Chances of having a stroke

Risk Factors for Stroke in Subjects With Normal Blood Pressure

It is generally accepted that high blood pressure (BP) is the major risk factor for stroke.1–3 There is a continuous and linear relationship between BP and risk of stroke,4 which holds even in individuals with a normal BP.1,5 Yet, people are classified into those with hypertension and normal BP. The majority of literature is devoted to exploring the relationship between hypertension and stroke.2,3 Few researchers have studied this association in those who are normotensive.6

It is evidenced that apart from high BP, the pathological causes of stroke are manifold, including the formation of atheroma, embolism from the heart, intracranial small vessel disease, malformations of the vasculature in the brain, etc.7 In addition, biological, sociodemographic characteristics and lifestyle factors, such as aging, smoking, physical inactivity, alcohol consumption, and diabetes, are also considered risk factors for stroke.8,9 However, whether these risk factors are similarly related to stroke in normotensive subjects is unclear.

To our knowledge, a comprehensive risk factor analysis of the incidence of stroke in normotensive individuals has not been documented so far. Therefore, the purpose of this study is to explore the risk factors for incidence of first-ever stroke among individuals who have a normal BP.

Methods

Study Population

From 1991 to 1996, all men and women born between 1923 and 1950 and living in the Malmö area in the southern part of Sweden were recruited into the Malmö Diet and Cancer (MDC) study. Detailed information of the MDC study has been reported previously.10 The final cohort consisted of 28 449 subjects (11 246 men and 17 203 women) from the eligible population of ≈74 000 individuals.11 Participants were offered a health assessment program, including a self-administered questionnaire in combination with clinical examinations at a screening center. All participants were followed from the time of baseline examination until death, or until December 31, 1999. Those who had a history of stroke before the examination (according to self-report or hospital register) were excluded.

Stroke Registration

Records of patients with stroke were retrieved by the data linkage to the Stroke Register in Malmö (STROMA).12 Since 1989, all Malmö residents who have experienced stroke, whether hospitalized or nonhospitalized, have been registered in STROMA. Stroke cases that have moved out from Malmö were retrieved by data linkage with the National Hospital Discharge Register.13

Stroke was defined as rapidly developing clinical signs of local or global loss of cerebral function that lasted for >24 hours or led to death within 24 hours. Subtypes of stroke were coded according to the International Classification of Diseases (ICD), 9th Revision. Events were classified as cerebral infarction (ischemic; ICD 434), intracerebral hemorrhage (ICD 431), and subarachnoid hemorrhage (ICD 430). Patients with transient ischemic attacks were excluded. The subtype of stroke was verified by computed tomography (CT) scan, autopsy, or lumbar puncture. Stroke was classified as unspecified stroke (ICD 436) if CT or autopsy record was unavailable.

Baseline Characteristics

The screening examination included a self-reported questionnaire as well as clinical examinations.

Sociodemographic Characteristics

Marital status was classified into 2 groups (ie, unmarried or married ). Educational level was divided into low (≤8 years), moderate (9 to 12 years), and high (college/university) levels. Occupational status was categorized into 2 groups on the basis of the Swedish socioeconomic classification.14 Manual workers and low-level nonmanual workers were classified as low-level occupations. High-level nonmanual workers together with medium-level nonmanual workers were grouped as high-level occupations.

Lifestyle Factors

Subjects were categorized into smokers and nonsmokers. Duration of smoking and daily cigarette consumption were assessed for smokers. Information on the total alcohol consumption was converted into 4-category variables. Subjects who reported zero consumption of alcohol were categorized as no alcohol intake. Levels of alcohol intake in consumers were defined according to an assumption of biological risk.15 Category ranges for men and women, respectively, were as follows: <20 g and <15 g alcohol daily (low), 20 to 40 g and 15 to 30 g daily (medium), and >40 g and >30 g daily (high). Physical activities during leisure time were revealed through 18 questions covering a range of activities in the 4 seasons.16 The number of minutes per week for each activity was multiplied by an intensity coefficient, and an overall leisure time physical activity scores was created. Scores were divided into 4 quartiles and subsequently categorized as low (quartile 1), moderate (quartile 2 to 3), and high (quartile 4) levels.

