STROKES: Catastrophic injuries to the Brain… Be Aware of the Early Signs; Prevention is the Best Defense

1. By
Dr. Maria Scunziano-Singh, M.D.
6/12/2014
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STROKES:
Catastrophic injuries to the Brain…
Be Aware of the Early Signs;
Prevention is the Best Defense

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Contents:
1) What is a stroke?
2) Major risk factors
3) Signs & Symptoms
4) What to do if you are experiencing symptoms
5) Causes
6) Diagnosis
7) Standard of care treatment, management
8) State of art techniques
9) Prevention is the key
10) Alternative approaches to stroke management
11) References

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WHAT IS A STROKE??
AKA…CEREBROVASCULAR ACCIDENT (CVA)
or BRAIN ATTACK…

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 Is a loss of brain FUNCTION due to an insult or blockage of
blood supply to an area of the brain.
 It persists BEYOND 24 hours
 It is due to either:
1) LACK OF BLOOD FLOW by a clot or reduced
blood flow (OCCLUSION OF LARGE BRAIN
VESSEL BY THE HEART OR OTHER NEARBY
BLOOD VESSEL)
or
2) BLEEDING into or around the brain by the
blood vessels (RUPTURE OF ANEURYSMS,*
AVMs OR SMALL VESSELS)

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 The result can be:
1) LOSS OF MOVEMENT OF LIMBS
2) LOSS OF SPEECH OR IMPAIRMENT OF SPEAKING ABILITY
3) VISION IMPAIRMENT
 It usually causes ½ of the body to become flaccid or weakened
 It is distinguished from a TIA or transient ischemic attack that
resolves within 24 hours; NOTE: a TIA usually resolves within 5-15
minutes
 140, 000 people in US die from strokes each year
 11 million people suffer with the “after effects” of strokes

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 90 % of strokes are caused by a blood clot that is within the
brain blood vessel (thrombus) or that travels to the brain
(embolus)
 Men are 25% more likely than women to suffer strokes
 95% of strokes occur in people 45 and older and 2/3 of strokes
occur in those over 60 years of age
 In the US stroke is the leading cause of disability
*AVM: arteriovenous malformation is a
malformation of the connection between an
artery and a vein. It is seen in brain blood
vessels and also in places like the intestinal
tract.

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HISTORICALLY…
 Strokes were reported in ancient Mesopotamia and Persia.
 Hippocrates (460-370 BC) was first to describe the sudden
paralysis that is associated with lack of blood flow or
ischemic type of stroke.
 Stroke was the second most frequent cause of death globally
in 2011 with over 6 million deaths (heart disease is first)

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MAJOR RISK FACTORS…
• Hypertension or High Blood Pressure
• Atrial fibrillation
• Diabetes
• Congestive heart failure
• Hyperlipidemia
• Myocardial infarction or heart attack
• Aging
• Obesity
• Smoking
• Alcohol abuse

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SIGN: That which is measurable or objective
SYMPTOM: That which is described or subjective
SIGNS AND SYMPTOMS…

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 SUDDEN NUMBNESS, TINGLING, WEAKNESS OR LOSS OF
MOVEMENT OF FACE, ARM, LEG, ESPECIALLY ON ONLY ONE SIDE
OF THE BODY
 SUDDEN VISION CHANGES
 SUDDEN TROUBLE SPEAKING
 SUDDEN CONFUSION OR TROUBLE UNDERSTANDING SIMPLE
STATEMENTS
 SUDDEN PROBLEMS WITH WALKING OR BALANCE
 SUDDEN SEVERE HEADACHES THAT IS DIFFERENT FROM ANY
OTHER
The following are general symptoms of a stroke:

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WHAT TO DO IF YOU ARE EXPERIENCING STROKE SYMPTOMS?
DON’T DELAY: CALL 911 IF YOU OR SOMEONE YOU ARE WITH
OR TRYING TO COMMUNICATE WITH IS HAVING SYMPTOMS

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Remember STROKE…
S---SPEECH PROBLEMS
T---TINGLING OR NUMBNESS
R---REMEMBER (MEMORY PROBLEMS)
O---OFF BALANCE
K---KILLER HEADACHE
E---EYES OR VISION AFFECTED

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F---FACE DROOP
A---ARM WEAKNESS
S---SPEECH DIFFICULTY
T---TIME TO CALL 911
Or FAST…
Unfortunately, many people do not take immediate action.
This delay can cost brain cells and body function.

