Strokes are increasing in number due to an aging population and are largely preventable. In the highest risk patients, a 90% relative risk reduction for stroke is attainable by appropriately using all the measures proven to reduce stroke: smoking cessation, a Mediterranean diet, control of hypertension, natural or pharmaceutical anticoagulants or antiplatelet agents, lipid lowering drugs or dietary supplements, and appropriate carotid endarterectomy when indicated. Vitamin therapy to lower homocysteine and carotid stenting are additional measures that may yet prove beneficial. Diet, smoking cessation and appropriate carotid endarterectomy reduce stroke more than prescription medicatiosn. Blood pressure control depends more on selecting appropriate therapy individualized for the patient, than on using any particular drug class.

Stroke family history
Brothers and sisters of people who have had a stroke are nearly twice as likely as the average American to experience a stroke themselves.

Strokes come in two major forms:
1) A blood clot in a blood vessel in the brain which reduces or stops blood flow to parts of the brain
2) A hemorrhage or bleeding in brain tissue.

When blood flow to the brain is disrupted, brain cells can die or be damaged from lack of oxygen. Brain cells can also be damaged if bleeding occurs in or around the brain. The resulting neurologic problems are called cerebrovascular disorders because of the brain (cerebrum) and blood vessel (vascular) involvement.

Insufficient blood supply to parts of the brain for brief periods causes transient ischemic attacks, temporary disturbances in brain function. Because the blood supply is restored quickly, brain tissue doesn't die, as it does in a stroke. A transient ischemic attack is often an early warning sign of a stroke.

In Western countries, strokes are the most common cause of disabling neurologic damage. High blood pressure and atherosclerosis--hardening of the arteries from fatty buildup--are the major risk factors for strokes. The incidence of strokes has declined in recent decades, mainly because people are more aware of the importance of controlling high blood pressure and high cholesterol levels.

How a stroke or transient ischemic attack affects the body depends on precisely where in the brain the blood supply was cut off or where bleeding occurred. Each area of the brain is served by specific blood vessels. For example, if a blood vessel in the area that controls the left leg's muscle movements becomes blocked, the leg will be weak or paralyzed. If the area that senses touch to the right arm is damaged, the right arm will lose feeling (sensation). The loss of function is greatest immediately after a stroke. However, some function is usually regained because, while some brain cells die, others are only injured and may recover.

Prevention of strokes
A person's odds of suffering a stroke might be significantly reduced by maintaining an overall healthy lifestyle, which includes not smoking, exercising daily, consuming a healthy diet, drinking alcohol in moderation and maintaining a healthy weight
Proper diet, increase intake of fruits and vegetables and fish.
Reduce hypertension
Reduce cholesterol. For additional info on cholesterol.
Reduce or eliminate smoking
Reduce alcohol
Aspirin is a much more cost-effective way to treat patients at risk of having a second heart attack or stroke than the new drug Plavix (clopidogrel).
Influenza and other serious respiratory infections significantly increase the risk of stroke, particularly during the period of infection and the week after. Therefore, keeping your immune system well by doing moderate exercise, sleeping well, and eating healthy foods can reduce the risk for influenza infection. Flu shots may help. Wash your hands if you are around sick people, and reduce your exposure to those with the flu, if possible.

Supplements or herbs that may be helpful
Antioxidants such as those found in fresh vegetables and fruits
Fish Oils, DHA except in cases of hemorrhagic stroke. Fish oils thin the blood and improve circulation
Ginkgo biloba in low dosages of 40 or 60 mg a day. See ginkgo biloba brain for more information.
Vinpocetine pill could improve oxygenation to brain tissue.

