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Canada Food Guide Revisited
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Childhood Diagnosis of Diabetes
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Debunking Diabetes Myths
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Dining Out
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The Discovery of Insulin
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Fats
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Health Benefits of Soy
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Home from the Hospital
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Living Powerfully with Diabetes
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Your Medication Expert
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No Need for Insulin?
Not Snoozing
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Sleep - a Missing Link
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Stress and Diabetes
Success in School
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Supporting Spouse with Diabetes
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Think Positive with Diabetes
Tiny Bites Equal Big Calories
Travelling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
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Understanding Diabetes
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Used Sharps
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World Diabetes Day
Your Medicine Cupboard
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Aspirin Every Day?
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Stroke
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Canada's New Blood System
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5 Tips to Manage Weight
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Battle the Bulge
Boost Your Bone Strength
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Breakfast is Important
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Building Your Bones
Celiac Disease
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Diet Reality Check
Drink Up!
Eating Smarter & Cheaper
Energy Drinks
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Food for Active Kids
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Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
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Healthy Eating on Business Travel
Healthy Ethnic Meals
Fad Diets
Fruits & Veggies - 5-10 a Day
Fats
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Feeding Your Kids
Fibre
Food Chemistry 101
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Healthy Eating for Teens
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New Ingredients for Your Shopping Cart
Iron
Kid's Food
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Mercury Levels in Fish
Night Snacking
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Nutrition Questions Top 5
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Preventing Cancer Through Nutrition
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Changing Role of the Pharmacist
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Expanding Role of Pharmacies
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Backpack Pain
Bacteria Fight Back
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Cell Phones and Driving
Childhood Obesity
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Disaster Planning
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Farm Safety for City Kids
Foodborne Illness
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The Flu and You
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Health Tips for Snowbirds
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H1N1 Virus - Plan Ahead
Household Mould
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Keys to Preventing Cancer
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Preventing Burns and Scalds
Preventing Cancer through Nutrition
Quit Smoking 101
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15 Great Reasons to Breastfeed
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Breast Cancer Screening Guidelines Changes
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Family Health Online / Pharmacy at Safeway
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Family Health Magazine - FAMILY MEDICINE

Stopping Stroke
Recognize and treat a ‘brain attack’ quickly

Your brain is the most complex organ in your body. It consists of over 100 billion specialized nerve cells called neurons. These brain cells control everything we do, from speaking to walking to breathing. Brain functions include:

Stroke is a sudden loss of brain function caused by an interruption in blood flow to the brain. The brain needs a steady supply of oxygen and blood to function properly. Without this, brain cells cannot do their job. A stroke or ‘brain attack’ occurs. Neurons cannot duplicate or repair themselves.

Very few Canadians know the symptoms of stroke.
Do you? Learning them and knowing what to do when they occur could save your life.
For more information, visit www.heartandstroke.ca

Recognizing stroke symptoms

The onset of stroke symptoms is very fast. This in itself is a key feature of stroke. The most common symptoms are highlighted in the graphic at left, and include:

Other important but less common symptoms include:

These symptoms are more commonly associated with hemorrhagic stroke events than ischemic ones.

Never ignore stroke symptoms!

ANATOMY OF A STROKE

Each stroke is different. Recovery will depend on which parts of the brain were damaged by the stroke as well as the size of the area damaged. A person’s health before the stroke also affects recovery.

The human brain is divided into sides or hemispheres (left and right), and regions within each hemisphere (lobes) that control various motor (movement) and sensory functions. If the stroke damages a specific region, the functions it controls can be affected. This causes symptoms like paralysis (loss of movement), difficulty speaking, or loss of coordination.

Effects of left hemisphere strokes include:

  • weakness or paralysis on the right side of the body
  • trouble reading, talking, thinking or doing math
  • behaviour that is slower and more cautious than usual
  • trouble learning or remembering new information
  • frequent instructions and feedback is needed to finish tasks.
  • Effects of right hemisphere strokes include:
  • weakness or paralysis on the left side of the body
  • vision problems
  • difficulty distinguishing distance, depth, between up and down or front and back, which makes it hard to pick up objects, button a shirt, or tie shoes
  • problems understanding maps
  • short-term memory issues – someone may be able to remember something that happened years ago, but not something that happened a few minutes ago
  • ‘neglect’ - forgetting or ignoring objects or people on the left side; stroke survivors may even ignore their own left arms or legs
  • judgment issues like acting impulsively or not realizing one’s limitations.