History of Chronic Disease and Family History of Cardiovascular Disease

Information about historical records of stroke and coronary heart diseases (CHDs; myocardial infarction or angina pectoris) was obtained in the questionnaire. Questions also covered other diseases and their treatment, such as diabetes mellitus, hypertension, asthma, cancer, struma, renal calculus, rheumatoid arthritis, gastric ulcer, and inflammatory colitis. Investigations also incorporated the family history of stroke or myocardial infarction.

Clinical Examination

By using a mercury sphygmomanometer, BP was measured once in the right arm after 5 minutes rest at the screening center. Hypertension was defined as systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg or treatment for hypertension.17 Among the subjects who had a normal BP, 4 subgroups were established: normal (<130 mm Hg) and high-normal systolic BP (130 to 139 mm Hg) groups, and normal (< 85 mm Hg) and high-normal diastolic BP (85 to 89 mm Hg) groups.17

Statistical Analysis

Logistic regression model was used to compare baseline characteristics in normotensive subjects with and without stroke with adjustments for age.

To explore the association between baseline risk factors and incidence of stroke, Cox-regression analysis was performed in 2 steps. First, all variables showing a significant relation to stroke in the initial analysis was run into the model. Secondly, a backward stepwise Cox-regression model was run. Variables with P values >0.10 were removed from the stepwise model.

All comparisons were 2-sided, and a 5% level of significance was used. Statistical analyses were conducted by SPSS software (version 11.5).

Results

Of 28 449 participants, 514 were excluded because records of BP were missing (n=47) or had a history of stroke (n=467).

The mean duration of follow-up was 5.7±1.6 years, and 466 patients had experienced first-ever stroke during follow-up. The incidence per 100 000 person years was 294 (95% CI, 267 to 321).

Stroke in Subjects With Normal BP

Among subjects who had normal BP, stroke patients were older and had a lower level of education than subjects without stroke. Nearly half of the stroke patients were current smokers and had smoked for ≈30 years but had a low consumption of alcohol (Table 1).

In addition, 55% of the patients were either overweight or obese, which was higher than in the nonstroke subjects. High-normal systolic BP (130 to 139 mm Hg) and high-normal diastolic BP (80 to 84 mm Hg) were significantly higher in stroke patients than in controls. Furthermore, incidence of stroke was highly associated with a previous coronary heart event and concurrent diseases, such as diabetes, gastric ulcer, and renal calculus (Table 2).

Multivariable Analysis

Discussion

The relationship between elevated BP and an increased incidence of stroke has been established in many prospective studies.1,2,3 Hypertension is generally regarded as the most important risk factor for stroke in the general population. However, some individuals experience a stroke even if their BP is within the normal range.1,5 To our knowledge, this is the first prospective study to estimate the comprehensive risk factors for stroke in normotensive subjects. Besides increasing age and a high-normal diastolic BP, the present results showed that smoking, obesity, history of CHD, and gastric ulcer were associated with stroke in this group.

The multivariate analysis identified traditional risk factors (age, high-normal diastolic BP, smoking, obesity, and history of CHD) and a new risk factor for stroke (gastric ulcer). Smoking had a comparatively high prevalence (49%) and high RR (RR, 3.21; 95% CI, 1.82 to 5.66). Besides age, smoking was the risk factor that accounted for most strokes in the population of normotensive subjects. In terms of population-attributable risk,18 it can be estimated that ≈39% of incident strokes were attributed to smoking among normotensive subjects.

However, there was a strong association between obesity and stroke. Previous studies of overweight/obesity and stroke are limited, and the results have not been fully consistent.19,20 The reason for this association is not completely understood. BMI is associated with a low-grade inflammation,21 which is associated with an increased incidence of stroke.22 BMI and low-grade inflammation are associated with dyslipidemia, diabetes, and hypertension. The greatly increased risk for obese subjects could be related to risk factors (dyslipidemia and inflammation) that were unavailable in this study, or to obesity, per se. Alternatively, it is possible that obese subjects more often developed hypertension during the 6-year follow-up period. Nevertheless, the present results show that obesity is an important risk marker for stroke even in the absence of high BP.

Diabetes mellitus is a classic risk factor for stroke. In our analysis, the prevalence of diabetes was significantly higher in stroke patients, but the relationship became nonsignificant in the multivariable analysis. Whether the absence of a significant relationship could be explained by lack of statistical power or if diabetes is associated mainly with stroke in hypertensive subjects remains to be explored.