Stroke prevention
A stroke can cause brain damage within three to four minutes, therefore stroke prevention is crucial. Stroke is one of the feared conditions in old age and fortunately much can be done to reduce the risk. For one, how a food is prepared can make a difference. Seniors eating tuna or fish that's been broiled or baked appears to lower stroke risk, but frying the catch of the day may increase it. Investigators found that people aged 65 and older who ordered frequent servings of tuna or other types of broiled or baked fish were up to 30 percent less likely than people who ate fish less than once per month to experience a stroke over a 12-year period. Diet has a strong influence on the stroke prevention. For instance, eating fresh fruits and vegetables reduces the risk.

Vinpocetine and Stroke
Could a simple herbal extract have an influence on stroke recovery? Vinpocetine is an alkaloid found in the periwinkle plant. It was introduced into clinical practice in Europe more than two decades ago for its role in cerebrovascular disorders and related symptoms. Experiments with vinpocetine indicate that it can dilate blood vessels, enhance circulation in the brain, improve oxygen utilization, make red blood cells more pliable, and inhibit aggregation of platelets. Vinpocetine even has antioxidant properties.
     A double-blind study was conducted to test the effects of vinpocetine on patients suffering from multiple cerebral infarcts. Twenty-six patients with multiple cerebral infarctions, aged between 50 and 83 years were examined, 14 of whom received vinpocetine and 12 placebo. Three months later, the vinpocetine patients did not show any significant worsening in symptoms, while the placebo group did. Several previous studies have indicated that vinpocetine may have beneficial effects in stroke prevention or therapy.
     We would like to see more studies before wholeheartedly recommending vinpocetine for stroke prevention or treatment. However, the results are intriguing enough that doctors who treat stroke patients should review this literature and decide whether some of their patients could benefit from vinpocetine. As to the dosage, it is difficult to know the long term amounts that are helpful. Our guess is 2 to 5 mg once or twice a day should be fine for most people. Vinpocetine is usually found in 10 mg amounts, so breaking a tablet in half, a third, or smaller portions is an option.

Folic acid and stroke reduction
Efficacy of folic acid supplementation in stroke prevention: a meta-analysis.
Lancet. 2007 Jun 2;369(9576):1876-82. Wang X, Qin X, Demirtas H, Li J, Mao G, Huo Y, Sun N, Liu L, Xu X.
Mary Ann and J Milburn Smith Child Health Research Program, Children's Memorial Hospital and Children's Memorial Research Center, Northwestern University Feinberg School of Medicine, Chicago, IL
The efficacy of treatments that lower homocysteine concentrations in reducing the risk of cardiovascular disease remains controversial. Our aim was to do a meta-analysis of relevant randomised trials to assess the efficacy of folic acid supplementation in the prevention of stroke. We collected data from eight randomised trials of folic acid that had stroke reported as one of the endpoints. Relative risk (RR) was used as a measure of the effect of folic acid supplementation on the risk of stroke with a random effect model. The analysis was further stratified by factors that could affect the treatment effects. Folic acid supplementation significantly reduced the risk of stroke by 18%). In the stratified analyses, a greater beneficial effect was seen in those trials with a treatment duration of more than 36 months, a decrease in the concentration of homocysteine of more than 20%, no fortification or partly fortified grain and no history of stroke. Our findings indicate that folic acid supplementation can effectively reduce the risk of stroke in primary prevention.

Diagnosis of stroke
CAT scans are the most common method of diagnosing a stroke in the emergency rooms but they only catch about one out of every four cases — far fewer than an MRI scan, which also was better at spotting the type of stroke. It is suggested that MRI scans should replace CT X-rays as the standard of care for stroke diagnosis.

Value of carotid artery testing questioned for stroke diagnosis or prevention
In December 2007, the U.S. Preventive Services Task Force recommended that individuals not be tested for narrowing of the carotid arteries, the major arteries in the neck that supple oxygen to the brain, provided that they have no symptoms of narrowing in the first place. Carotid artery narrowing or "stenosis" is a common finding in older adults, which can lead to a stroke if it is severe. The condition can be treated with surgical removal of the plaque lining the inside of the arteries that cause the stenosis or with the placement inside the arteries of a stent, a tiny metal tube that maintains an open passage for blood flow. Based on evidence that screening for symptomless carotid artery stenosis may cause more harm than good, new guidelines from  this practice in the general population. Annals of Internal Medicine, December 18, 2007.

