What is Psoriasis?

Psoriasis is a chronic or lifelong disease which affects the immune system. Its manifestation varies from person to person and response to the known treatment of psoriasis also differs from one person to another. It usually manifests as red lesions and irritations on the skin. It can manifest anywhere in the body. Lesions can form on the eyelids, on the ears, mouth and lips, skin folds, hands and feet and even on the nails.

It occurs when the body’s immune system sends out incorrect signals which speed up the growth cycle of skin cells.  However, it is neither communicable nor contagious. You could not be “infected” by a person with psoriasis and you could not infect other people if you have the disease because it is an autoimmune disorder.  An autoimmune disorder is a condition that occurs when the immune system mistakenly sees the cells of the body as “aliens” and attacks and destroys normal healthy body tissues.

It is considered as the most common autoimmune disease.  There are approximately 7.5 million people affected with psoriasis in the United States alone while all over the globe, about 125 million people are afflicted with this disorder.

A number of people with psoriasis may experience problems with self-confidence because of the lesions on the skin which is the usual symptom of the disorder.

Finding the link between psoriasis and stroke

A new study made by scientists from Denmark had found that patients with psoriasis have an increased risk of experiencing atrial fibrillation (the most common heart problem where both right and left atrium contract very fast and very irregularly) and an ischemic stroke (a stroke caused by a clot in the blood vessels in the brain) in the future. Their study is an addition to the growing body of research which had linked psoriasis with problems with the heart and blood vessels. The results of their study were published online last August in the European Heart Journal.

The link between psoriasis and stroke as well as other cardiovascular diseases can be attributed to two main reasons. First, individuals with the disorder tend to have more cardiovascular risk factors. These include obesity, smoking and having high lipid levels in the blood. Second, people with psoriasis are in a constant state of inflammation. This natural response of the body is believed to be “the link” between the two conditions.

They said that the link between psoriasis and stroke can be attributed to problems with an individual’s lifestyle. The results of the latest study theorized that all persons who have psoriasis are likely candidates for a change of lifestyle which may include smoking cessation having a healthy weight, increasing physical activity, having a healthy diet, and etc.  The latest paper also said that selected patients with psoriasis need to undergo medical treatment such as reducing hypertension, treatment which can lower lipids (fats in the body) and other medical treatments.

The scientists believe that their latest research is a step towards acknowledging the fact that the role of psoriasis as a risk factor for future cardiovascular event which includes a stroke. They also deem that their findings call for an increased awareness of cardiovascular risk factor management in people afflicted with psoriasis. And since a large number of people have the disorder, there is also a bigger problem of how to modify the lifestyles of these patients to lessen their chances of experiencing AF or a stroke in the future.

The numbers game

Using national registries of inpatient hospitalization and dispensing of medications, the researchers tried to determine the risk of having an AF and an ischemic stroke in patients with varying degrees of psoriasis (36,765 patients with mild psoriasis and 2,793 patients with severe psoriasis) and also from a large number of psoriasis-free individuals (4.5 million).

The researchers said that their study showed alarming results. They found out that the risk of having AF was increased by as much as 50% when a patient is below 50 years old and has mild psoriasis. On the other hand, an increase of 16% was observed on patients who have mild psoriasis and were older than 50. People with severe psoriasis were more prone to having AF. The researchers said that the chances of having AF rose by 198% for patients younger than 50 years of age while the chances of older patients was pegged at 29%.

The chances of having an ischemic stroke were no different from the chances of having AF.  They said that the risk of having a future ischemic stroke grew by 97% for patients who have mild psoriasis and were younger than 50 years. They painted a grim picture for people with severe psoriasis. They said that their chances of experiencing an ischemic stroke in the future were increased by as much as 180%.  They also gave a bleak prediction for older patients with mild and severe psoriasis. They said that their chances of having an ischemic stroke grew by 13% and 14% respectively.

What should be done?

The researchers proposed that patients with psoriasis should be closely monitored for any indicators of cardiovascular disease which includes arrhythmias. They also suggested that these individuals should be considered as potential candidates for interventions which can greatly reduce the risk of having cardiovascular disease. These interventions can include lifestyle modifications such as increasing physical activity, smoking cessation and even taking medications.

The researchers did point out that an important goal for future research is to evaluate the impact of changes in primary cardiovascular prophylaxis in patients with psoriasis, such as medical management.   They also revealed that an important thing to consider is whether improving psoriasis treatment such can modify the risk of having cardiovascular events in the future.