Physical inactivity is another risk factor for stroke. Previous studies of physical activity suggest that the protective effects are greater for hypertensive than normotensive subjects.23 However, lack of statistical power is another possible explanation for the nonsignificant findings.

Gastric ulcer was significantly associated with incidence of stroke in this study. However, the diagnosis of disease was based on self-reported data, lacking laboratory records. Therefore, we can only speculate about the causal relations with stroke. Infection with the microorganism Helicobacter pylori is a major cause of gastric ulcer. H pylori infection has been associated with CHD and may be important for development of atherosclerosis.24 We are not aware of any previous prospective studies on gastric ulcer and incidence of stroke. However, case-control studies have reported more H pylori seropositivity in stroke cases than in controls.25,26 The relationship between gastric ulcer and incidence of stroke remains to be clarified. Because gastric ulcer is a potentially treatable condition, this relationship could have important clinical implications.

Change of exposure during the follow-up period is an inherent problem in prospective cohort studies. The risk factors in this study were assessed only once. We do not know whether some subjects developed hypertension during the follow-up. However, the follow-up in the present study was rather short, ≈6 years, and it can be assumed that relatively few subjects developed high BP. The diagnosis of hypertension should ideally be assessed by several BP measurements on several different occasions. In this study, BP was measured only once. If BP had been measured repeatedly for subjects who initially had high BP, the number with hypertension would be lower and, hence, the normotensive group larger.27 However, the present sample would still be classified as normotensive.

Atrial fibrillation (AF) is an important risk factor for stroke. However, the information on AF is difficult to acquire from a population-based cohort, and the validity of self-reported AF is probably low because most older people are unaware of occurrence and type of cardiac arrythmia. The absence of data on blood lipids, glucose, and inflammatory markers is another limitation of the study.

Conclusion

In this population-based study of subjects with normal BP, a number of potentially modifiable risk factors were associated with an increased incidence of stroke.

This study was supported by grants from the Swedish Council for Working Life and Social Research, the Segerfalk Fund, Syskonen Svenssons Fund, and Apotekare Hedbergs Fund. We wish to thank Swedish Cancer Society, Swedish Medical Research Council, and Scania Regional Government.

Footnotes

Correspondence to Dr Cairu Li, Department of Community Medicine, Malmö University Hospital, Malmö, Sweden, 205-02. E-mail

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Stroke and high blood pressure

Stroke is a leading cause of death and severe, long-term disability. Most people who’ve had a first stroke also had high blood pressure (HBP or hypertension).

High blood pressure damages arteries throughout the body, creating conditions where they can burst or clog more easily. Weakened arteries in the brain, resulting from high blood pressure, put you at a much higher risk for stroke — which is why managing high blood pressure is critical to reduce your chance of having a stroke.

What happens when you have a stroke

A stroke occurs when a blood vessel to the brain is either blocked by a clot (ischemic stroke) or bursts (hemorrhagic stroke). When that happens, part of the brain is no longer getting the blood and oxygen it needs, so it starts to die. Your brain controls your movement and thoughts, so a stroke doesn’t only hurt your brain — it can threaten your ability to think, move and function. Strokes can affect language, memory and vision. Severe strokes may even cause paralysis or death.

A majority of strokes are ischemic strokes— caused by narrowed or clogged blood vessels (atherosclerosis) in the brain that cut off the blood flow to brain cells. (Cerebral thrombosis and cerebral embolism are ischemic strokes.) Watch an interactive animation of an ischemic stroke.

A much smaller percentage of strokes are hemorrhagic strokes (cerebral hemorrhages) that occur when a blood vessel ruptures in or near the brain, resulting in a subarachnoid hemorrhage (SAH) on the surface of the brain or intracerebral hemorrhage (ICH) deep within the brain. View a detailed animation of a hemorrhagic stroke.

A TIA (transient ischemic attack) is caused by a temporary clot. Often called a “mini stroke,” these warning strokes should be taken very seriously. See what happens during a TIA.

Don’t let high blood pressure lead to stroke:

  • Spot the warning signs of a stroke — FAST!
  • Know your blood pressure numbers
  • Make changes that matter to help prevent stroke
  • Learn the important connection between BP, atrial fibrillation and stroke

Conditions That Increase Risk for Stroke

High blood pressure is a leading cause of stroke. It occurs when the pressure of the blood in the arteries is too high.

