How Head Injuries Seem To Affect The Risk For Stroke

 

Twenty percent of strokes hit people under age 65, and the cause of many of those strokes remains a mystery. Having had a concussion or other traumatic brain injury might make the risk of a stroke more likely, a study says.
Back in 2011, researchers in Taiwan had an association between traumatic brain injury and stroke by combing through hospital records.
It's one of those "Oh, really?" findings that gets scientists itching to check it out themselves.
Researchers at the University of Michigan and the took on the challenge. They dug through billing records from emergency rooms in California from 2005 to 2009.
They found more than 436,000 people who had come to the ER with a traumatic brain injury. Those people were 30 percent more likely to have a stroke afterwards than people who hadn't had a traumatic brain injury. A little over one percent of them ended up having a stroke later on. The were published online in the journal Neurology.
The researchers found that people under age 50 were more likely to have a stroke after a TBI than were people over 50. That said, the for someone under age 50 is low, so raising the relative risk by 30 percent has very little impact on an individual's risk.
Still, there are a lot of people out there who have had a concussion or other brain injury at some point in their lives.
To find out how much we should be concerned, Shots called up , the study's lead author and just days away from becoming an assistant professor at the University of Michigan. He says that when he saw the Taiwanese study he spotted some goofs in the methodology that he figured accounted for the finding. "I thought we would not find the same thing," he says.

So he was surprised to find an association between TBI and stroke in the California data, and even more surprised to find that it persisted despite efforts to find other reasons.
"I think the association's real," Burke told Shots. "The question is, what does it mean?"

What it doesn't necessarily mean is that TBIs cause strokes, or even increase the risk of stroke. It may be that people who have TBIs are already in poor health, or that their general health declines after the brain injury, increasing stroke risk.This study couldn't measure that.
If TBI does turn out to increase stroke risk, the most plausible reason would be that the TBI injures blood vessels in the brain, making them more vulnerable. The increased risk was found in , which is caused by a blood clot blocking a vessel in the brain.
People who have had a concussion or other brain injury shouldn't fret, Burke says. Instead, they should do what we should all do: reduce stroke risk by maintaining a healthful blood pressure, and be aware of , since immediate treatment of ischemic stroke with a clot-busting drug greatly reduces the risk of disability and death.


source http://www.npr.org/blogs/health/2013/06/27/196217617/how-head-injuries-seem-to-affect-the-risk-for-stroke

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Brain Changes May Explain Stroke Risk In Migraine Sufferers

It was hard to ignore those headlines saying that people with migraine have brain damage, even if you're not among the 12 percent or so who do suffer from these painful, recurring headaches.
Don't panic, says the neurologist whose work sparked those alarming headlines. "It's still not something to stay up nights worrying about," says Dr. Richard Lipton, director of the Montefiore Headache Center in New York.
But knowing about the brain anomalies that Lipton and his colleagues found might help people reduce their stroke risk. Some people who get do have a slightly . And some of the brain changes identified in the study look like mini-strokes.
"On the MRI they look like very tiny strokes," Lipton tells Shots. But the people aren't having any stroke symptoms. Still, Lipton is convinced that the process is the same. "We now know it's a risk factor for these very small silent strokes," he says.
The scientists evaluated data from 19 studies in which people with migraine headaches got MRI scans of their brains. Just about everybody is going to have some abnormalities show up in a scan.
But the people who had migraines were more likely to have two common abnormalities: white matter abnormalities and infarct-like lesions. The were published in the journal Neurology.
The brain's white matter coordinates communication among brain regions. White-matter abnormalities are more likely in people with headaches, and as people grow older. Scientists have been studying these abnormalities for decades, but still don't know if they have any health impact.
This study found that people with migraines were more likely to have white-matter abnormalities compared to people with no migraines, but only four studies had good enough data to evaluate. "They sometimes scare the patient, and even the doctor," Lipton says of the abnormalities. "My take is that because they're common and of unknown significance, they're nothing to worry about." Doctors should reassure patients that this is nothing to worry about, the study says.
But the infarct-like lesions might be something for people to worry about, or at least act on. The scientists found that people with aura, who see flashing lights or other visual disturbances before the migraine itself starts, are more likely to have tiny brain lesions that look like strokes, called infarct-like lesions.
That doesn't mean that people with those lesions will have strokes. But since there is a slightly higher stroke risk in people who have migraine with aura, Lipton says it would be wise to practice .
"My sense is that people who have migraine with aura should be particularly vigilant about managing their other [stroke] risk factors," Lipton says. That means not smoking, getting exercise and eating healthful foods. "If they have high blood pressure, diabetes or high cholesterol they should work with their physician to reduce their overall stroke risk."
That's good advice for everybody, not just people with migraines.
Historically migraines were considered harmless, if miserable. But recently scientists have begun to think that the disorder may be tied to neurological abnormalities caused by genetic mutations. That may be why migraines often run in families.
This research is part of ongoing efforts to figure out how brain structure and function could be causing , or how the headaches might affect the brain.
The study also found that people with more frequent migraines had more infarct-like lesions, suggesting that avoiding migraine triggers could protect the brain. "Taking steps to reduce the number of migraines you have will certainly improve your life today," Lipton says, "and might have long-term benefits."


