Common Misconceptions and Questions About Cerebrovascular Disease

Who Is at High Risk for Cerebrovascular Disease?

Individuals over the age of 40 are at higher risk, especially those with conditions such as hypertension, hyperlipidemia, diabetes, or heart disease. Additional risk factors include smoking, excessive alcohol consumption, and a family history of stroke. Awareness of these risks is the first step toward prevention.

Young Patients and Cerebrovascular Symptoms

Even younger individuals can experience stroke-like symptoms such as transient ischemic attacks (TIAs) or hemorrhagic events. It's essential for these patients to undergo evaluation for conditions like Moyamoya disease or other cerebrovascular abnormalities that may not be immediately apparent.

Recognizing the Signs of an Impending Stroke

Symptoms such as temporary numbness or weakness in limbs, blurred vision, dizziness, unexplained falls, or slurred speech should never be ignored. Some patients may also experience chronic headaches and significant memory decline, which could indicate underlying cerebral ischemia.

Effective Strategies for Stroke Prevention

Preventing stroke involves a comprehensive lifestyle and medical approach. Here are key steps to consider:

1. Eliminate Tobacco Use

Completely avoid smoking and exposure to secondhand smoke. Tobacco use significantly increases the risk of stroke and other cardiovascular diseases.

2. Limit Alcohol Consumption

While moderate alcohol intake may be acceptable for some individuals, excessive drinking raises blood pressure and stroke risk. Ideally, alcohol should be avoided altogether.

3. Managing the "Three Highs"

Controlling hypertension, hyperglycemia, and hyperlipidemia is essential in stroke prevention. Let's break this down further:

Managing Hypertension

Target blood pressure should be around 120/80 mmHg, although patients with existing cerebral ischemia may require a different target. Always consult with a physician before adjusting medication. Long-acting medications such as amlodipine are preferred over short-acting alternatives to maintain stable blood pressure throughout the day.

Remember, hypertension is often a lifelong condition. Do not stop medication just because your readings appear normal. Regular blood pressure monitoring is crucial to ensure levels remain within a safe range. If blood pressure is difficult to control, work with your doctor to find the most suitable medication—not necessarily the most expensive one. Each individual may respond differently to various drugs.

Adopting a low-salt diet and maintaining a healthy weight are also important. For men, a healthy weight (in kg) is roughly height (in cm) minus 100. For women, it's height (in cm) minus 105.

Blood Sugar Control for Diabetics

Diabetes plays a significant role in increasing stroke risk. Understanding how glucose metabolism works is key to managing the condition. After eating, blood glucose levels rise, and insulin is released to regulate them. In diabetics, this process is impaired, leading to prolonged high blood sugar levels that can damage blood vessels.

Glucose is a vital energy source for cells, so maintaining balanced blood sugar levels is critical. Both high and low glucose levels can be harmful. Carbohydrates, fats, and proteins can all be converted into glucose, so portion control is essential regardless of food type.

Managing diabetes involves two key steps:

• Determine total daily caloric needs based on weight and activity level. Distribute calories across meals in a way that suits your dietary preferences.
• Adjust medication dosage according to your eating habits and regular blood glucose monitoring. Measure both pre- and post-meal glucose levels to ensure optimal control.

Avoid sugary drinks and sweet fruits like watermelon and pears, as they can cause rapid spikes in blood sugar. Other foods can be consumed normally, as long as portion sizes are appropriate. Fiber-rich foods such as non-sweet vegetables (e.g., cucumbers, cabbage) can help manage hunger without raising blood sugar levels significantly.

It's important not to rely solely on fasting blood sugar readings. Many patients have normal fasting levels but elevated post-meal glucose, which can go undetected without proper monitoring. Insulin or oral hypoglycemic agents may be used under the guidance of an endocrinologist.

Currently, there is no known cure for diabetes. Be cautious of products or claims that promise a complete cure, as they are often misleading and potentially dangerous.

Cholesterol and Lipid Management

High cholesterol contributes to atherosclerosis, increasing the risk of stroke. Reduce intake of fatty foods such as fried items and heavy soups. Lean meats like chicken, turkey, and fish are better options, but avoid consuming bone broth or chicken soup regularly, especially at night when physical activity decreases.

Think of blood vessels like plumbing pipes—too much fat can cause blockages. While fats are essential, they should be consumed in moderation. Opt for plant-based oils like olive or canola oil instead of animal fats.

Regular lipid profile checks are essential, especially focusing on low-density lipoprotein (LDL) levels. For high-risk individuals or those with a history of stroke, LDL levels should ideally remain below 2.07 mmol/L. Standard statin medications like atorvastatin are often recommended for lipid control.

Antiplatelet Therapy

Platelets play a vital role in preventing bleeding, but in individuals with the "three highs," they can contribute to clot formation. Aspirin (100 mg daily) is commonly prescribed for long-term use in patients with a history of cerebral ischemia, provided there are no contraindications such as peptic ulcer disease.

For patients with frequent TIAs, clopidogrel (75 mg daily) may be added to aspirin therapy. However, those with a history of cerebral hemorrhage should use these medications with caution and under medical supervision.

Important: Combination therapy with clopidogrel and aspirin may increase the risk of bleeding, including symptoms like gum bleeding, heavy menstrual flow, or black stools. If any of these occur, stop the medication immediately and seek medical attention.

Stay Hydrated

Maintaining proper hydration, especially before bedtime, helps reduce blood viscosity and lowers stroke risk. During hot weather, be sure to replenish fluids lost through sweating.

Diagnostic Tools for Cerebrovascular Health

Various imaging and diagnostic tools are available to assess cerebrovascular health:

• Head CT scan – Useful for detecting cerebral hemorrhage but not effective for identifying acute cerebral infarction.
• Brain MRI – Excellent for identifying old or new infarcts.
• Diffusion-weighted MRI – Detects acute cerebral infarction with high sensitivity.
• CT angiography (CTA) – Reveals vascular stenosis, occlusion, or aneurysms in the neck and brain.
• MRI angiography (MRA) – Similar to CTA in detecting vascular abnormalities.
• Carotid ultrasound – Non-invasive method to assess carotid artery health, though it may not provide detailed images.
• Echocardiogram – Helps detect cardiac thrombi that may lead to stroke.
• Electrocardiogram (ECG) – Identifies arrhythmias or signs of prior myocardial infarction.

When Surgical Intervention Is Needed

Patients with carotid artery stenosis greater than 50% should consult a specialist to determine if procedures like carotid endarterectomy or stenting are necessary. Those with less than 50% stenosis typically only require medical management.