For every minute of delay in
treating a stroke, almost two million
brain cells are lost. For each hour in which treatment does not occur, the brain losesas many neurons as it does in more than three years of normal aging.

Are you at risk of stroke?

Take the Heart & Stroke Risk Assessment:
www.heartandstroke.ca/risk

Risk factors

Medical and lifestyle reasons can make a person more likely to have a stroke. These are called stroke risk factors. Some are beyond control, including the following.

With medical attention and lifestyle changes, you can lower your risk of a first stroke or the chances of having another.

For the top 10 risk factors, see table below.

The top 10 risk factors for stroke and how to manage them
Blood pressure (BP): high BP (hypertension) is the number one risk factor for stroke. Normal BP should be less than 120/80. You may not feel high blood pressure, but serious side effects can appear if it remains consistently high. Talk to your doctor about the right medications for you. It may take more than one to adequately control your high blood pressure.
  • Check BP regularly, at least every two years.
  • Take medications as prescribed.
  • Eat a healthy diet.
  • Consume alcohol in moderation.
  • Reduce your stress.

Cholesterol: Dyslipidemia, known as high cholesterol, may also cause a stroke. Cholesterol deposits build up inside arteries, blocking them and causing increased blood pressure and other problems.
Regular blood levels of:

  • Low density lipoproteins (LDL or ‘lousy’ cholesterol) should be less than 2 mmol/L.
  • High density lipoproteins (HDL or ‘healthy’ cholesterol) should be greater than 1.3 mmol/L for women, and greater than or equal to 1.0 mmol/L for men.
  • Total cholesterol to HDL ratio should be less than 4 mmol/L, and
  • Triglycerides (another common fatty acid) should be less than 1.5 mmol/L.
  • See your GP for regular blood work.
  • Eat a healthy diet.
  • Exercise regularly.
  • Moderate alcohol consumption.
  • Take your medication as prescribed.
Diabetes: Poorly controlled diabetes damages small blood vessels in your brain. Normal fasting blood glucose should be between 4 and 7 mmol/L. Serum hemoglobin (Hgb) A1C is a good indicator of how well you are managing your blood glucose. It should be less than or equal to 7 per cent. For many people with diabetes, the goal is to keep your level at or below 6.5 to 7 per cent.
  • Eat a healthy diet.
  • Exercise regularly.
  • Check your blood glucose and take your medication as prescribed.
Atrial fibrillation: In atrial fibrillation (AF), the heart’s upper chambers (the atria) quiver instead of beating effectively, causing blood pooling and clots. AF increases stroke risk four to six times compared to those without AF.
  • Take your blood thinner as prescribed.
  • Have frequent blood work done.
  • See your doctor regularly.
Tobacco use: Tobacco damages blood vessels. Quitting smoking reduces your risk of stroke by half after two years of being smoke-free.
  • Find a smoking cessation program that is right for you.
Diet: Keep your total daily sodium intake to less than 1500 milligrams. Read food labels when purchasing processed food. Do not add salt to food. Use other flavor-enhancers, like herbs and spices. Eat a varied diet of fruits, vegetables, whole grains and lean meats.
  • Balance calories with exercise.
  • Take in less than 1500 mg of sodium daily.
  • Make healthy choices when eating.
  • Shop the perimeter of the store, where the fresh groceries are located.
Alcohol: Heavy alcohol use increases your risk of stroke in a number of ways. Drink in moderation – less than 14 drinks per week for men, and less than nine per week for women.
  • Consume alcohol in moderation.
  • Avoid binge drinking.
Obesity: Extra weight, especially around the abdomen, increases your risk of stroke and heart attack. A healthy waist circumference is 102 centimetres (40 inches) or less for men, and 88 cm (35 inches) or less for women. Talk to a dietitian or other health care provider about a diet and exercise plan to help you control your weight.
  • Maintain a healthy weight.
  • Balance a healthy diet with exercise.
  • Consult a dietitian, especially if you have special considerations like diabetes or high cholesterol.
Physical activity: Being physically active reduces your risk of heart attack and stroke, makes your heart stronger, helps to control weight and blood pressure, and can even improve your mood.
  • Check with your doctor before starting.
  • Get at least 1½ hours of moderate exercise per week.
  • Try a variety of activities.
  • Look for simple ways to become more active.