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1) Thrombotic: a blood clot on a plaque in the blood vessel
wall; atherosclerosis or hardening of arterial walls is the
most common cause for a thrombus to form.
2) Embolic: a travelling thrombus or debris in the arterial
bloodstream originating from elsewhere; most commonly
and embolus is rooted in a thrombus (arising in the heart in
atrial fib) in an artery but can be from fat (from bone
marrow in a broken bone), air, cancer cells or even bacterial
clumps (from an infection in a heart valve).
ON CAUSES…

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3) Low blood flow (hypoperfusion): due to heart dysrhythmias, heart
attacks, lung clots (pulmonary emboli), fluid around the heart
(pericardial effusion), bleeding in the body or cardiac arrest; blood
flow to brain is compromised & damage happens.
4) Venous thrombosis: increase in the pressure of the veins in the
brain that then leads to bleeding into brain.
5) Intracerebral hemorrhage: from small arteries commonly due to
high blood pressure, AVMs or from clots that cause bleeding; also
from **trauma, illicit drugs like cocaine or amphetamines
(stimulants).

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6) Silent stroke: no outward symptoms; person usually unaware; more
common than most realize; high blood pressure and diabetes are
significant contributors; can be found on MRI incidentally or when
person is under full examination.
7) Sickle cell anemia (SSA): blood cells clump up and block blood
vessels; stroke is a second leading cause of death in people under 20
who have SSA.
**TRAUMA: falls, blunt trauma to skull, bullets or other penetrating objects into the
brain can cause bleeding that will compress brain tissue, reduce oxygen to the site and
ultimately cause direct toxicity with high likelihood of loss of brain function.
NOTE: repeated blunt trauma to head as in sports injuries, recurrent falls or physical
violence are all implicated in both short and long term brain dysfunction.

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We try to understand the precise cause for a stroke via
the following approaches. Thirty % of the time, we
cannot pinpoint the exact cause. The suspicion based on
a clinical picture, however, will generally give us an
answer to the question of how it happened.
HOW IS STROKE DIAGNOSED?????

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1) Neurological exam by a doctor
2) CT scan
3) MRI scan
4) Doppler ultrasound of carotid arteries
5) Echocardiogram and electrocardiogram
6) Holter monitor
7) Arteriography
8) Blood testing to check for high cholesterol
or bleeding problems
9) NOTE: NO COMMONLY USED OR
STANDARD BLOOD TEST to actually
DIAGNOSE a stroke

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1) Medical support with any & all necessary fluids to maintain adequate
blood volume and pressure for brain preservation
2) Removal of the clot directly by THROMBECTOMY: neurosurgeon to
evacuate the clot and any blood debris; NOT ALL CASES WILL NEED
SURGERY.
3) Breaking up the clot by THROMBOLYSIS: within 3 hours of a stroke a TPA
(tissue plasmninogen activator) infusion into the bloodstream may
prevent residual damage to the brain; only for NON-BLEEDING strokes;
only a small percentage of stroke patients are seen early enough to
receive this treatment.
A stroke or CVA is managed as follows:

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4) Direct intra-arterial fibrinolysis: a catheter is passed into a brain artery
and medication is injected at the site of the thrombosis.
5) For NON-BLEEDING STROKES: Anticoagulation can be initiated once and
only once the stroke has been confirmed to be such.
6) Anticoagulation: NOT FOR BLEEDING STROKES; aspirin alone- up to
325mg daily; warfarin or Coumadin; antiplatelet agents like PLAVIX
(clopidogrel) and PERSANTINE (dipyridamole) plus aspirin; they can be
used as solo agents or combined, e.g. aspirin and one of the others; all
have risks of bleeding so must be monitored.
7) Rest, observation and may need sedation

