For voila-ga only, please!

What are the symptoms, diagnostic procedures and treatments associated with stroke?

Thanx!

Greetings, dietpepsi, and thanks for requesting my services.

No matter what you call it -- cerebrovascular accident, cerebral
infarct, brain attack, or Trung Fong* in Chinese  -- stroke is a
silent killer.  Each year in the US, there will be 500,000 people who
will suffer stokes and of those one-quarter of them will die. 
Following heart disease and cancer, stroke remains the leading cause
of death in America.  Compounding those figures, there are as many as
three million people in our country living with disability following a
stroke, so it's a very serious situation indeed.

I guess we should first ask the question -- 

======================
WHAT IS A STROKE?
======================

"A stroke is a sudden disruption in the flow of blood that supplies
life-sustaining oxygen and nutrients to the brain. Without effective
early treatment, affected brain cells become damaged or die. Movement
of limbs and speech can be temporarily or permanently impaired. 
Although considered a sudden brain attack, stroke usually develops
over the years. Deposits of fat, cholesterol and other substances
accumulate on the inner walls of the arteries, causing them to become
hard and constricted instead of supple. The resulting ’hardening of
the arteries’ is the cause of many forms of heart disease and the
source of most strokes."
http://www.johnmuirmtdiablo.com/index.php/publications15.html


===================================
WHAT ARE THE SYMPTOMS OF A STROKE?
===================================

From stroke.org:  http://www.stroke.org/pages/recog_five.cfm

Five Most Common Stoke Symptoms:

1. Sudden numbness/weakness of face/arm/leg, especially on one side of
the body

2. Sudden confusion, trouble speaking or understanding

3. Sudden trouble seeing in one or both eyes

4. Sudden trouble walking, dizziness, loss of balance or coordination

5. Sudden severe headache with no known cause


===========================
HOW IS A STROKE DIAGNOSED?
===========================

Assessing Stroke:
http://www.1uphealth.com/medical/disease/brain-neurological-disease/stroke-brain-attack-8.html

"Blood tests, an electrocardiogram, and CT scans will often be done. 
One test that helps doctors judge the severity of a stroke is the 
standardized NIH Stroke Scale, developed by the NINDS. Health care 
professionals use the NIH Stroke Scale to measure a patient's 
neurological deficits by asking the patient to answer questions and to
perform several physical and mental tests. Other scales include the 
Glasgow Coma Scale, the Hunt and Hess Scale, the Modified Rankin
Scale,
and the Barthel Index.

Carotid Doppler:
http://www.intelihealth.com/IH/ihtIH/WSIHW000/8772/21905.html

"One test that is used to evaluate strokes that might stem from
problems in the carotid arteries is the carotid ultrasound (variously
called the duplex Doppler scan or ultrasound scan of the neck). This
test uses sound waves and a type of sonar detection system to generate
a black and white picture of the carotid arteries in the neck. This
painless test shows the doctor if there is narrowing of one or both of
the neck arteries."

Detailed Neurologic Exam:
http://www.fpnotebook.com/NEU45.htm


========================
HOW IS STROKE TREATED?
========================

There are two methods for treating stroke:  thrombolytics and
neuroprotectants.

Thrombolytics (clot busting drugs):

"Ischemic strokes, the most common type of strokes, can be treated
with a drug called t-PA, that dissolves blood clots obstructing blood
flow to the brain. The window of opportunity to start treating stroke
patients is three hours, but to be evaluated and receive treatment,
patients need to get to the hospital within 60 minutes."
http://www.ninds.nih.gov/knowstroke

Further Discussion on tPA's Limitations:
http://public.incresearch.com/core_synapse.php3?Sec=0601

Neuroprotectants:

"Neuroprotectants are medications that protect the brain from
secondary injury caused by stroke. There are several different classes
of neuroprotectants that show promise for future stroke therapy,
including calcium antagonists, glutamate antagonists, opiate
antagonists, antioxidants, apoptosis inhibitors, and many others.