TIA versus full stroke
Insufficient blood supply to parts of the brain for brief periods causes transient ischemic attacks, temporary disturbances in brain function. Because the blood supply is restored quickly, brain tissue doesn't die, as it does in a stroke. A transient ischemic attack is often an early warning sign of a stroke.

Risk factors for stroke
In Western countries, strokes are the most common cause of disabling neurologic damage. High blood pressure and atherosclerosis -- hardening of the arteries from fatty buildup -- are the major risk factors for strokes. The incidence of strokes has declined in recent decades, mainly because people are more aware of the importance of controlling high blood pressure and high cholesterol levels.

In the country of Iran
People who live in Iran have strokes more often and at younger ages than those in many Western countries. Only the Ukraine has a higher rate of stroke than Iran. Dr. Mahmoud Reza Azarpazhooh, of Ghaem Hospital in Mashhad, Iran says the reasons for the high rate among Iranians, including relatively young people, are not yet clear. Dr. Mahmoud Reza Azarpazhooh thinks that perhaps poor control of stroke risk factors is one reason. Nearly half of Iranian stroke sufferers with high blood pressure reported poor compliance with their treatment. The same was true of 61 percent of those with high cholesterol and 36 percent of those with diabetes. Stroke, January 2010.

Prescription drugs that increase the risk of stroke
Two prescription drugs pulled from the market in recent years -- Vioxx (also known as rofecoxib) and Bextra (also known as valdecoxib) - increase the risk of stroke.

Drug use and stroke
Young people who abuse cocaine and amphetamines are at heightened risk for suffering a stroke.

Consequences of stroke
How a stroke or transient ischemic attack affects the body depends on precisely where in the brain the blood supply was cut off or where bleeding occurred. Each area of the brain is served by specific blood vessels. For example, if a blood vessel in the area that controls the left leg's muscle movements becomes blocked, the leg will be weak or paralyzed. If the area that senses touch to the right arm is damaged, the right arm will lose feeling (sensation). The loss of function is greatest immediately after a stroke. However, some function is usually regained because, while some brain cells die, others are only injured and may recover.

Stroke in Women
Dr. Susanna Horvath, neurologist at New York Methodist Hospital in Brooklyn, N.Y., says: "Despite its standing as the third leading cause of death and the number-one cause of disability in the U.S., stroke is often a misunderstood condition -- particularly among women. While it is true that men outnumber women among
stroke patients over the age of 65, a new study found that women between the ages of 45 and 54 are up to 2.5 times more likely to have a stroke than men in the same age group. Sadly, women are largely unaware of the unique risks,
symptoms and prevention strategies they need to know in order to protect themselves from stroke." Dr. Susanna Horvath is a neurologist and stroke specialist at New York Methodist Hospital in Brooklyn, N.Y.

Exercise, physical conditioning, and stroke
Middle-aged and older adults who stay agile, and in good physical shape, are less likely to suffer a stroke than their less-nimble peers. Those who have good physical functioning such as having little problem climbing stairs or carrying groceries, for instance -- are less likely to have a stroke.

Risk of mini stroke - TIA
Mini strokes lead to a major stroke within one week in 1 out of 20 people and should be treated as a medical emergency. Patients who are immediately treated for small strokes, called transient ischemic attacks (TIAs) have significantly less risk of a major stroke soon afterward. But people who do nothing about a TIA have a small risk of a major stroke within the next few weeks. TIAs are smaller versions of major strokes and cause similar symptoms such as dizziness, weakness of an arm or leg or visual disturbances. The symptoms are usually mild and transient, so it's easy for people to ignore these episodes. However, TIAs are a warning sign that a larger stroke may be on the way that can cause paralysis, loss of speech, cognitive confusion or death.