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8) Anticonvulsants are used in a percentage of strokes to prevent
post-stroke seizures.
9) ANGIOPLASTY or STENTS: research is under way to see if these
can be used in ACUTE stroke. They are used in prevention
measures.
10) Support on a stroke unit in a hospital facility or rehab center. Can
be inpatient and then outpatient services. Rehab includes:
PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY,
PSYCH THERAPY for the purpose of relearning how to move and
use muscles again, perform usual activities of daily living, speak
coherently, cope with the mental trauma.
11) Family support, psych counselling
12) Antidepressant therapy may be needed

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State of the Art Techniques for Stroke:
These are on the horizon and being researched but yet to be proven
effective or approved by FDA and others:
• Angioplasty or balloon catheterization for acute stroke
• Stenting of arteries for acute stroke
• Stem cells injected directly into the brain; very nice potential
according to current research! Some dramatic recoveries seen.
• Meds to inhibit glutamate to prevent cell death in a stroke
• Meds to inhibit cell death (apoptosis)
• Free radical scavengers
• Antioxidants

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PREVENTION IS THE KEY!!
Pay attention everyone…

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• Take care of your diet. Eat high quality
plant-based foods. Avoid junk food and
processed food. Use less meat and dairy
for better health. Eat less. No artificial food
or drink. Very little alcohol or better NONE.
• Exercise every day and keep weight in good
control. Use yoga, power walks, dancing,
swimming, cycling and other active sport
activities to increase vitality, flexibility and
stamina
• Good sleep and relaxation; naps are good.
Modifiable risks factors:

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• STOP SMOKING; this is a significant
stroke risk factor
• Watch your blood pressure; even
small increments are risks for events
in the brain; lower BP conclusively
prevents both ischemic and
hemorraghic strokes.
• Have a medical checkup with at least
EKG and blood testing to evaluate
baseline condition of the heart.
• If pre-diabetic or diabetic, MUST
control the sugar and calories.

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• Surgical intervention if indicated; those with
blockages in the carotid arteries in the neck
must be followed and decisions about a
procedure called and ENDARTERECTOMY
can be made.
• Low dose aspirin for those with history of
high blood pressure, previous strokes,
previous TIAs or incidences of these in the
family.
• Keep close with family, friends and social
support; a therapist can be very helpful for
those who are lacking family or friend
support. All resources for group support or
other services need to be looked into for
those in need.
• Pets are very supportive and help keep the
blood pressure down! Some people who
have suffered a stroke may require a service
animal for assistance in their daily lives.

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ALTERNATIVES/NATURAL THERAPIES IN
STROKE PREVENTION/CARE

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A stroke needs to be addressed rapidly to prevent the long-term
damage. One should not assume that the symptoms will just go
away.
If you have suffered a stroke, it is best to review how you have
been conducting your life and make all necessary changes.
Your food selection is probably the most controllable element in
stroke prevention and subsequent treatment. Foods that will
nourish the body and not break it down must be a priority here.
Avoiding meats, dairy, sugar and processed foods and salts are
absolutely key to making your journey to better cardiovascular
health.

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As mentioned above, best food choices, daily exercise, normal body
weight, adequate sleep, relaxation and distressing are all
fundamentally required for prevention of stroke or most disease.
When these are in place, addition of the following can be done in
prevention. They are also very beneficial for the stroke victim:
Meditation to deeply relax and quiet the mind. Blood pressure
reduction is a nice benefit here, among many more health benefits.
Detoxification with cleansing foods and bitter herbs. This is a nice way
to remove a lot of build-up in the digestive tract and hence, improve
brain function.
Massage to stimulate and energize the flow of blood and lymph. This
is a part of detoxification and should be done as often as one can.