One of the calcium antagonists, nimodipine, also called a calcium
channel blocker, has been shown to decrease the risk of the
neurological damage that results from subarachnoid hemorrhage. Calcium
channel blockers, such as nimodipine, act by reducing the risk of
cerebral vasospasm, a dangerous side effect of subarachnoid hemorrhage
in which the blood vessels in the subarachnoid space constrict
erratically, cutting off blood flow."
http://www.holistic-online.com/Remedies/Heart/stroke_conv_drug-therapy.htm

STROKE PROCEDURES:
http://www.strokecenter.org/trials/index_procs.htm

======
OTHER
======
There are several other therapies on the horizon showing promise and
I've listed several here:

Piracetam:
http://www.strokecenter.org/trials/InterventionDetail.asp?therapyName=ints/intPage34.htm
Additional References on Stroke

Desmodus Rotundus Salivary Plasminogen Activator (DSPA) or 
Desmoteplase:
http://www.americanheart.org/presenter.jhtml?identifier=3007500

Black Widow Spider Venom:
http://arti.indiana.edu/ott/technol/techs/0210.htm

=========================================
STROKE PREVENTION/RISK FACTORS/RESOURCES
=========================================

Assessing Your Stroke Risk/What You Can and Can't Control:
http://www.stroke.org/stroke_risk.cfm

Other Risk Factors for Stroke:
http://www.strokeassociation.org/presenter.jhtml?identifier=1060

Acute Stroke Management:
http://www.strokecenter.org/prof/management.htm

Best Practices Report for Stroke/TIA:
http://merck.praxis.md/bpm/bpm.asp?page=BPM01NE13&section=report&ss=1&hilight=stroke

Classification of Stroke:
http://neuroland.com/cvd/stroke_class.htm

Brain Attack Coalition:
http://www.stroke-site.org/index/index.html

Latest Information on Stroke through NIH:
http://www.nlm.nih.gov/medlineplus/stroke.html

Internet Stroke Center
http://www.strokecenter.org

Stroke Resources
http://www.strokehelp.com/resource_information.htm

==========================================
OTHER CONDITIONS THAT *MAY* MIMIC STROKE
==========================================

TIA:
http://www.umm.edu/ency/article/000730.htm

Algorithm for TIA:
http://www.ahcpr.gov/clinic/stshel2.htm

Signs and Tests for TIA/Stroke:
http://www.thirdage.com/health/adam/ency/article/000730sym.htm

CVA/TIA/PVD:
http://www.urmc.rochester.edu/fammed/web98/cva_tia_.htm

Retinal Migraine
http://imigraine.net/migraine/retinal.html

Temporal Arteritis:
http://www.emedicine.com/radio/topic675.htm

Understanding Stroke of the Optic Nerve/AION/NAAION:
www.visionww.org/drswindsor-opticnerve.htm

Migraine or Migraine-Variant Headache:
http://www.cdc-cdh.edu/hospital/cardio/art87.html

"What seems clear is that there are blood flow changes in the brain 
cortex during an attack of migraine: vasodilation (opening up) of tiny
blood vessels in the brain, followed by inflammation and irritation of
the tiny nerves around the small blood vessels. Some theorize the 
opposite: vaso-constriction (clamping down) of the vessels in the 
brain leading to reduced blood flow and diminished oxygen supply to 
the cortex of the brain.

Diagnosing/Treating Severe Headache:
http://www.thrombosis-consult.com/articles/Textbook/46_acuteheadache.htm

Dietary and Non-Food Triggers for Migraines:
http://users.bigpond.net.au/allergydietitian/migraine.html

More Food/Drink Triggers:
http://www.sfcrc.com/html/hatriggers.htm

"NOTE: Avoid all alcoholic beverages, if possible. If you must drink,
no more than two (2) normal size drinks. Suggested drinks include 
Haute Sauterne Riesling, Seagram's V.O., Cutty Sark, Vodka.