Reference:

Medscape.com

Msnbc.msn.com

Nhlbi.nih.gov

Medterms.com

Psoriasis.org

Fluoxetine (also known by the tradenames Prozac, Sarafem, Fontex, among others) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class used to treat depression obsessive-compulsive behavior, a number of eating disorders and panic attacks. SSRIs are the most commonly prescribed antidepressant medication. SSRIs are relatively safe and generally cause fewer side effects than any other type of antidepressant. They work by blocking the reabsorption or the reuptake of the neurotransmitter serotonin increasing its levels in the brain. This increase seems to help brain cells send and receive chemical messages which in turn boosts a person’s moods. They are called selective because they only affect serotonin and not the other neurotransmitters in the brain. Side effects of SSRIs may include:

• Nausea
• Dry mouth
• Headache
• Diarrhea
• Nervousness, agitation or restlessness
• Reduced sexual desire or difficulty reaching orgasm
• Inability to maintain an erection (erectile dysfunction)
• Rash
• Increased sweating
• Weight gain
• Drowsiness
• Insomnia

About the study

Dr. François Chollet, MD, the study’s lead author, a professor of neurology at the Toulouse University Hospital in France said that their team thinks that fluoxetine encourages an increase in the brain’s capacity to reorganize – it acts by helping in rewiring the brain. He added that using fluoxetine is like opening another capacity, another target and another pathway for treating patients who had experienced a stroke.

Currently, ischemic stroke patient are being treated with tissue plasminogen activator (tPA), a thrombolytic drug approved by the US Food and Drug Administration. Dr. Chollet’s team hopes that, in the near future, fluoxetine or other SSRIs can also be a treatment option for these stroke patients. However, Dr. Chollet said that before that can take place several questions must be answered first. He said that the researchers need to determine the length of time for optimal treatment; they also need to find out the long-term effects of the treatment on stroke patients; and what are the other possible effects on neuronal activity in general.

The participants of the study

118 subjects 5-10 days after ischemic stroke were randomized from 9 stroke centers in France. These stroke victims were between 18 and 85 years old and either had hemiplegia (paralysis on either the left or right side of the body) or hemiparesis (weakness on either the left or right side of the body) which are the most common deficits caused by a stroke, with a Fugl-Meyer motor scale of 55 or less. Patients with severe post stroke disabilities (NIHSS score > 20), clinically diagnosed with depression (MADRS > 19), pregnant or with other major diseases were excluded from the study.

Results: Fluoxetine vs. placebo

All of the stroke patients were randomly assigned into 2 groups of 59 members. One group was given 20 milligrams of fluoxetine while the other group was only given a placebo. The researchers started to administer fluoxetine or placebo 5-10 days after the onset of the stroke and they continued for a total of 3 months. All of the stroke victims were given standard post-stroke care and they also underwent physical rehab from physical therapists (PT) who were instructed to use conventional therapy according to the protocol of their medical centers. The PTs were also made to assess the motor functions of all the stroke victims starting from day 0 (the baseline), after 30 days and then 90 days after starting the program.

The result of the study shows that the group treated with fluoxetine recorded a 40% improvement on the Fugl-Meyer motor scale as compared to the placebo group (34 points in the fluoxetine group vs. 24.3 in the placebo group).

Fugl-Meyer Motor Assessment (FMA) is a clinical examination performed to assess the upper extremity and lower extremity motor and sensory impairments in post stroke patients. FMA is being increasingly being used for clinical assessment of motor recovery after a stroke. In a recent clinical trial from July 2011, FMA was used to evaluate safety and efficacy on motor recovery of NeuroAiD in 150 Caucasian subjects after stroke. Subjects on NeuroAiD achieved 27% higher recovery on their motor function as compared to the placebo group. Click here to learn more about the Fugl-Meyer Assessment after a stroke.

Limitations of the study

Although the results of this study shows the positive effect of fluoxetine in motor recovery on post ischemic stroke patients, we should not forget that there are some limitations to it. First, the number of patients included was small (118), also they were selected for motor deficit and do not represent the general population of stroke patients. Second, the treatment was performed for 90 days and it is not well known how the motor recovery evolves over time after the treatment has stopped. Third, a potential random error derived from the statistical analysis cannot be ignored, although this probability is remote (the change in FMA score at day 90 had a statistical relevance of p= 0.003, in other words, the odds that it is an error is 3 in 1000).

Benefits and side effects of SSRIs

Fluoxetine is relatively inexpensive and is commonly available. Fluoxetine, is not a new drug so its side effects are well known, generally mild and very infrequent. Other SSRIs aside from fluoxetine may have the same positive effects, as shown by a study published in 2010 which showed patients who are taking escitalopram (another type of SSRI) had a marked improvement in cognition, particularly memory, compared to patients who were given a placebo.

Depression post-stroke

It is not unusual for post-stroke patient to experience depressive symptoms especially if they have disabilities arising from the stroke. Dr. Chollet‘s team noted that the placebo group had a higher number of stroke patients having significant deficits (7%) compared with the fluoxetine group (5%), there were more depressed stroke patients in the placebo. Approximately 30%-50% of post-stroke patients develop some form of depression and fluoxetine could serve as both mood and motor recovery enhancer. This in turn is a welcome combination of benefits to post-stroke patients.

Fluoxetine was given to the stroke patients as soon as possible after their stroke and that there was no “stroke window” during which it must have been delivered. On the contrary, tPAs must be given within 3.5 hours after the onset of the stroke symptoms because of the risk for bleeding. The earlier fluoxetine is administered, the better for the stroke patient. Dr. Chollet added that what healthcare providers know about the natural history of stroke is that patients recover mainly during the first three months. This period is the time where stroke patients experience the biggest improvements. However, it is still not clear what the optimal duration of treatment is. The long-term effects of fluoxetine and possible other benefits on neurologic functions of this new possible treatment for stroke patients needs to be elucidated.

