Saturday, November 18, 2017
Health

Mayo Clinic Q&A: Stroke causes; metabolic syndrome-diabetes connection

RECOMMENDED READING


Cause of stroke sometimes a mystery

Is it always possible to figure out what causes a stroke? My husband had a stroke two months ago at age 38. He has mostly recovered, but doctors never pinpointed a cause. I want him to see a specialist. Is that a good idea?

Doctors often can identify the cause of a stroke, but not always. Before deciding that the cause of a stroke can't be found, however, people who have had a stroke should receive a detailed and comprehensive evaluation to investigate all potential causes. That's particularly important in younger people. Your suggestion that your husband see a stroke specialist is a good one.

A stroke happens when the blood supply to part of the brain is interrupted or significantly reduced, depriving brain tissue of oxygen and nutrients and causing brain cells to die. There are two basic types of strokes. By far, the most common strokes are those caused as a result of blood clots in blood vessels of the brain. These are called ischemic strokes. The clots may form in other parts of the body and travel to the brain, or they can be due to narrowing of arteries in the brain that suddenly clot off and stop blood flow. A much less common type of stroke is a result of bleeding into or around the brain. This is a hemorrhagic stroke.

When investigating the underlying cause of a stroke, doctors take a number of issues into consideration. Factors that can raise the risk for a stroke include aspects of a person's lifestyle, such as being physically inactive, being overweight or obese, drinking heavily or smoking. Medical conditions can play a role in raising stroke risk, too. High blood pressure, high cholesterol, diabetes, a sleep disorder called chronic sleep apnea and cardiovascular diseases can all be contributing factors.

An evaluation after a stroke should include tests that can help identify the medical conditions that are common causes of stroke. The tests may include a brain CT or MRI scan, imaging tests of the heart and a variety of blood tests.

For someone younger than age 50, there are several additional conditions that may lead to a stroke that are uncommon in older adults, including certain autoimmune disorders, hypercoagulable states and metabolic disorders. An evaluation following a stroke in younger people needs to include a thorough assessment for these conditions, as well.

Because your husband's exams so far have not uncovered the cause of his stroke, making an appointment to see a stroke specialist is a wise next step. If he seeks additional evaluation with a specialist and the specialist still cannot identify the source of the stroke, then it is reasonable to assume that the cause won't be found. In that case, the stroke is labeled "cryptogenic," and no further evaluation is pursued. About 30 percent of strokes fall into that category.

Even if no specific cause is identified, your husband can take steps to lower his risk of another stroke. They include exercising regularly, staying at a healthy weight, not smoking, drinking only moderate amounts of alcohol and maintaining his blood pressure and cholesterol at healthy levels.

Maria Aguilar, M.D., Neurology, Mayo Clinic, Scottsdale, Ariz.

METABOLIC SYNDROME, DIABETES ARE RELATED

My mother is in her 70s and was just diagnosed with metabolic syndrome. Is this just another name for diabetes?

Metabolic syndrome and diabetes are not the same, but they are related. When a person is diagnosed with metabolic syndrome, it means he or she has several conditions that, if untreated, significantly raise the risk for developing diabetes. Metabolic syndrome also increases the risk for heart and blood vessel problems. Treatment for metabolic syndrome typically focuses on lifestyle changes.

Although the specific definition health care providers use may vary somewhat, metabolic syndrome generally includes having three or more of the following characteristics: a large waistline, a high triglyceride level, low HDL cholesterol, high blood pressure and blood sugar that is higher than normal, but not high enough to qualify as diabetes.

High blood sugar is the hallmark sign of diabetes. When a blood sample is taken after a person fasts overnight and blood sugar measures 80 to 100 milligrams per deciliter, or mg/dL, that level is considered normal. A fasting blood sugar measurement of 126 mg/dL or higher on two separate tests is considered diabetes. The range between the two is referred to as prediabetes. The blood sugar level of people who have metabolic syndrome often falls into the prediabetes range.

After a diagnosis of metabolic syndrome, the first step in treatment usually involves lifestyle changes. Getting to and staying at a healthy weight can make a big difference in reducing the risk of health problems associated with metabolic syndrome.

Losing weight may help lower blood pressure, blood sugar and triglyceride levels. It also can help reduce waist size. That's important because studies have shown that carrying weight around your abdomen raises the risk of developing diabetes, heart disease and other complications of metabolic syndrome. Doctors generally recommend a waistline of less than 35 inches for women and less than 40 inches for men.

Regular exercise can help with weight loss, as well as improve some of the medical concerns associated with metabolic syndrome. A good goal is 30 minutes or more every day of activity that is moderately intense.