Silent strokes common in middle aged people
Routine brain scans in a group of middle-aged people show that 10 percent of them have had a stroke without knowing it, raising their risk for further strokes and memory loss. People with atrial fibrillation, the most common type of irregular heart beat in people over 65, have a higher rate of these silent strokes. Silent cerebral infarctions or SCIs are brain injuries caused by a blood clot that interrupts blood flow to the brain.

Drugs that increase stroke risk
Tibolone, a drug with hormone-like effects, reduces the risk of fractures and the risk of breast and colon cancer in postmenopausal women with osteoporosis. Tibolone seems to increase the risk of stroke, according to the results of the Long-Term Intervention on Fractures with Tibolone (LIFT) trial.
   People taking antipsychotic drugs are nearly twice as likely to have a stroke compared to those not on the treatment.

Red Bull and stroke risk
The popular stimulant energy drink Red Bull may increase the risk of heart attack or stroke, even in young people, according to Australian medical researcher. "One hour after they drank Red Bull, (their blood systems) were no longer normal. They were abnormal like we would expect in a patient with cardiovascular disease," lead researcher Scott Willoughby, from the Cardiovascular Research Centre at the Royal Adelaide Hospital, told an Australian newspaper. Scott Willoughby and his group tested the cardiovascular systems of 30 young adults one hour before and one hour after consuming one 250ml can of sugar-free Red Bull. The results showed "normal people develop symptoms normally associated with cardiovascular disease" after consuming the drink, created in the 1980s by Austrian entrepreneur Dietrich Mateschitz based on a similar Thai energy drink.

Symptoms
Older people poorly understand most of the important warning signs of stroke and factors that increase risk for this medical emergency. Many do not realize that sudden dizziness, numbness, weakness, and quick onset headache are common warning signs of stroke. Many older people do realize that slurred speech is an indicator of stroke.

Stroke natural therapy and prevention questions
Q. My mom had a minor stroke. Luckily we caught it and got her to a stroke treatment center in 1 hour. They used the clot busting drug and within an hour she was back to normal speech and only shows a little weakness in right arm / fist and leg / foot. Her carotid artery is clear. Mom has Atral Fib which make people like her more prone to stroke. due to the clotting at the heart level. For about 6 years she was on Coumadin. She started to have some nose bleeds so they took her off. I believe the nosebleeds were a combination of dry winter weather and the Coumidin. They put her on low dose aspirin every night. She has been good for 9 years. She did develop some vision issues which I wonder if they were clot related. Anyway. now that she is coming home and doing better we naturally don't want a repeat. Is starting Coumidin or Plavix a good option her and see how it goes? Or possibly aspirin with some other natural blood thinner?
   A. We wish your mom well and hope she has an optimal outcome, however we are not in a position to offer individual advice without doing a full medical history and examination. The decisions regarding medication or natural supplements rest on her health care provider who knows her full history and blood studies and EKG, neurological exam, etc.

Q. My Father has recently affected by stroke blood clot in brain. Do you think Noni or basil herb will help?
   A. We have not any research with noni or basil for stroke treatment.

Q. Can you tell me if Passion RX may help me, as I had a stroke 4 years ago? I also have a carotid artery stenosis.
   A. We don't suggest Passion Rx to anyone with a serious cardiovascular or cerebrovascular problem.

Q. I am wanting to make sure I take supplements needed for prevention of osteoporosis. The vitamin bottle I have for osteoporosis prevention contains 150 mcg of Vitamin K per capsule. My concern is that being of the age for possible strokes, does taking Vitamin K influence stroke incidence?
   A. This is a difficult question to answer since one has to weigh the benefits of vitamin K supplementation versus the risk for stroke. Much depends on an individual person's risk factors for stroke and their clotting or bleeding tendencies. Some people clot too easily, others have a tendency to have very thin blood. One has to also consider whether vitamin K is necessary for osteoporosis prevention when there are other supplements that are quite effective. We have not seen much research to determine if taking vitamin K supplements has a measurable effect on increasing stroke risk. It is difficult to predict the benefits versus risks of vitamin K supplementation and to determine which option is better.