References

Medscape.com

Nlm.nih.gov

Mayoclinic.com

Medicine.mcgill.ca

In the field of stroke recovery, there are also words to denote some form of evaluation which can be used in patients who had just experienced a stroke. Examples of such words are weak or strong, weaker or stronger and others. These words are helpful in giving and determining the current status of a patient. Healthcare providers use them in assessing the difference between the unaffected and affected side of the stroke patient’s body.

However, these words are very subjective and will depend on the judgment of a person. A physician’s assessment of a stroke patient may differ from another member of the stroke rehab team. This may cause a problem since objectivity should always be practiced when assessing a stroke victim.

A complete assessment should be made for the benefit of the stroke survivor which will be used as reference for proper therapeutic management and for the stroke patient’s rehabilitation. Also, the advent of new treatments and rehab options for post-stroke therapy has made measuring recovery after a stroke very important. Aside from establishing the plan of treatment for the stroke patient, such assessments can also prepare the stroke survivor, his or her family and his or her significant other for any anticipated and expected outcomes. A tool currently employed by members of the healthcare team in properly evaluating patients is the Fugl-Meyer Assessment (FMA) for Motor Recovery after a Stroke.

The Fugl-Meyer Assessment (FMA)

The FMA is a stroke-specific and performance-based impairment index. This means that all stroke survivors are considered unique and that a grading system is in place for proper evaluation.  Basically, what it does is it can determine the severity of the stroke, describe motor recovery, plan the post-stroke treatment and evaluate these treatments. It also evaluates the capacity of the stroke survivor to perform activities of daily living (ADL) and pain. Evaluation can be done immediately after a stroke and can be repeated while the stroke patient is already undergoing therapy. It was developed  to be used in both clinical and research setting and is the first quantitative evaluation tool based on the chronological stages of motor and sensory return in hemiplegic (paralysis of either left or right side of the body) stroke patients. It allows the healthcare team to properly measure the motor and sensory recovery of survivors after a stroke (http://physical-therapy.advanceweb.com/Article/The-Fugl-Meyer-Assessment-After-Stroke.aspx).

Aside from motor and sensory functions, it can also assess balance and joint function in post-stroke patients.

A physical therapist, an occupational therapist or any other rehab professional trained on FMA can administer the evaluation on the stroke patient on a one-on-one basis. The person tasked to administer the test shall guide the stroke victim through test through demonstration and by giving out verbal instructions.

It can be applied in any setting – a hospital, a clinic even at the stroke survivor’s home. Most importantly, it does not need any special equipment. Although, it does require a mat or a bed and a number of small objects for assessment of sensation, reflexes and range of motion (ROM).

The test tracks the stroke patient’s progress from the initial day that he or she had the stroke to days, weeks, months or even years post-stroke.

Sections of the evaluation can be administered separately. The FMA is that it usually takes about 30-35 minutes to administer the whole test. A copy of the FMA can be obtained by following the link towards the Institute of Rehabilitation Medicine, University of Gothenburg, in Sweden http://www.neurophys.gu.se/sektioner/klinisk_neurovetenskap_och_rehabilitering/neurovetenskap/rehab_med/fugl-meyer/.

However, certain stroke patients may have difficulty with the assessments and may take longer than usual to finish the test. It had been found that the FMA is quite challenging to administer to aphasic (has problems with speech or language) and severely affected patients post-stroke.  Since it is based on direct observation, stroke victims who need a proxy to complete tasks will not be permitted to undergo the test.

Features and scoring

• Scoring in the FMA is based on direct observation of the stroke survivor’s performance and is based on the ability to complete an item in the test.  Items in the FMA are scored on a 3-point scale.
  • 0 = cannot perform
  • 1 = performs partially
  • 2 performs fully

• The maximum score that a stroke patient can have is 226 points

• There are five domains which is evaluated by the occupational or physical therapist
  • Motor function – this part of the test includes assessing the movement, coordination and reflex action of the shoulder, elbow, forearm, wrist, hand, hip knee and ankle. The score for this test range from 0 (paralysis) to 100 (normal motor function). The total score is divided into:
    • Upper extremity maximum score = 66
    • Lower extremity maximum score = 34
  • Sensory function (evaluates light touch on two surfaces of the arm and leg, and position sense for 8 joints) maximum score = 24
  • Balance (contains 7 tests, 3 seated and 4 standing) maximum score = 14
  • Joint range of motion (8 joints) maximum score = 44
  • Joint pain (maximum score 44)

Depending on the need, each of the five domains of the test can be administered without using the full FMA evaluation. This means that if the therapist wishes only to evaluate upper extremity function, the subsections which specifically deal with assessing upper extremity movement, sensation, joint motion and pain can be performed without having to administer the full test. Also, modified or shortened versions had been developed for these purposes.