Healthy eating is a crucial component of treatment for metabolic syndrome. Encourage your mother to talk with her doctor or to a dietitian about the right diet for her situation. Two diets that are often recommended for people with metabolic syndrome include the Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet. Similar to many healthy-eating plans, these diets limit unhealthy fats and focus on fruits, vegetables, fish and whole grains. Beyond weight loss, studies have shown that both diets offer important health benefits for people who have components of metabolic syndrome.

Finally, if your mother smokes, it's very important that she stop. Smoking cigarettes can make many of the health complications of metabolic syndrome worse. It also can significantly raise the risk for other illnesses and diseases.

If lifestyle changes are not enough to control metabolic syndrome, medication may be part of the treatment plan. Medicine to control blood pressure, manage triglycerides and lower blood sugar can be useful in treating some cases of metabolic syndrome.

Robert Rizza, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ[email protected] For more information, visit mayoclinic.org. © 2016 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.

Comments
New shingles vaccine touted as a breakthrough for older adults

New shingles vaccine touted as a breakthrough for older adults

Medical researchers and government health policymakers, a cautious lot, normally take pains to keep expectations modest when they’re discussing some new finding or treatment.They warn about studies’ limitations. They point out what isn’t known. They ...
Published: 11/17/17
In Tampa Bay and elsewhere, early numbers show record sign-ups for Obamacare

In Tampa Bay and elsewhere, early numbers show record sign-ups for Obamacare

Despite the budget cuts, the attempts to repeal and replace, and reports of sharp rises in premiums, Floridians and other Americans are signing up for health insurance under the Affordable Care Act at record rates this year.Enrollment has surged 47 p...
Published: 11/16/17
Updated: 11/17/17
Study: Mental quickness exercises can lower risk of dementia

Study: Mental quickness exercises can lower risk of dementia

Where did I leave my keys?As we age, it can take longer to answer a question like that.Humans begin to lose cognitive ability at age 25. Dementia, or the decline of memory most commonly seen in aging adults, takes hold early on and is gradual, but ac...
Published: 11/16/17
Blood pressure of 130 is the new ‘high,’ according to update of guidelines

Blood pressure of 130 is the new ‘high,’ according to update of guidelines

The nation’s heart experts tightened the guidelines for high blood pressure Monday, a change that will sharply increase the number of U.S. adults considered hypertensive in the hope that they, and their doctors, will address the deadly condition earl...
Published: 11/13/17
Are Honey Nut Cheerios healthy? A look inside the box

Are Honey Nut Cheerios healthy? A look inside the box

I had a bowl of Honey Nut Cheerios recently. It had been awhile. Regular Cheerios are more my thing. But sometimes I finish my box faster than my kids do and find myself straying to their side of the cupboard.Honey Nut is America’s best-selling break...
Published: 11/11/17
Owner of Bayfront Health St. Petersburg faces federal inquiry over funds for low-income patients

Owner of Bayfront Health St. Petersburg faces federal inquiry over funds for low-income patients

The corporate owner of Bayfront Health St. Petersburg could be facing a serious federal investigation related to its commitment to take care of St. Petersburg’s poorest residents.In its most recent filing with the U.S. Securities and Exchange Commiss...
Published: 11/09/17
Updated: 11/14/17
Learn to practice gratitude year-round, not just on Thanksgiving

Learn to practice gratitude year-round, not just on Thanksgiving

Is it part of your Thanksgiving tradition to go around the dinner table and have everyone share one thing they are thankful for? The exercise reminds us that the day is about more than just turkey and pie. And, for those who take it seriously, it for...
Published: 11/07/17
Updated: 11/10/17
When the goal is getting to the ER fast and cheap, some choose Uber over 911

When the goal is getting to the ER fast and cheap, some choose Uber over 911

Matt Lavin had just arrived in Charlottesville, Va., for a business trip when he started feeling sick. By the time he got to his hotel around 11 p.m., he felt excruciating pain. "I didn’t know what was happening, but I knew something wasnR...
Published: 11/06/17

Stunning study: Heart stents fail to ease chest pain

A procedure used to relieve chest pain in hundreds of thousands of heart patients each year is useless for many of them, researchers reported Wednesday.Their study focused on the insertion of stents, tiny wire cages, to open blocked arteries. The dev...
Updated one month ago
Vigil calls attention to overdose victims, and brings hope

Vigil calls attention to overdose victims, and brings hope

NEW PORT RICHEY — The room was filling up fast. For Monica Rousseau, the sight of so many people searching for a seat at the annual Narcotics Overdose Prevention and Education candlelight vigil was both heartbreaking and uplifting. "I can’t even gues...
Updated one month ago