How can I prevent a stroke from happening?
Strokes result from either hemorrhage or ischemia in the brain. Hemorrhage in the brain results from arteriolar bleeding due to hypertension, coagulation disorders, cocaine and amphetamine abuse, and vascular malformations. Ischemia is the result of hypoperfusion of brain tissues due to either obstruction of the arterial, oxygenated supply of blood by thrombus or embolus or because of systemic circulatory problems such as heart failure. Prevention of stroke is through the addressing of these risk factors.
Prevention of Hemorrhagic Stroke:
- Control of hypertension via smoking cessation, exercise, weight management, and treatment with antihypertensives and statins
- Diagnose and treat bleeding disorders, if present
- Avoid of substance abuse, especially sympathomimetics and substances that act as vasoconstrictors, such as the nicotine in tobacco products
- Observe for warning signs of CNS vascular malformation, such as headache and transient ischemic attacks (TIAs)
- Aggressive surveillance if there is a blood disorder such as sickle cell anemia, protein deficiency, antiphospholipid syndrome, etc
- Strict glycemic control in diabetics
Prevention of Ischemic Stroke:
- Control of hypertension via smoking cessation, weight management, and treatment with antihypertensives and statins
- Strict surveillance of the carotid circulation in patients with hypertension, diabetes, dyslipidemia, or a strong family history of deep vein thrombosis or pulmonary emboli
- Aggressive diagnostics (imaging) after TIA
- Address any hypercoagulable state to discourage thrombus formation
- Smoking cessation, weight management
- Avoid excessive alcohol intake
- Low-dose daily aspirin for those ≥50 years without excess bleeding risk
Prevention of a Second Stroke (Secondary Prevention):
- Anti-platelet therapy by aspirin or clopidogrel (Plavix) for the prevention of thrombus formation and to safeguard a patient from complications (emboli) of atrial fibrillation.
- Use of anti-diabetic medication to reduce insulin resistance