References:

Ncbi.nlm.nih.gov

Medicine.mcgill.ca

Rehabmeasures.org

Neurophys.gu.se

Medical-dictionary.thefreedictionary.com

When you are or somebody you know is having a fever, your immediate action is controlling the increase in the body’s temperature. This may be done by taking medications, taking a shower or a sponge bath or just relaxing in a cool and restful environment.

Nowadays, cooling the body for therapeutic purposes (therapeutic hypothermia) is being incorporated into other medical purposes and not just only for controlling a fever. A good example is during surgery. Induced hypothermia is being employed to save vital organs when patient go under the knife.

Lately, it is being used during procedures involving the heart as well as the brains. Scientific studies had proven the benefits of lowering the body’s temperature when treating ischemic cerebrovascular diseases. This practice had been applied within the last decade especially during the clinical management of acute stroke.

Some people may disagree with induced hypothermia being employed during instances of acute ischemic stroke. They would argue that lowering the body’s temperature would be more harmful since it causes the constriction of the blood vessels. They would claim that blood flow to the brain is already diminished because of the blockage caused by the stroke. And inducing hypothermia would make the blood flow to the brain more diminished. They would vouch for increasing the body’s core temperature. They would say that this would be more beneficial to the stroke patient since the blood vessels become more dilated thus, increasing blood flow to the brain.

History

Induced hypothermia had been used as early as the 17^th century BC. Its use was first described in the Edwin Smith Surgical Papyrus. The Edwin Smith Surgical Papyrus is one of the oldest of all known medical documents.

During the 1930s, Dr. Temple Fay, an American neurosurgeon applied this technology in treating neurological diseases. It was then used in cardiac arrest victims during cardiac bypass surgery during the 1950s.  Induced hypotension was then applied to intracranial aneurysm surgery to create a bloodless operation for better handling of delicate brain tissues. Fifty years later, it is now being used by medical practitioners as an effective brain-protecting agent for out-of-hospital cardiac arrest patients. Today, induced hypothermia is the only treatment which has been proven to protect brain cells during global ischemia such as heart attacks. These benefits gained from induced hypothermia have created interest in the application such technology as a brain-protector in acute ischemic strokes.

Lowering the body’s temperature

Therapeutic hypothermia is deliberately causing a controlled reduction of a patient’s core temperature below 36°C. It may either be classified as mild therapeutic hypothermia (34°C – 35.9°C), moderate (32°C – 33.9°C), moderate/deep (30°C – 31.9°C), or deep (< 30°C).

The aftermath of an ischemic event is different levels of tissue damage. The end result of which is cellular death. The same is true for brain tissues. This is most evident during instances of ischemic strokes where brain cells are subjected to diminished blood flow. Brain cells eventually die because of decreased blood flow to brain tissues.

Past studies of induced hypothermia on animal subjects had shown positive results. These studies had shown that inflammatory responses of the body were inhibited when body temperature is lowered. Such results are beneficial in the application of the technology to stroke patients. These had shown that hypothermia works against cellular injury by inhibiting swelling of brain cells after an acute stroke.

Different methods

There are several ways of inducing therapeutic hypothermia. Lowering the body’s temperature can be induced by cooling the surface, the core (intravascular) and other selective methods. Note that induced hypothermia should be performed in a health center under the supervision of a health professional.

Among the 3, surface cooling is the most noninvasive, least expensive and is the easiest to implement.  However, there may be fluctuations in body temperature and a longer time is needed to achieve the desired temperature. Surface cooling methods include the use of air, volatile liquids, cold water and/or ice as media for the transfer of heat.

Intravascular cooling is done by administering ice-cold fluids, inserting intravascular catheters with electronic feedback temperature control, using devices which irrigates the peritoneum (the lining of the abdominal cavity) and extracorporeal (occurring outside the body) circulation. These methods require a shorter amount of time to reach desired temperatures. Also, achieving desired temperatures are more precisely controlled.

Lately, the interest in selective cooling methods is increasing most notably in the field of stroke. Proponents of therapeutic hypothermia are studying the benefits of using selective therapeutic hypothermia to counter the effects of an ischemic stroke. They had devised a cooling helmet for inducing hypothermia. They found out that stroke patients undergoing selective hypothermia had a lower brain temperature compared with other stroke patients.

Advocates of selective cooling say that there are no complications when using a cooling helmet compared with whole body hypothermia. They also vouched for using a cooling helmet during emergency situations. They said that it was safe for implementation by emergency medical services (EMS).

Disadvantages of induced hypothermia

Induced hypothermia also has its share of disadvantages. The most common type is shivering but it can be controlled. Methods of controlling shivering include re-warming the patient and using medications.

Another drawback to such technology is the frequent electrolyte shifting while inducing hypothermia. Important electrolytes (sodium, potassium, calcium, etc.) can move from the within the cells and into the blood and vice versa while the body’s temperature is decreasing. This shifting action may cause a decrease in the amount of needed electrolytes within the cells of the body.