source http://www.npr.org/blogs/health/2013/08/29/216818981/brain-changes-may-explain-stroke-risk-in-migraine-sufferers

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Young Doesn't Mean Invincible When It Comes To Strokes

Strokes sounds like an old folks' problem, but they hit young people, too. And they don't all shake it off. One-third of people who had a stroke before age 50 are struggling with disability and loss of function nine years later.
Many of those people aren't able to live independently or need help with everyday tasks, such as managing their finances or personal care, a study of young stroke survivors finds. About 1 in 8 wasn't able to live independently.
Dutch researchers looked at how 722 people were doing after having a between the ages of 18 and 50. About 10 percent of strokes affect this age group.
Doctors often predict full recovery for younger stroke patients, the study authors note, just because they're young. But the road back can be rough, these data suggest, and patients and their families should be aware that a full recovery may be impossible.

People who had more severe strokes were less likely to regain function, not surprisingly, as were people who were at the upper end of the age range.
The type of stroke mattered, too. People who had a , a small stroke that comes and goes quickly, showed the best recovery, with 11 percent having poor outcomes as measured by a that measures the ability to handle everyday tasks such as driving a car, shopping and cooking, managing a household and using a phone.
With people who had an caused by a blood clot, almost 15 percent weren't self-sufficient; and 18 percent of people who had strokes caused by bleeding in the brain were disabled.
This is part of a long term study of younger people in the Netherlands who had strokes, starting in 1980 and following them until 2011. It's unusual to ahve a long-term study like this, especially in an age group that's been less frequently studied because they're considered at lower risk.
The were reported Thursday in the journal Stroke.
The moral of this story, of course, is that avoiding stroke is a really good idea. High blood pressure and cigarette smoking are two of the biggest , along with diabetes Obesity and lack of exercise matter, too.

source http://www.npr.org/blogs/health/2014/02/27/283421719/young-doesnt-mean-invincible-when-it-comes-to-strokes

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Alzheimer's Diagnosis Expanding To Catch Early Warning Signs

Alzheimer's disease isn't what it used to be. After 30 years of having doctors diagnose the disease by symptoms alone, researchers and advocacy groups are calling for new diagnostic criteria that recognize changes in the brain as well as changes in behavior.
The goal is to eventually allow doctors to diagnose "preclinical" Alzheimer's in patients who do not have problems with memory or thinking, but who do have an abnormal brain scan or some other sign that the disease may be developing.

More than 5 million Americans fall within the existing diagnostic criteria for Alzheimer's, according to the latest from the Alzheimer's Association.
The current symptom-based diagnosis "is really a representation of a disease process that's been happening in the body for potentially 10 to 20 years," says , vice president of medical and scientific relations for the Alzheimer's Association. That process includes the accumulation of or in the brain, and eventually the death of brain cells.
It's becoming possible to detect those signs of trouble using brain scans, tests of spinal fluid or , and other so-called biomarkers, Carrillo says. These markers "can tell us that underlying biology is really changing in the body before memory starts to change," she says.
Biomarker tests are still costly or painful or unreliable. But eventually, they should make it possible to identify people at high risk for Alzheimer's, much the way cholesterol tests identify people at high risk for heart disease, Carrillo says. And that could make it easier to do something about Alzheimer's.
"We haven't completely obliterated heart disease. But we've reduced risk by about 30 percent," Carrillo says. "We can do the same for Alzheimer's disease."

At the moment there aren't any treatments that slow down the disease. But that could change because of something known as the , says , principal investigator of the study and researcher at Brigham and Women's Hospital and Massachusetts General Hospital. "The study will test whether or not we can slow the earliest cognitive changes that people experience years before they get to the stage of dementia," says Sperling.
The A4 study, which has just started enrollment, more than 60 sites around the country and about 1,000 patients. The participants can't have symptoms of Alzheimer's when they enter the study but must have brain scans showing a buildup of amyloid plaque. Some of the participants will receive an experimental drug that helps clear amyloid from the brain.
This drug, like several others, failed to help people in the later stages of Alzheimer's. But the drug appeared to slow cognitive decline in people who started taking it when they still had only mild symptoms. If it does the same thing for people who haven't developed symptoms, Sperling says, "We'd make a huge dent in preventing dementia."