=====================
STROKE INCIDENTALS
=====================

Summary and Conclusions/Journal Articles:
http://www.lef.org/protocols/abstracts/abstr-102.html

Association Between Migraine and Stroke: 
http://www.ama-assn.org/special/migraine/library/readroom/oc6196.htm

Stroke Vaccine:
http://nindsupdate.ninds.nih.gov/news_and_events/pressrelease_stroke_vaccine_090502.htm

CADASIL:
http://www.thedoctorsdoctor.com/diseases/cadasil.htm

Stroke Stats:
http://www.ireland.com/focus/health/day2stroke.htm

"The annual incidence of stroke in the Republic is 375 cases per 100,
000 of the population aged 45 or older. In the US, the equivalent 
figure is 352, while in Denmark it is 386, so that our incidence is 
average in comparison to other developed countries.

European Stroke Initiative:
http://www.eusi-stroke.com/l2_pres_intro.shtml
http://www.eusi-stroke.com/stroke_prevention/sp_introduction.shtml

Notch-3 Gene:
http://www.emedicine.com/neuro/topic710.htm

"Known risk factors for large and small vessel infarcts are largely 
the same. This suggests another influence, such as genetic or 
environmental factors, on the manifestation of vascular risk factors.
The study of familial stroke is further complicated by the occurrence
of infarcts without clinical accompaniment. A relationship appears to
exist between parental stroke and silent cerebral infarcts in their 
offspring."

Use of Imaging in TIA/Strokes:
http://216.185.102.50/Scientific/statements/1997/079705f1.html

Functional Areas of the Brain:
http://www.molbio.princeton.edu/courses/mb427/2000/projects/0008/anatobrainmain.html
http://www.mercksource.com/pp/us/cns/cns_health_library_frame.jsp?cd=3d&pg=/pp/us/cns/cns_hl_adam.jsp?pg=/pp/us/cns/content/adam/ency/article/000726.htm&t=MSLNKGO0103_01e

Aspirin Use in Heart Attack/Stroke:*
http://216.185.102.50/Heart_and_Stroke_A_Z_Guide/aspirin.html

*There is some data indicating a *slight* increase in stroke risk for
healthy patients taking aspirin, so be sure you discuss its 
advisability with a physician before starting on an ASA regimen.

Hospitals To Declare Stroke Preparedness:
http://www.centredaily.com/mld/centredaily/news/4735532.htm

"The Washington meeting was prompted, in part, by the medical
community's frustration that so few patients receive the only approved
treatment for stroke: an intravenous, clot-busting drug called TPA
(tissue plasminogen activator). TPA was approved by the FDA in 1996.
Yet today, only 2 to 4 percent of stroke patients get the drug,
experimental clot-breaking treatments delivered directly to the brain
or emergency surgery."

===========================

For additional information on stroke-related information and migraine,
please check this excellent research from my fellow colleagues:

MRIs (tehuti)
http://answers.google.com/answers/main?cmd=threadview&id=96395

MRIs/CTs (gale)
http://answers.google.com/answers/main?cmd=threadview&id=2014

Functional Impairment: (wayga)
http://answers.google.com/answers/main?cmd=threadview&id=101123

Pre-Hospital Use of Thrombolytics in MI/Stroke: (jacq)
http://answers.google.com/answers/main?cmd=threadview&id=2327

Migraines (zerocattle)
http://answers.google.com/answers/main?cmd=threadview&id=43461

Lastly, I would urge everyone to check this directory for their
nearest stroke unit.

Stroke Center Directory:  
http://www.strokecenter.org/strokecenters.html

Thanks very much for the opportunity to bring this information to you
and to the larger GA community.  If any of this information is unclear
or a link malfunctions, kindly ask for clarification before rating my
answer.

Best wishes for your good health and that of your family,
V


*Trung Fong
http://web.wt.net/acupudoc/article.html

---

Clarification of Answer by voila-ga on 29 Jan 2003 11:47 PST

Thanks so much for your kind rating and your very generous tip.  If
you can stand one *more* link, the Stanford University site has quite
up-to-date stroke information.

http://www.stanford.edu/group/neurology/stroke/learning_guide.html

I hope no one will take me to task for offering diagnoses that mimic
stroke.  Anyone should go *immediately* to the hospital if they
exhibit any of the above symptoms.  Do not shrug off these symptoms as
insignificant since this is a time-critical diagnosis.

Please let me know if I or any of the researchers here can assist you
further on any of your research topic needs.  It's been a pleasure!

Kindest regards,
V