors say that researchers would need about 4,000 patients to draw significant conclusions on whether or not closing PFOs is an effective way to prevent recurrent strokes. The study also included patients who had other stroke risk factors, making it difficult to tell whether the PFO alone was the cause.

Some critics also say the STARFlex device used to close PFOs in the trial is inferior to other available devices. The STARFlex device is no longer available since its manufacturer, NMT Medical, went bankrupt in 2011.

Furlan, the lead author, didn't dispute the critics who called the CLOSURE trial flawed, but he said it is so far the best information available comparing the effectiveness of PFO closure to medication.

Many doctors frequently recommend closing PFOs in patients, saying the procedure is not only safe and effective, but also gives patients peace of mind that a potential problem is solved.

Dr. Jonathan Tobis, director of interventional cardiology research at the UCLA Medical Center and an investigator in upcoming trials studying PFOs, said that relieving a patient's fears about their heart is a major factor in his decisions to close PFOs. He said the outcome of the CLOSURE trial is not enough to dissuade him from closing PFOs in some of his patients.

"I'd still consider placing one just for the anxiety-lowering effect," Tobis said.

Currently, the U.S. Food and Drug Administration has not approved any device for closing PFOs, including the STARFlex device used in the trial. But many doctors use devices off-label.

"During the 9 years it took for the results of this trial to be reported, approximately 80,000 patients have had a patent foramen ovale closed with the use of a device at an average cost of $10,000 per procedure," said Dr. Claiborne Johnston, of the Clinical and Translational Science Institute at the University of California, San Francisco, in an editorial published with the study.

Many doctors still say the results of the CLOSURE trial don't rule out closing PFOs. Doctors should assess each patient individually and determine the best option.

Two future trials are currently underway that will also compare PFO closure to medication therapy.

Copyright 2012 ABC News Radio

Thursday
Dec292011

Silent Strokes Linked to Memory Loss in Older Adults

iStockphoto/Thinkstock(NEW YORK) -- Some stints of memory lapse in older adults may be due to silent strokes, tiny spots of dead cells inside the brain that bring on undetectable stroke symptoms, according to a study published Wednesday in the journal Neurology.

Nearly a quarter of older adults have experienced a silent stroke, according to the study. Silent stroke is one type of ischemic stroke, which is characterized by a blood clot in a vessel that supplies blood to the brain. Ischemic strokes account for 87 percent of all stroke cases, according to the American Stroke Association.

While symptoms may not be outwardly detectable, research suggests the condition could cause damage to parts of the brain and long-term memory loss.

"Typically people think of a lot of memory decline as an early indicator of Alzheimer-like changes," said Adam Brickman, assistant professor of neuropsychology at Columbia University's Taub Institute for Research on Alzheimer's Disease and the Aging, and co-author of the study.

Brickman and his colleagues looked at 658 participants with an average age of 79 who had no history of dementia. They were administered a test that gauged their memory, language skills and thinking abilities. Researchers also measured the size of the participants' hippocampus, crucial to the regulation of memory and emotion, and they also administered an MRI brain scan.

A smaller hippocampus has been previously associated with cognitive decline.

The brain scans showed that 174 of the participants had experienced silent strokes, and those participants did not perform as well on their memory tests, independent of their hippocampus size.

"We showed that above and beyond size, stroke also contributed to the memory loss and could be a potential indicator for Alzheimer's development," said Brickman.

Study findings suggest that Alzheimer symptoms may be due both to the size changes in the hippocampus and the vascular changes in the brain, Brickman said.

Risk factors for silent stroke include high blood pressure, obesity and high cholesterol.

According to Dr. Shazam Hussain, director of the stroke program at Cleveland Clinic, many people are suffering strokes at earlier ages in adulthood.

"Over time these strokes accumulate damage," said Hussain. "Unfortunately, stroke is a problem that's not reversible."

Brickman said it's unrealistic to use MRIs as a screening method to check for silent strokes in older adults, but it would be beneficial to monitor those who are at high risk for the condition.

"By controlling vascular symptoms, we can prevent stroke, which may be a viable way of preventing cognitive changes of aging," he said.

While the study suggests some connection between silent strokes and memory decline, it's unclear whether silent strokes are a potential marker for later development of Alzheimer's disease. Researchers are now following participants over a longer period of time to see whether some will develop Alzheimer's.

"I think what's emerging is a story in which vascular disease contributes to the symptoms of Alzheimer's disease," said Brickman.

Copyright 2011 ABC News Radio

Friday
May272011

Researchers Develop New Treatment for Post-Stroke Blood Clots

BananaStock/Thinkstock(BALTIMORE) -- Treating patients who suffer from hemorrhagic strokes, in which a blood vessel ruptures inside the brain, can be tricky.

The blood clot that forms after the rupture can either be treated with surgery or clot-busting drugs, but both options pose a serious risk to the patient's health.

Now, researchers at Johns Hopkins University School of Medicine have a developed a new clot-busting treatment that could change the current standards of care.

The researchers treated 60 stroke patients by threading small catheters into the blood clots in their brains and "dripping" blood thinners directly into the clots.  They found that the patients' blood clots shrunk by more than 50 percent, compared to the one percent reduction in clot size in patients treated with the current non-surgical standard of care.

Although both treatment groups were found to have equal death rates, those treated with the new and experimental procedure had a higher degree of function six months later than those who received standard care.  The authors conclude that "reducing the clot's size with a minimally invasive method seems to be pivotal for optimizing patient recovery."

Copyright 2011 ABC News Radio

Monday
May092011

Study: 14 Percent of Strokes Happen When Asleep

Creatas Images/Thinkstock(CINCINNATI) -- New research suggests that 14 percent of all strokes may be so-called wake-up strokes.

The study from the University of Cincinnati examined almost 2,000 cases of strokes seen in the Cincinnati and northern Kentucky region. Of the case studies, about one in seven occured while the person was asleep.

The average age for these wake-up stroke victims was 72. Most of these patients would have needed a clot-busting drug if they had been awake.

The study did not find major differences in habits or risk factors between wake-up stroke and conscious stroke victims.

Copyright 2011 ABC News Radio







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