Many common medical conditions can increase your chances of having a stroke. Work with your health care team to control your risk.

Previous Stroke or Transient Ischemic Attack

If you have already had a stroke or a transient ischemic attack (TIA), also known as a “mini-stroke,” your chances of having another stroke are higher.

High Blood Pressure

High blood pressure is a leading cause of stroke. It occurs when the pressure of the blood in your arteries and other blood vessels is too high.

There are often no symptoms of high blood pressure. Get your blood pressure checked often. If you have high blood pressure, lowering your blood pressure through lifestyle changes or medicine can also lower your risk for stroke.

High Cholesterol

Cholesterol is a waxy, fat-like substance made by the liver or found in certain foods. Your liver makes enough for your body’s needs, but we often get more cholesterol from the foods we eat. If we take in more cholesterol than the body can use, the extra cholesterol can build up in the arteries, including those of the brain. This can lead to narrowing of the arteries, stroke, and other problems.

A blood test can tell your doctor if you have high levels of cholesterol and triglycerides (a related kind of fat) in your blood.

Heart Disease

Lower Your Risk for Stroke

Learn the ABCS of stroke prevention:

Aspirin: Aspirin may help lower your risk for stroke.

Blood Pressure: Control your blood pressure.

Cholesterol: Control your cholesterol.

Smoking: Quit smoking or don’t start.

Learn more about the ABCS at the Million Hearts® websiteexternal icon.

Common heart disorders can increase your risk for stroke. For example, coronary artery disease increases your risk for stroke, because plaque builds up in the arteries and blocks the flow of oxygen-rich blood to the brain. Other heart conditions, such as heart valve defects, irregular heartbeat (including atrial fibrillation), and enlarged heart chambers, can cause blood clots that may break loose and cause a stroke.

Diabetes

Diabetes increases your risk for stroke. Your body needs glucose (sugar) for energy. Insulin is a hormone made in the pancreas that helps move glucose from the food you eat to your body’s cells. If you have diabetes, your body doesn’t make enough insulin, can’t use its own insulin as well as it should, or both.

Diabetes causes sugars to build up in the blood and prevent oxygen and nutrients from getting to the various parts of your body, including your brain. High blood pressure is also common in people with diabetes. High blood pressure is the leading cause of stroke and is the main cause for increased risk of stroke among people with diabetes.1

Talk to your doctor about ways to keep diabetes under control.

Sickle Cell Disease

Sickle cell disease is a blood disorder linked to ischemic stroke that affects mainly black and Hispanic children. The disease causes some red blood cells to form an abnormal sickle shape. A stroke can happen if sickle cells get stuck in a blood vessel and block the flow of blood to the brain.

Learn more about sickle cell disease at the National Heart, Lung, and Blood Instituteexternal icon.

Learn what steps you can take to prevent stroke.

Reference

  1. National Institute of Neurological Disorders and Stroke. (2009). Stroke: challenges, progress, and promiseexternal icon. Bethesda, MD: National Institutes of Health.

If you’re like many women, chances are you go to great lengths not to burden those around you. But the signs of stroke demand immediate attention.

Ten days after Tamika Quinn‘s daughter Sequoia was born, she woke up with an excruciating headache. Her regular doctor wasn’t available so she went to an urgent care clinic where she was given painkillers and medication for high blood pressure. The pain intensified, so Tamika went to the ER where she was diagnosed with a hemorrhagic stroke, followed by a second stroke three days later.

It took months for Tamika to recover her ability to walk and speak, and she continues to deal with long- and short-term memory loss and muscle control.

The strokes were a wake-up call to take her health more seriously. She took her medication as prescribed and lost weight.

But after four years, Tamika went back to overeating and eating unhealthy foods, and not taking her blood pressure medication. After talking to her doctor about a migraine, Tamika learned her blood pressure had gone back up.

“My doctor told me I was headed down the path to have another stroke,” she said. “I realized I needed to get my life together.”

Signs that you may be having a stroke:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing or blurred vision in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

You should never wait more than five minutes to dial 9-1-1 if you experience even one of the signs above. Remember, you could be having a stroke even if you’re not experiencing all of the symptoms. And remember to check the time. The responding emergency medical technician or ER nurse at the hospital will need to know when the first symptom occurred.