Metabolic syndrome: This group of risk factors increases your risk for stroke. If you have at least three of the five conditions listed below, you have metabolic syndrome.

  • abdominal obesity
  • having or being on medication for high triglycerides
  • low HDL
  • having or being on medication for high blood pressure
  • having high blood glucose, or being on diabetes medication.

This puts you at increased risk for stroke and heart disease.

  • Make healthy lifestyle changes, as listed above.

Drugs used in stroke prevention

Several medications and categories of medication may be used to protect against first or recurring stroke or TIA. These include the following.

Your doctor must know what other medications you are taking when prescribing one of these anti-stroke drugs. Some medications, such as anti-inflammatory drugs, can cause serious medical problems when combined with anti-stroke drugs.

Many people are interested in alternative medicine. However, there is no evidence that vitamins or herbal remedies provide real protection against stroke or TIA. If you are interested in these medicines, ask your doctor for more information.

Stroke is a life-threatening event. Still, quick medical attention can mini​mize the effects. Talk with your doctor about your risk for stroke. You can reduce your risk factors by making healthy choices and living an active lifestyle. Know the signs and symptoms of stroke. Get medical attention immediately if you suspect stroke in yourself or someone else.

Types of stroke

Ischemic stroke – This is a stroke caused by blockages in blood flow to the brain. Blood clots, formed in the heart or elsewhere in the body, can create one type of blockage. Another is the build-up of plaque or other fatty deposits in an artery that make the artery harden and clog. Chunks of this build-up can break off and float in the blood, eventually blocking an artery. Most strokes (about 80 per cent) are ischemic in nature.

‘Mini-stroke’ or transient ischemic attack (TIA) – This type of stroke is caused by a temporary interruption in blood flow to the brain. Typically symptoms go away within minutes or hours. Some people do not even know they have had a TIA. However, this important warning event puts a person at risk of a bigger and potentially more serious full-blown stroke. The risk of stroke following TIA is high: 10 to 20 per cent within 90 days. Half of these actually occur within the first two days after the TIA. Someone who has had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.

Hemorrhagic stroke – With this stroke, a blood vessel in the brain suddenly breaks, leading to uncontrolled bleeding into the brain tissue. About 20 per cent of all strokes are hemorrhagic. As bleeding into the brain interrupts normal blood flow, brain cells die. If a blood vessel located between the brain and the skull ruptures, it can bleed into the brain. This is called a subarachnoid hemorrhage. It is usually related to a structural problem with a blood vessel.

A weakened area on the wall of a blood vessel (called an aneurysm) fills with blood (like a balloon) and bulges out. Another kind of bleeding in the brain happens when an artery deep within the brain itself ruptures. This is called an intracerebral hemorrhage. High blood pressure or trauma can make a bulge rupture, resulting in uncontrolled bleeding into the brain.

Brain stem strokes - This type of stroke is uncommon. The brain stem is the area at the very base of the brain, right above the spinal cord. When a stroke occurs in the brain stem, there can be problems with:

Strokes in the cerebellum - The cerebellum is located at the lower back of the brain. Although strokes are less common in the cerebellum, the effects can be severe. Four common effects of strokes in the cerebellum include:

Lobes of the brain affected by stroke

Tests used to diagnose stroke

Stroke is an emergency. If you have any stroke symptoms or recognize them in someone else, call 911 immediately!

If a stroke or TIA is suspected, the family doctor or an emergency room doctor will do a physical examination and tests of blood and urine. One or more tests can also give a picture of what is happening in the brain, blood vessels or heart.

On first arriving in the emergency room, taking blood pressure readings and listening to the heart and lungs allows doctors to assess breathing, airway and circulation. Neurological (nervous system) status will be checked to see if there is weakness or loss of function. Tests can determine the severity, type and extent of the stroke, and may include the following.

Neurovascular imaging

All patients with suspected acute stroke or TIA are assessed using brain imaging.

Cardiovascular investigations


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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
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