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.
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