Heart rate and cardiac output (the volume of blood pumped by the heart per minute) are also decreased when a person experiences mild to moderate hypothermia. However, such action is negated by the fact that the body slows down its normal metabolic rate when experiencing cold temperature. This normal response of the body helps in conserving oxygen levels in the blood.

Lastly, a person may also acquire pneumonia. It is the most common infectious complication when a person experiences cold temperatures. Acquiring the disease depends on the duration and the degree of hypothermia.

Hypothermia and stroke

During the late 1990s, the Copenhagen Stroke Study Registry ascertained that there is a direct relationship between body temperature and stroke. When stroke patients are admitted after experiencing an acute stroke, they found out that for every 1°C increase in the body’s temperature, there is also an increase in risk of having a poor outcome.

This data was used as a starting point for the research of inducing hypothermia in stroke patients in 2000. The second study determined that patients who had an acute stroke and underwent induced hypothermia did not have poor outcomes, the incidence of death was decreased and had a lower incidence of complications brought about by infection. They reached these results after inducing hypothermia on acute stroke patients within 12 hours of the onset of the symptoms of stroke. They did note that the most common uncomfortable event was shivering which was controlled using medication.

These outcomes resulted in an increase in interest in lowering the body’s temperature in other stroke patients. The results of these later studies also yielded favorable outcomes.

Currently, there is an increasing body of data which espouses the induction of hypothermia on acute stroke patients. However, there had been no large-scale study proving the effectiveness of such technology on acute stroke. Still, lowering the body’s temperature remains a mode of treatment for stroke.  Additional studies are still needed to determine the optimal time to induce hypothermia for best results. And when that happens, this technology will eventually alter the pattern of acute stroke management in clinical practice.

Reference:

Medscape.com

Cerebral Aneurysm is also called as intracranial aneurysm or brain aneurysm. It is the bulging or weak balloon like spot formed on the artery wall of the brain or in the brain’s blood vessels. Such an abnormality caused in the brain’s blood vessel is essentially due to pounding of blood flow against its walls which gradually starts thinning out due to force or pressure of the blood flow. These artery walls or blood vessels so thinned out are succumbed to the continuous flow of blood, which eventually swell outward over a period of time. This eventually forms bulging spot or ballooning of blood vessels in the brain. The dangers of the blood flow escaping into surrounding vicinity of the brain (threat of rupture) cannot be negated. In case of such brain bleeding, immediate surgical attention is required.

Rate of Occurrence of Cerebral Aneurysm

Due to the fact that aneurysm occurs on the walls of arteries or blood vessels of the brain over a period of time, its occurrence in children and youngsters is extremely rare. Thus, Cerebral Aneurysm is mostly found in adults in the age group of 35 to 60. Facts suggest those unruptured brain aneurysms are found 1 in 50 or approximately six million people in the United States. However ruptured brain aneurysms are found in approximately 25000 to 27000 people in the United States. Further, of the ruptured cerebral aneurysms found, nearly 40% of the cases are fatal. Moreover, out of the people surviving ruptured cerebral aneurysms, facts have suggested that nearly 66% suffer from neurological problems and certain disabilities. Cerebral aneurysms are more commonly found in people with genetic diseases, and certain circulatory disorders. It is also suggested that ruptured Cerebral aneurysms account for 3 to 5% of cerebral stroke or bleeding stroke

Types of Aneurysm

On the basis of shape, Aneurysm is of two types:

• Saccular Aneurysm: 80 to 90% of all Cerebral Aneurysm found belong to this type. These berry shaped projections occur at the base of the brain in the shape of either wide neck or a well defined neck. Nontraumatic Subarachnoid Hemorrhage (SAH) is mostly caused by these sac-like projections.
• Fusiform Aneurysm: This is not common type of Aneurysm. These are spindle shaped and does not have a profound neck. In this, the artery walls or blood vessels expand in all directions there by creating a pouch like shaped on both the sides. These forms of Aneurysm very rarely experience a rupture.

On the basis of size Aneurysm is of four types:

• measuring less than 5 mm are Small aneurysms
• measuring around 6–15 mm are Medium aneurysms
• measuring around 16-25 mm are Large aneurysms
• measuring more than 25mm are Giant aneurysms

Symptoms associated with Cerebral Aneurysm

Unruptured cerebral aneurysms are mostly small aneurysms and do not show any signs or symptoms of their presence. Only the uncommon unruptured aneurysms which are the large aneurysms depict signs of their presence. Certain symptoms depicted by these breed of unruptured aneurysms include: Dilating of pupils, localized headache, pain around and behind eyes, experiencing blurred vision, numbness, difficulty in communicating and feeling of weakness.

Ruptured cerebral aneurysms

When blood ruptures into brain’s vicinity or subarachnoid space, certain definite symptoms are experienced by the victim as: experiencing unconsciousness, excruciating pain around and behind eyes, strenuous headache, feeling of vomiting, sudden weakness or numbness, photophobia or sensitivity to light, stiff neck and drooping of eyelids

Can unruptured cerebral aneurysm bleed?

