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regulates · 5
Many ischemic strokes share their upstream cause with heart attacks: ApoB-carrying lipoprotein particles get into the artery wall and build plaque. When a plaque ruptures, it either blocks the vessel on the spot or sends fragments downstream to block smaller branches.
The small-vessel route is the most insidious: years of high blood pressure thicken the walls of the tiny penetrating arteries deep in the brain and narrow them until they close, leaving small lacunar infarcts behind. Any one may cause no symptoms, but as they accumulate they show up as unsteady walking, slower reactions and cognitive decline.
Controlling blood glucose is a basic step in preventing stroke: chronically high glucose damages the lining of blood vessels and small vessels, adding to the same pathway as high blood pressure, abnormal lipids and smoking rather than opening a separate one. The INTERSTROKE study estimated that 10 modifiable risk factors, these among them, account for about 90% of the population-attributable risk of stroke.
Strokes caused by clots from the heart often trace back to atrial fibrillation: in AF, clots form easily in the left atrium, more than 90% of them in the left atrial appendage, and if one breaks loose it can travel into the brain's arteries. Repeated breathing pauses at night, with low oxygen and swings in chest pressure, are linked to AF developing. So when AF comes up, think about sleep too.
One kind of palpitation is atrial fibrillation, a beat that is irregular with no pattern, and it raises the risk of stroke. In a smartwatch study of 419,000 people, 34% of those who got an irregular-pulse alert and later wore an ECG patch had atrial fibrillation. So a watch alert is worth an ECG, and a newly irregular heartbeat with no pattern that you feel yourself means seeing a doctor the same day.
contrast · 1
With sudden vertigo, the first job is to tell a benign inner-ear problem from a stroke in the blood supply to the back of the brain. Early brain imaging misses a sizable share of these strokes, while a bedside eye-movement exam (HINTS) done by an experienced clinician is more sensitive. If vertigo comes with slurred speech, weakness in an arm or leg, or trouble walking, go to the emergency department right away.