What is stroke?

Stroke occurs when the blood vessel that carries oxygen and nutrients to the brain is interrupted or reduced (by clots or bursts), depriving brain tissue of oxygen and nutrients. Brain cells begin to die within a few minutes. 

80 percent of strokes are ​PREVENTABLE​.

When to see a doctor?

SEEK immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think “​FAST​” and do the following:

• F​ Ask the person to smile. Does one side of the face droop?
• A​ Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up?
• S​ Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
• T​ If you observe any of these signs, call 999 immediately.

Causes

Stroke caused by a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, TIA or ‘mini stroke’) that doesn’t cause permanent damage.

 1.  Ischemic stroke

About 80% of strokes are ischemic strokes, which occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:

a. Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain.

b. Embolic stroke. An embolic stroke occurs when a blood clot or other debris form away from your brain – commonly in your heart or arteries in the upper chest and neck – and is swept through your bloodstream to lodge in narrower brain arteries.

2.  Hemorrhagic stroke

• It occurs when a blood vessel in your brain leaks or ruptures. The blood from that artery creates excess pressure in the skull and swells the brain, damaging brain cells and tissues.

• Types of hemorrhagic stroke include:

a. Intracerebral haemorrhage. A blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells.

b. Subarachnoid haemorrhage. An artery on or near the surface between the surface of your brain bursts and spills into the space between the surface of your brain and your skull..

 3.  Transient ischemic attack (TIA)

• Sometimes known as a mini-stroke, is a temporary period of symptoms similar to stroke but there is no permanent tissue damage and no lasting symptoms.

Risk factors:

• Lifestyle risk factors

• Being overweight or obese

• Dietary (salt, trans fat, saturated fats, cholesterol)

• Physical inactivity

• Heavy or binge drinking

• Use of illicit drugs such as cocaine and methamphetamines

• Medical risk factors

• Blood pressure readings higher than 120/80 millimetres of mercury (mm Hg)

• High cholesterol

• Diabetes

• Obstructive sleep apnoea

• Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm

• Personal or family history of stroke, heart attack or transient ischemic attack.

• Age – people age 55 or older have a higher risk

• Race – African-americans have a higher risk

• Sex – men have a higher risk

• Hormones – use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth

 Supplements that could help prevent stroke

• Vitamin E​, found naturally in palm oil, is a lipid-soluble antioxidant that increases resistance of low-density lipoprotein cholesterol to oxidation, reduces smooth muscle cell proliferation, and reduces adhesiveness of platelets to collagen.

• Vitamin D, ​according to the ​Journal of Clinical and Diagnostic Research​, getting sufficient vitamin D can help boost your health by providing neuroprotective, neuromuscular, and osteo protective benefits.

• Vitamin B12​, can found in animal products like meat, fish, poultry, eggs and milk, can boost proper functioning and development of the brain and nerve cells.

• Fish oil ​is excellent for a healthy brain by boosting brain function and reducing potential stroke risk factors.

• Co-enzyme Q10​,naturally found in most liver organs like the heart, liver and kidney, is a powerful antioxidant that excellent in promoting heart and brain health by protecting your tissues from the damage that toxic molecules (free radicals).

• Promegranate ​concentrate is high in ​antioxidants​and phytosterols, which are plant steroids that lower cholesterol can help in reducing cholesterol and side effects of statin.

• Ashwagandha, ​also known as Indian ginseng, has antioxidant properties that may prevent and treat stroke.

• Bilberry ​improves cholesterol​and ​lower blood sugar​.

• Garlic ​prevents ​blood clotting​and ​destroys plaque​.

• Asian ginseng​ improves memory.

• Gotu kola​​ boosts cognitive function​in people who have had strokes.

• Turmeric​ may lower cholesterol levels and help prevent artery blockages.

• Olive leaf and olive oil​ has anti-hypertensive and anti-atherosclerotic effects.

• Nattokinase​, an enzyme extracted from fermented soybeans, can help reduce blood pressure in hypertensive patients. It reduces the viscosity of blood, lowering blood pressure and clot risk.

• L-carnitine​, a cofactor in the metabolism of lipids into cellular energy L-carnitine, has been shown in preclinical studies to be neuroprotective that has a protective effect against thrombosis in ischemic stroke.

• Vinpocetine​, which is an extract from the leaves of periwinkle, has neuroprotective and cerebral blood flow-enhancing properties, as well as anti-inflammatory action.

References

1. Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. The New England journal of medicine. Nov 23 1995;333(21):1392-1400.
2. Brott T, Bogousslavsky J. Treatment of acute ischemic stroke. The New England journal of medicine. Sep 7 2000;343(10):710-722.
3. Dekanski D, Selakovic V, Piperski V, et al. “Protective effect of olive leaf extract on hippocampal injury induced by transient global cerebral ischemia and reperfusion in Mongolian gerbils.” Phytomedicine. 18(2011): 1137-1143
4. Kim JY, Gum SN, Paik JK, et al. “Effects of nattokinase on blood pressure: a randomized, controlled trial.” Hypertens.Res. 31(2008): 1583-1588
5. Kojima G, Bell C, Abbott RD, et al. “Low Dietary Vitamin D Predicts 34-Year Incident Stroke: The Honolulu Heart Program.” Stroke (2012)
6. Graeme J. Hankey, 2012. Vitamin Supplementation and Stroke Prevention. Available at : https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.111.639930