Q. I was surprised to see little about the ability of serrapeptase to dissolve fibrin thus increasing blood flow in large and small vessels. Perhaps nattokinase is a better choice. I am a nutritionist but i am obviously learning as I go on this. I'll check Pubmed but I'd like to have Ur opinion. I am trying to deal with restricted blood flow to the brain, beyond using gingko (160mg). This is clearly present in people with CFIDS / ME but - I assume - w people who have drop attacks. Your opinion on nutraceuticals you've found helpful on drop attacks would really help : I found no ref so far.
   A. Drop attacks have many, many potential causes, and we are not aware of any single supplement that can prevent drop attacks.

Q. Aggrenox, prescribed as a stroke and TIA avoider is very expensive. Could nattokinase be used instead? Any other substitutes?
   A. We have not seen any studies comparing nattokinase to Aggrenox in terms of stroke prevention or treatment.

Can my mother at 80 years old take systemic enzymes if she has experienced a hemorrhagic stroke in 2007. Will they cause her to bleed resulting in another stroke? I want to find out if these enzymes will help relieve pain that my mum is experiencing. She is now on Lyrica which is a last resort option she is taking. She obviously has some pain that is nerve related but she also has joint pain. She has had a hemorrhagic stroke two years ago. Wobenzym thins the blood, so I have read. How can she take this and still not run the risk of another bleed. Should she test periodically for blood thickness. Are there foods that build blood that she should increase in her diet. My mum is a vibrant 80 year old who is now very filled with pain and it is beginning to daunt her otherwise upbeat, humorous spirit. She is not on aspirin nor warfarin. The challenge is that enzymes thins the blood, I am told. Today she can walk and an speaks clearly with a slight slur. She has never been depressed and is actually quite alert and witty. She has been on the following medications: Fosamax: discontinued in December 2008, Tritace (Ramipril) for blood pressure monitoring. Diamicron for diabetes, Vit C and Glucosamine with Vit B. She is however constantly in pain and has difficulty sleeping because it. She has tried several pain meds and all but one has given her some relief. Pain meds tried: Mobec (Mobic) - stopped about four months ago, Vallium - stopped about 4 months ago, (Elavil, Endep) Amitriptyline 25mg. The amitriptyline has given her relief so that she is able to get a few hours relief from pain during the night time. She was on this drug for 4 days and then taken off. The doctor did not recommend the lower dose of 10 mg. He felt the side effects were too severe. She experienced the following side effects: Sleepiness for 18 to 20 hours daily, glazed stare, constipation. No bowel movement for 3 days. Halucinations, tactile, visual and auditory.
She is now on Lyrica which is supposed to work and with four days into it’s usage we think she is getting some relief only during sleep time. Not sure since she seems to be in more pain now. Since we are trying to have her rehabilitate, she cannot afford to be sleeping all the time because now instead of her not being able to do her exercise routines on account of pain, she is unable to do them on account of sleepiness and lethargy.
    Some systemic enzymes could thin the blood.

I had a stroke 12 years ago due to bypass surgery. This left me with hemiplegia. Now, I have developed a series of TIA's. I'm taking many herbs and vitamin supplements including Nattokinase and 81mg of aspirin twice a day. My doc wants me to go on statins and Plavix, I am 81 what do you think?
    This is a decision you and your doctor need to make.

I suffered a Hemorrhagic stroke on March 21 2008 and it left my right side partialy paralysed. I've since regained some of movement but I was wondering if you had any advice that could help me get back to normal.
    We are not in a position to offer individual advice.

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