It will take about five years to know whether the drug is working. In the meantime, it's important to begin identifying people with preclinical Alzheimer's, Sperling says. That approach paid off in diseases like diabetes and HIV, where screening tests came along well before good treatments were available, she says.
With Alzheimer's, better biomarker tests and effective treatments may arrive at nearly the same time. "It's a race," Sperling says. "We need to develop these screening tests and the biomarkers simultaneously with working on these clinical trials, so that if we succeed, we're prepared for how we would go about screening individuals to receive those treatments."
Millions of people in the U.S. could potentially benefit from a drug that prevents or delays Alzheimer's. About 30 percent of people older than 65 have amyloid plaque building up in their brains, Sperling says.

source http://www.npr.org/blogs/health/2014/03/19/291475129/alzheimers-diagnosis-expanding-to-catch-early-warning-signs

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Yes, It's A Headache. No, You Don't Need A Brain Scan

Headaches may be the most common human malady, accounting for one-quarter of all doctor visits.
It's almost always just a headache. But what if it's a brain tumor? Shouldn't I get a CT scan or MRI exam just to make sure?
Evidently I'm not alone in that thought. People in the United States get $1 billion worth of brain scans each year because they have a headache, according to researchers at the University of Michigan.
But since headaches are almost never caused by a tumor or other serious brain problem, that $1 billion is money down the drain, according to , the assistant professor of neurology who led the study.
"It's such a big number," Callaghan told Shots. "It's just an incredible number of MRIs and CTs that people get."

From 2007 to 2010, people visited the doctor 51 million times for headache-related problems, according to a national database of outpatient visits. And 12 percent of the time, the doctors sent their patients for a brain scan. Those numbers are on the rise, the analysis found, even though urge doctors to shun the scans. The were published Monday in JAMA Internal Medicine.
Our scan-happy habits not only waste money, Callaghan says, but expose us to harm that can come from putting a healthy head in a scanner. There's needless radiation exposure from a CT, for one. And MRIs often turn up false positives — things that though they look odd will never cause any harm, yet can prompt a cascade of tests and invasive procedures.

"Most headaches are not caused by something bad," Callaghan notes. "Even people with brain tumors rarely have headaches." Instead, the overwhelming majority of headaches are tension headaches or migraines.
Both doctors and patients are to blame for the brain scan craze, Callaghan says.

Doctors order scans because it gets patients out the door quickly and makes them feel like the doctor is taking care of them. And patients ask for scans because, well, they're worried.
So doctors need to quit being so quick to grab the referral slip, Callaghan says, and patients need to presume they're not going to get a scan. "I actually find that most patients are quite reasonable if you're willing to explain all the things that went into deciding why not to get a scan."
When should someone worry? If a strikes suddenly, the neurologists say. People also should seek medical help for that are markedly different than ones in the past, are brought on by exertion, or come with fever, vomiting, loss of coordination, or a change in vision, speech or alertness.


resource http://www.npr.org/blogs/health/2014/03/18/291044766/yes-its-a-headache-no-you-dont-need-a-brain-scan

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For Strokes, Superfast Treatment Means Better Recovery

Time is brain, the saying goes. The faster people get treatment for a stroke, the less brain damage they suffer. A new study says much faster is much better, especially for mild and moderate strokes.
People treated with a clotbusting drug within 90 minutes of having symptoms of a had excellent recoveries, with less lasting disability.
The scientists compared the records of 6,856 people who were treated for strokes in 10 European stroke centers. About 20 percent of the people were treated with clotbusting drugs within 90 minutes of reporting sudden symptoms like vision problems, weakness in a limb, or difficulty talking.

"What this just reinforces is that earlier is better," says , a professor of neurology and director of the Duke Comprehensive Stroke Center. "There's nothing magical about 90 minutes."
That 90 minutes was the cutoff picked by the researchers in the study, which was published Thursday in the journal Stroke. Clotbusting drugs are approved by the Food and Drug Administration for use within three hours of symptoms, but Goldstein says "three hours was never good enough."
The real gold standard in the United States is treatment within an hour after a patient comes in the emergency room door, but that's not easy to do.
The only way that can even remotely happen is in places organized to give stroke care," Goldstein, who is a spokesman for the American Heart Association but did not participate in the research, told Shots.

FAST: A simple way to remember at least some stroke symptoms.

American Heart Association

There are a patient history to be taken, lab tests to be run and a brain imaging study to be done. Doctors have to be sure that the patient doesn't have a , where a blood vessel bursts and bleeds into the brain. Using clotbusting drugs on those people can cause catastrophic bleeding. Ischemic strokes, in which a clot blocks blood flow, are more common and are treated with , a drug that is given intravenously to dissolve clots.
Some hospitals are specializing in rapid stroke treatment and seeking under the Joint Commission, an independent organization. There are more than 800 certified primary stroke centers in the United States. (This can help locate stroke centers near you.)
But the hospital can't treat stroke if a patient doesn't go there. The AHA has been promoting the mnemonic FAST, for face, arm, speech, time. The notion is that stroke symptoms often reveal themselves as a face slack on one side, a weak arm, or slurred speech. ("Time" is "time to call 911.")
"The only issue is that patients can still be having a stroke with significant deficits that's not covered [by FAST]," Goldstein says. "There are other symptoms that people need to think about." They include vision problems, a suddenly weak leg, or issues with balance and coordination.
In the study, people who had moderate strokes got the most benefit out of jackrabbit-quick treatment with tPA. That may be because people with severe strokes have larger clots that are blocking blood flow to larger areas of the brain, and the clots are too big to be dissolved completely, the researchers say.
The results were published online in the journal Stroke.


source http://www.npr.org/blogs/health/2013/08/22/214528373/for-strokes-super-fast-treatment-means-better-recovery

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