Larger unruptured aneurysms are more likely to bleed than smaller unruptured aneurysms. Apart from shape, the possibility of bleeding is also dictated by location of aneurysm and the symptoms that flow from it. Once an aneurysm has bled, the possibility that it will bleed again cannot be deemed as remote. If one has already had an aneurysm that has ruptured the chance of him getting it again or that the aneurysm would multiply, is a little over 20%. Moreover, if the causes of cerebral aneurysms are hereditary, then in such case the risk of bleeding is much higher. It is therefore pertinent for cerebral aneurysm to be detected at the first instance, in its initial phase of formation and when it is unruptured and small.

Detecting cerebral aneurysms

Cerebral Aneurysm can be detected by varied tests. It is optimal for one has to be more specific in choosing his tests. The types of tests for detecting cerebral aneurysms would depend on health facility conducting the tests. But if one has to undertake test on basis of ruptured aneurysm, then Angiogram is the best test. If normal tests of screening have to be undertaken then M.R.I (M.R.A.) or C.T.A. should suffice. However, the best overall tests for detecting cerebral aneurysms are:

Magnetic Resonance Angiogram

This method is used as a screening tool of detecting medium to large aneurysms. Small aneurysms cannot be detected by this test. In case of detecting medium to large aneurysms, success rate of this test is over 70%. The risk of MRI stroke is minimal.

Computerized (C.T.) Angiogram

This test is very similar to M.R.A., except that it uses iodine injection and is recommended for those who already had aneurysm clipped before.

Cerebral Angiogram

This is deemed to be the best method of detecting cerebral aneurysms. In this detection there is highest risk of permanent brain stroke, howsoever negligible, rate of risk being 0.5 to 1%.

Certain causes which increases the chance of Aneurysm to bleed

It is rather mysterious that the causes of bleeding in an aneurysm are unknown. However the causes which increase chances of aneurysm to bleed are depicted:

• aneurysm could rupture due to High blood pressure
• aneurysm could rupture due to strain and strong emotions
• aneurysm could rupture due to inclusion of Blood “thinners” found in prescription drugs as well as diet pills and also in cocaine

Treatment options of Cerebral Aneurysm

A person can undertake brain injury therapy or just be under observation in case where aneurysm has not ruptured but only detected. But in the scenario where aneurysm has already ruptured, person has to immediately adhere to surgical treatment as open bypass surgery or usage of endovascular approach.  In treating ruptured aneurysm, care has to be taken to see that rebleed of aneurysm is immediately arrested by getting it sealed by either using the coiling option of treatment or by the clipping option.

Coiling option of treating aneurysm

In this mode of treating aneurysm, angiogram approach is used in inserting multiple coils in aneurysm in order to pack the aneurysm in such a manner so as to enable the blood flow within it to completely clot. Although the success rate of this mode of treatment is a little above 50%, the risk of occurrence of clot stroke or of any other complication is only 3%.

Clipping option of treating aneurysm

This option of treating aneurysm depends on various factors such as consideration of patient age, size and location of aneurysm, shape of aneurysm, Neurological condition of patient, hereditary occurrence of aneurysm or SAH history of occurrence. However, the risk of recurrence of aneurysm is a mere 1.5%, where the treatment is by efficiently clipped aneurysm. The use of this method to treat aneurysm has been drastically increased over number of years. The rate of complication of this procedure depends on the aforementioned factors. The facts however suggest the complication rate to be 17% in this mode of treatment.

Source:

http://www.bafound.org

http://www.neurosurgery.com.au

We did not want to stop there, we want to hear more from our own customers about their experience, that is why we continuously survey our customers and monitor their progress. We thought such a survey would help answer the frequent question “what are my chances and risk with NeuroAiD?” Here below are the result of a survey conducted in 2010 on patients who purchased NeuroAiD for at least 1 month (inclusive) of treatment between January 1st 2009 and February 28th, 2010. Customers were emailed an on-line questionnaire in three different languages (English, French and Spanish). We received 144 answers which are the basis for the chart below. We are currently conducting a survey of all customers who purchased NeuroAiD in 2011 and results will be published by the second quarter of 2012.

Here are the results of our last customer survey on patients who purchased NeuroAiD and we would love to share these insights with you.

Tolerance to NeuroAiD

NeuroAiD is a natural product and has no known drug interactions. Several studies have proven the safety profile of NeuroAiD. Our customer report support the findings in these clinical studies: 90% of patients report no side effect when taking NeuroAiD.

Side effects reported are mild and usually in the form of digestive discomfort (due to the high herbal concentration), allergy or headache.

Efficacy of NeuroAiD

There are many factors that can affect the outcome of NeuroAiD treatment. These factors include age of the patient, the diverse nature of strokes and the different degree of rehabilitation intensity and effort to which patients are exposed. Therefore the observed improvement when taking NeuroAiD varies from patient to patient. Nevertheless, we are happy to see that 70% of patients experience improvement when taking NeuroAiD.