Stroke is not only the No. 4 cause of death in the United States, it’s also a leading cause of severe, long-term disability. That’s why it’s important to take action immediately. Research conducted by The American Stroke Association shows that patients who take a clot-busting drug, or thrombolytic, within three hours of their first stroke symptom can reduce long-term disability from ischemic stroke – the most common type, accounting for about 87 percent of all cases.

When you know the signs of stroke, the life you save could be your own or someone else’s. Learn to spot the signs of stroke, or spot a stroke F.A.S.T. (Face drooping, Arm weakness, Speech difficulty, Time to call 911) with the help of our mobile app for iphone/ipad. Your life is in your hands!

Learn more about your risk for heart disease and stroke as well as factors that increase your risk.

EMBARGOED FOR RELEASE UNTIL 4 PM ET, March 07, 2005

St. Paul, Minn. – Warning signs of an ischemic stroke may be evident as early as seven days before an attack and require urgent treatment to prevent serious damage to the brain, according to a study of stroke patients published in the March 8, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology. Eighty percent of strokes are ischemic, caused by the narrowing of the large or small arteries of the brain, or by clots that block blood flow to the brain. They are often preceded by a transient ischemic attack (TIA), a “warning stroke” or “mini-stroke” that shows symptoms similar to a stroke, typically lasts less than five minutes, and does not injure the brain. The study examined 2,416 people who had experienced an ischemic stroke. In 549 patients, TIAs were experienced prior to the ischemic stroke and in most cases occurred within the preceding seven days: 17 percent occurring on the day of the stroke, 9 percent on the previous day, and 43 percent at some point during the seven days prior to the stroke. “We have known for some time that TIAs are often a precursor to a major stroke,” said study author Peter M. Rothwell, MD, PhD, FRCP, of the Department of Clinical Neurology at Radcliffe Infirmary in Oxford, England. “What we haven’t been able to determine is how urgently patients must be assessed following a TIA in order to receive the most effective preventive treatment. This study indicates that the timing of a TIA is critical, and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack.” Rothwell also noted that clinical guidelines should be amended accordingly. The study included two population-based studies (Oxford Vascular Study and Oxfordshire Community Stroke Project) as well as two randomized trials (UK-TIA Aspirin Trial and European Carotid Surgery Trial).

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, LinkedIn, Instagram and YouTube.

Editor’s Notes:Common symptoms of a TIA, which are similar to those of a stroke yet temporary, include:
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion or problems understanding
Sudden difficulty speaking
Sudden vision difficulty in one or both eyes
Sudden dizziness, loss of balance or coordination, or difficulty walking
Sudden, severe headache with no apparent cause

Healthdirect 24hr 7 days a week hotline

Recognising the symptoms of a stroke, using ‘FAST’

The signs and symptoms of a stroke vary from person to person but usually begin suddenly. Since different parts of the brain control different parts of the body, your symptoms will depend upon the part of your brain affected and the extent of any damage.

The main stroke symptoms can be remembered with the word ‘FAST’: Face-Arms-Speech-Time.

  • Face — the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped.
  • Arms — the person may not be able to lift one or both arms and keep them there because of arm weakness or numbness.
  • Speech — their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake.
  • Time — it is time to call triple zero (000) immediately if you see any of these signs or symptoms.

It is important for everyone to be aware of these signs and symptoms. If you live with or care for somebody in a high-risk group, such as someone who is elderly or who has diabetes or high blood pressure, being aware of the symptoms is even more important.

The symptoms described in the FAST test will identify about 9 out of 10 strokes.

Are you at risk?

Find out if you’re at risk of heart disease, type 2 diabetes or kidney disease using our Risk Checker.

Other signs and symptoms may include:

  • paralysis, numbness or weakness in the face, arm or leg, especially in one side of the body – try lifting both arms over the head at the same time; if one falls down, it could be a sign of a stroke
  • sudden loss of vision in one or both eyes, or seeing double
  • dizziness or losing balance, or an unexplained fall
  • communication problems, difficulty talking and understanding what others are saying
  • slurred speech
  • problems with walking, balance and co-ordination
  • a sudden, severe headache, unlike any the person has had before, especially if associated with neck stiffness
  • difficulty swallowing
  • fainting (in severe cases)

‘Mini-stroke’ or transient ischaemic attack (TIA)

The symptoms of a transient ischaemic attack (TIA) are the same as for a stroke and last from between a few minutes to a few hours. They then disappear completely. However, never ignore a TIA because it is a serious warning sign that there is a problem with the blood supply to your brain.