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Acupuncture or acupressure: to reduce pain and increase
“chi” or life flow through the body.
Aromatherapy: to calm the nervous system; improve blood flow; many
options here to work with
Chelation in the intravenous form preferred. Oral chelation may also be
helpful. This involves use of EDTA, vitamins and minerals to help reduce
plaque and other debris in the arterial walls, digestive tract and other
organs. Outcomes vary and those with arterial plaque build-up have
been shown to reduce the blockages with several IV treatments.
Chanting/Prayer: spiritual motions for improving the mind and body.

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Earthing or grounding: skin contact with the earth; using electromagnetic
frequencies from earth source to help heal the body; increasing vitality,
improving pain, stimulating; natural earth and purchase of products that can be
used in home or office to obtain the electromagnetics of natural ground. No
proof but anecdotal reports are emerging that reveal good results on blood
pressure reduction.
Nattokinase: this is a natural enzyme derived from the soy plant that can reduce
blood viscosity and help lower blood pressure. One must decide if this is best
option especially if there are a lot of risks for stroke or one has already suffered a
stroke. This is not recommended or approved by the FDA for use in stroke
situations. Nattokinase was founded by Dr. Hiroyuki Sumi from Japan in 1980. It
acts on fibrin that reduces blood thickness and clot accumulation in the artery.
Carrots: 5 servings a week with a Harvard study of 87, 000 women showed 68%
reduction in stroke compared with those who consumed only 2 servings a month.

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CAUTION: IF YOU ARE ON COUMADIN OR A
COMBINATION OF IT WITH ANY OTHER
ANTICOAGULANTS, YOU MUST BE VERY
CAREFUL WITH ALL HERBALS AND
SUPPLEMENTS. SPEAK TO YOUR PROVIDER
BEFORE ANY PLANS TO TAKE IN ADDITIONAL
NATURAL ITEMS.

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 Cayenne 100mg twice daily to help circulation and reduce blood
pressure
 Pigweed (amaranthus) 1000mg daily
 Willow bark… acts like aspirin; caution if you have an ulcer or are
bleeding since is does thin the blood!
 Gingko biloba and Siberian ginseng… to improve circulation by
reducing blood viscosity and reducing capillary fragility
The following HERBS and SUPPLEMENTS have been very helpful; are
used alone or in combination; use according to results experienced;
DO NOT TAKE ALL OF THESE SUPPLEMENTS TOGETHER; use of 3-4 of
the items at any given time is adequate:

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 Hawthorne berry 200mg 2-3 times a day
 Horsetail.. a silicon-containing herb good for
blood vessels, bones, muscles; tea or capsule
daily
 Green tea… antioxidant to protect brain; daily
use ok; avoid if blood pressure is high
 Astragalus 200mg 4 times a day to detoxify for
at least 2 weeks
 Damiana, lavender, rosemary, elderberries,
hyssop can be used in diet or aromatherapy to
help support blood flow in the nervous system
 Pinebark in tea or supplement
 Grapeseed extract in any form
 Garlic every day!

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There is no specific formulation with the herbal
approaches. One is wise to implement a small
program and slowly permit the body to experience
these items without excessive or overdoing the pills or
concoctions.
Always keep in mind that whole foods are what you
need most!

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Andreoli, T., Carpenter, C. et al. Cecil Essentials of Medicine. W.B. Saunders,
Philadelphia, 1996
“Brain Basics: Preventing Stroke”
(http://www.ninds.nih.gov/disorders/stroke/preventing_stroke.htm).
National Institute of Neurological Disorders and Stroke
Fauci, A., MD, Kasper, D., MD et al. Harrison’s Principle’s of Internal
Medicine; 18th Ed. McGraw Hill, USA, 2012
http://webmd.com/stroke/news/20140520/exercise-aids-in-stroke-recovery
Kushi, M. The Macrobiotic Path to Total Health. Ballantine Books, NY, 2003.
Ober, C., Sinatra, S., MD. Earthing. Basic Health Publications, 2010
REFERENCES