The reported efficacy tends to be better in patients who suffered a stroke more recently. Furthermore, 68% of the respondents experienced a better recovery in motor functions and 52% experienced a noticeable improvement in aphasia.

The take home message

We are glad to see that the reported tolerability and efficacy are in consonance with published clinical studies. The reasons why most patients respond positively to the treatment is because NeuroAiD have shown to trigger multiple mechanisms enhancing the brain’s own capability to recover after an injury, a process called neuroplasticity (you can learn more about it here). However we would like to stress that NeuroAiD is not a miracle cure, in any given treatment there is a percentage of patients that does not respond well or does not respond at all. The reasons for this vary greatly from patient to patient. Some of the factors affecting the outcome of the treatment may be the own and unique genetic background of the patient, the age of the patient, how long after stroke NeuroAiD treatment started, the severity and type of stroke, other concomitant diseases, rehabilitation routine, etc. We are happy to see that about 70% of customers have reported improvement but we also empathize that 30% have not benefited from the NeuroAiD treatment.

NeuroAiD helps stroke recovery by providing a good environment for the growth of new neurons in the brain and it is especially effective when combined with rehabilitation exercises. Clinical studies have indicated that NeuroAiD acts as a booster in stroke recovery.

Especially at this time of the year when the holiday cheer brings about abundant food and festivities, one must be aware of what kind of foods are healthy and what should be avoided (or eaten in moderation).

GENERAL GUIDELINE TO HEALTHY EATING

When it comes to preparation, the best way to eat most meats is when it is grilled or baked. Avoid the skin and the fat and serving it fried is not recommended because of the high cholesterol. When preparing a dish, use lower-fat or no-fat ingredients. Also try and avoid using salt too much. The recommended daily sodium intake is less than 1500 mg a day.

For salads, use fat-free margarine (avoid butter), low fat meats, and sugar free products in the dressing. This also goes for desserts.

CHOLESTEROL AND STROKES

Having high cholesterol levels in the bloodstream can lead to clots that causes strokes. An ischemic stroke occurs when there is an obstruction (blood clot) in the blood vessel supplying blood to the brain. Ischemic strokes are not to be confused with Transient Ischemic Attack (TIA) where the obstruction is temporary (an average of a minute) and cause no permanent brain injury.

An ischemic stroke limits blood flow to the brain damaging it. Aside from paralysis, speech defects, and vision problems, ischemic strokes can also impair the body’s fine motor control. Among all impairments stroke victims suffer from, fine motor control is one of the hardest to rehabilitate.

RECOMMENDED DIETS AND FOOD

For eating healthy, The American Heart Association recommends the following diet:

• Fruits and vegetables: At least 4.5 cups a day
• Fish (preferably oily fish): At least two 3.5-ounce servings a week
• Fiber-rich whole grains: At least three 1-ounce-equivalent servings a day
• Sodium: Less than 1,500 mg a day
• Sugar-sweetened beverages: No more than 450 calories (36 ounces) a week

Other Dietary Measures:

• Nuts, legumes and seeds: At least 4 servings a week
• Processed meats: No more than 2 servings a week
• Saturated fat: Less than 7% of total energy intake

As for what specific foods are healthy and cholesterol free, Dr I.V. van Heerden of DietDoc recommends the following foods:

1. Olive oil and olive products – Olive oil is rich in monounsaturated fatty acids and vitamin E. It has been shown that foods such as this have a high monounsaturated fatty acid content that lowers low-density lipoprotein (LDL) cholesterol and increase high-density lipoprotein (HDL) cholesterol. LDL is considered bad while HDL is considered good cholesterol.
2. Polyunsaturated, ‘lite’ and Flora ‘pro-activ’ margarine – Soft or tub margarine with high polyunsaturated fatty acid content will also help to lower LDL cholesterol.
3. Legumes- These include dry, cooked or canned beans, lentils, peas and all the soya products. Legumes have a high dietary fiber content that lowers cholesterol and energy intake. They are also rich in protective nutrients, including minerals, B vitamins and phytonutrients which protect the heart.
4. Fat-free yoghurt and other fat-free dairy products – People with high cholesterol should avoid full cream dairy products and most cheeses since these have high saturated fat content.
5. Antioxidant-rich fruit and vegetables – All fruits and vegetables, especially those that are rich in vitamin C and beta-carotene can help to lower cholesterol and protect the heart.
6. Garlic and other members of the onion family – Garlic, spring onions and other onions (members of the allium family)  can be used to lower cholesterol and protect the heart.
7. Whole, unsifted or unprocessed grains – These are rich in B vitamins, minerals and dietary fiber, but are low in fat and cholesterol.
8. Fish - People who eat fish 3 or more times a week are less likely to suffer from strokes, heart disease and high blood pressure. This is because of the high omega-3 fatty acid content of fish. The omega-3 fatty acids can play a significant role in helping to reduce the risk of high cholesterol levels.