There is a greater risk of having a full stroke within the 4 weeks following a TIA. If you have had a TIA, you should contact your doctor or local hospital as soon as possible.

Not sure what to do next?

If you are still concerned about your stroke symptoms, check with healthdirect’s online Symptom Checker for advice on when to seek medical attention.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it’s self-care, talking to a health professional, going to a hospital or calling triple zero (000).

Stroke

What is a stroke?

A stroke happens when the blood supply to part of your brain is suddenly interrupted. Then brain tissue is damaged. Most strokes happen because a blood clot blocks a blood vessel in the brain or neck. A stroke can cause movement problems, pain, numbness and problems with thinking, remembering or speaking. Some people also have emotional problems, such as depression, after a stroke.

What does diabetes have to do with strokes?

If you have diabetes, your chances of having a stroke are 1.5 times higher than in people who don’t have diabetes. But you can lower your risk by taking care of your health.

How do I know whether I’m at high risk for a stroke?

Having diabetes raises your risk for stroke. But your risk is even greater if:

  • you’re over age 55
  • your family background is African American
  • you’ve already had a stroke or a transient ischemic (ih-SKEE-mik) attack (also called a TIA or a mini-stroke)
  • you have a family history of stroke or TIAs
  • you have heart disease
  • you have high blood pressure
  • you’re overweight
  • you have high LDL (bad) cholesterol and low HDL (good) cholesterol levels
  • you are not physically active
  • you smoke

You can’t change some of these risk factors. But you can lower your chances of having a stroke by taking care of your diabetes and tackling some of the other risk factors, such as losing weight if you’re overweight. It’s up to you.

How can I lower my risk of having a stroke?

Lower your risk by keeping your blood glucose (blood sugar), blood pressure and cholesterol on target with healthy eating, physical activity, and, if needed, medicine. And if you smoke, quit. Every step you take will help. The closer your numbers are to your targets, the better your chances of preventing a stroke.

What are the warning signs of a stroke?

Typical warning signs of a stroke develop suddenly and can include:

  • weakness or numbness on one side of the body
  • sudden confusion or trouble understanding
  • trouble talking
  • dizziness, loss of balance, or trouble walking
  • trouble seeing out of one or both eyes
  • double vision
  • severe headache

If you have warning signs of a stroke, call 9-1-1 right away. Getting treatment as soon as possible after a stroke can help prevent permanent damage to your brain.

Review the symptoms of a stroke with your family and friends. Make sure they know about the importance of calling 9-1-1.

If the blood flow to your brain is blocked for a short time, you might have one or more of the warning signs temporarily, meaning you’ve had a TIA (mini-stroke). TIAs put you at risk for a stroke in the future.

How is a stroke diagnosed?

A number of tests may be done if a stroke is suspected:

  • Your health care provider will check for changes in how your body is working. For example, your provider will check your ability to move your arms and legs. Your health care provider also can check brain functions such as your ability to read or to describe a picture.
  • CT and MRI tests use special scans to provide images of the brain.
  • An ECG (electrocardiogram) provides information on heart rate and rhythm.
  • An ultrasound examination can show problems in the carotid (kuh-ROT-ihd) arteries, which carry blood from the heart to the brain.
  • In a cerebral (seh-REEB-rahl) arteriogram (ar-TEER-ee-oh-gram), a small tube is inserted into an artery and positioned in the neck. The health care provider injects dye into the artery. Then the provider takes X-rays to look for narrowed or blocked arteries.

What are the treatments for stroke?

Treatment you need right away
“Clot-busting” drugs must be given within hours after a stroke to minimize damage. That’s why it’s important to call 9-1-1 if you’re having symptoms.

Surgical treatments you may need
Several options for surgical treatment of blocked blood vessels are available. These include:

  • Carotid artery surgery, also called carotid endarterectomy (en-dar-tuh-REK-tuh-mee) removes buildups of fatinside the artery and restores blood flow to the brain.
  • Carotid stenting can remove a blockage in a blood vessel to the brain. A small tube with a balloon attached is threaded into the narrowed or blocked blood vessel. Then the balloon is inflated, opening the narrowed artery. A wire tube, or stent, may be left in place to help keep the artery open.

Other treatments
The way you are cared for following a stroke includes treatments and exercises to restore function or help people relearn skills. Physical, occupational and speech therapy may be included, as well as psychological counseling. Steps to prevent future problems should include quitting smoking, healthy eating, physical activity, to manage blood sugar, blood pressure and cholesterol levels.

Learn More about heart disease and stroke from the Reducing Cardiometabolic Risk Toolkit.

6 Emergency Complications of Type 2 Diabetes

Stroke

If you suddenly experience any of the following stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death. Stroke warning signs may include:

  • Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
  • Feeling confused
  • Difficulty walking and talking and lacking coordination
  • Developing a severe headache for no apparent reason

Nerve Damage

People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don’t feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb. A recent large study from Sweden of 2,480 patients with diabetic foot ulcers found that certain factors increased the likelihood of amputation, including being male and having had diabetes for longer than 23 years.

Diabetes can also make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.

If you notice any of the following symptoms, see your doctor:

  • Inflammation and tenderness anywhere on your body
  • Red, itchy rash surrounded by small blisters or scales
  • Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
  • Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
  • Sharp pain that gets worse at night
  • Muscle weakness that makes walking difficult
  • Bladder infections and problems with bladder control
  • Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
  • Erectile dysfunction in men and vaginal dryness in women

Kidney Disease

Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.

Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:

  • Swelling in your ankles and legs
  • Leg cramps
  • A need to go to the bathroom more often at night
  • A reduction in your need for insulin
  • Nausea and vomiting
  • Weakness and paleness
  • Itching

The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.

Eye Problems

People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.

Call your doctor if you notice any of these warning signs:

  • Blurry vision that lasts for more than two days
  • Sudden loss of vision in one or both eyes
  • Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
  • A sensation of seeing “flashing lights”
  • Pain or pressure in one or both eyes

High Blood Sugar (Hyperglycemia)

Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn’t always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:

  • Frequent urination
  • Extreme thirst
  • Feeling tired and weak
  • Blurry vision
  • Feeling hungry even after eating

If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.

The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don’t smoke.

Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.

Diabetes patients are 2-3 times more likely to suffer from stroke than those that do not have diabetes. Studies have shown that people with diabetes are at a higher risk of death or paralysis due to stroke.

What Causes a Stroke?

In particular, the type of stroke that diabetes patients are so susceptible to is the most common type of stroke known as ischemic stroke. Ischemic stroke happens due to a clogged blood vessel supplying blood to the brain. The blockage disrupts blood and oxygen flow to the brain which damages brain cells and hence leading to a stroke.

The clogged blood vessels that causes the stroke are usually formed when:

  • Fat accumulates on the walls of the blood vessel in the brain.
  • A blood clot originally from another part of the body flows to the vessels in brain

Common Signs of Stroke

Stroke is a dangerous condition and can be fatal or debilitating. Anyone who is showing some signs of a stroke must be taken to the hospital immediately. The signs of stroke includes:

  • bad headache, which is often sudden
  • inability to control or move a limb
  • tingling sensation and numbness of the limb
  • difficulty in speaking,
  • drooping of one side of the face
  • fainting
  • confusion
  • blurred or loss of vision of both eyes.

Proper diagnostic test should be done if symptoms of diabetic stroke are observed. One of these is to have the patient to hold up both arms at the same height. If he or she cannot do so, then it may be a stroke.

Warning

An ambulance or doctor must be immediately called for help in the event of a diabetic stroke, even if the person will strongly insist that they are okay and they do not want to go to the hospital. When someone suffers from stroke, this cuts off the energy to the brain and the longer that you will get help, the more damage in the brain will occur.

How to Prevent Diabetes Stroke?

People with diabetes are highly susceptible to diabetic strokes. It is therefore important to work on its prevention which includes:

  • Regular exercise and proper diabetes friendly diet
  • Smoking must also be stopped as it could slow down the blood circulation and cause the heart and blood vessels work harder
  • Having a minor stroke in the past also increase chances of a major stroke later on
  • Doctors will often prescribe a low dose aspirin to lower blood pressure and also to regulate the blood sugar level for those with diabetes and suffered from stroke

Managing your diabetes and keeping control of your blood sugar levels minimizes your risk of stroke and protect your heart from other vascular diseases. Start exercising and a healthy diet today.

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