Source:

http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Nutrition-Center_UCM_001188_SubHomePage.jsp

http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/DiningOut/Dining-Out_UCM_304183_SubHomePage.jsp

http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Healthy-Diet-Goals_UCM_310436_SubHomePage.jsp

http://www.health24.com/dietnfood/Top_10_foods/15-3528,43395.asp

http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyCooking/Healthy-Cooking_UCM_001183_SubHomePage.jsp

Strokes can cause paralysis, speech defects, and vision problems. Ischemic strokes can also impair the person’s ability to be cognitive as well as affect one’s moods and emotions.

CAUSES OF STROKE IN CHILDREN

Although it sounds improbable, children can also suffer a stroke. But unlike adult strokes that are caused by factors such as high blood pressure, high cholesterol, smoking, alcohol and obesity, children’s strokes, on the other hand, are often caused by birth defects, infections (e.g. meningitis, encephalitis), trauma, and blood disorders such as sickle cell disease.

Sickle cell disease is a blood disorder that’s associated with ischemic stroke. In sickle cell disease, the blood cell can’t carry oxygen to the brain, and blood vessels leading to the brain may have narrowed or closed.

EFFECTS OF STROKE IN CHILDREN

Depending on what part of the brain the stroke impacts, the child can also have typical stroke disabilities found in adults such as paralysis (hemiplegia or disphagia), visual problems, cognitive deficits (such as apraxia or agnosia), language deficits (dysarthria and aphasia) and emotional deficits (such as depression). But unlike adults, there are stroke related disabilities that are unique to children such as cerebral palsy, mental retardation and epilepsy.

Other complications brought about by the stroke are fever, loss of emotional control, memory problems, judgment and problem solving skills, and behavioral changes. And because of prolonged bed rest, physical and nutritional factors may also be affected.

RECOVERY

The upside of being a child is that a child has better healing abilities than an adult. The brain of a child is still developing and may have a greater chance of stroke recovery. Physical and speech therapy helps greatly in recovering the child’s use of his/her arms and legs and recover proper speech patterns after a stroke.

SIGNS AND SYMPTOMS OF CHILDHOOD STROKE

Be aware of the following signs and symptoms that may be a sign of a stroke in the child. It is best to immediately call or bring the child to the nearest doctor or hospital for immediate treatment

• Severe headache- this is often the first complaint
• Nausea and/or vomiting/ warm, flushed, clammy skin
• Slow, full pulse – may have distended neck veins
• Speech difficulties- absent, slurred or inappropriate speech
• Eye movement problems – partial or complete blindness, blurred vision, unequal pupils
• Numbness – paralysis, weakness, or loss of coordination of limbs, usually on one side of the body; loss of balance
• Facial droop or salivary drool
• Urinary incontinence
• Seizures
• Brief loss of consciousness; unconscious ‘snoring’ respirations
• May show signs of rapid recovery (TIA)

The incidence of stroke in children is relatively low; about six cases in every 100,000 children per year and at least one-third of those cases are in newborns. They are a bit more common in children under the age of two.

Source:

National Institute of Neurological Disorders and Stroke

American Stroke Association

St. John’s Hospital

The stroke victim can suffer from paralysis, speech defects, and vision problems. Ischemic strokes can also impair the person’s ability to be cognitive as well as affect one’s moods and emotions.

Changes in Personality Caused by a Stroke
When a person suffers a stroke, a part of the brain that affects mood and behavior is impacted. It can cause several changes in the personality of a stroke victim. Some of the changes a person who suffered from a stroke may be the following:

• Depressed – After a stroke, a significant change in the behavioral personality of a stroke victim is depression. This is caused by biochemical changes that happened in the brain cause by the stroke.  A depressed stroke victim often feels hopeless, are fatigued, sleep poorly and do not eat well.
• Apathetic – A person after having a stroke can be apathetic. Apathy is when a person is indifferent and unmindful of the surroundings and is content with not doing anything.
• Impulsive – Another personality change a stroke victim may experience is impulsiveness. This is when the person does not think ahead and often does something too quickly, on impulse. The normal brain pattern of deciding whether to do or not to do something is impaired and the resulting behavior is impulsiveness.

These behavioral changes in personality are not always permanent. Stroke victims as well as family and loved ones should be aware that a psychologist or psychiatrist can help in recovering from these changes. With proper care and guidance, these personality changes will start mellowing down.

How Family and Loved Ones Can Help in Stroke Recovery

Caring for someone who suffered a stroke is a difficult thing.  After having a stroke, the person is physically impaired, suffers mood and behavioral swings, and is generally difficult to deal with. It is important to note that family and loved ones have a significant role in the recovery of a stroke victim. They should know and prepare on what to do after a stroke.

A simple guideline for family and loved ones of a stroke victim is to do and be mindful of the following:

1. Be Sympathetic – People around the patient must understand that the stroke victim is the priority. It is not about them, it is about him or her. People should exhibit emotional control with dealing with a stroke victim who is temperamental and moody.
2. Be Firm, Supportive, and Positive – It is best to show understanding of the person’s behavior and rephrase questions or statements to reflect the positive side rather than the negative. It is akin to keep saying the glass is half full rather than saying that it is half empty.
3.  Be relaxing – It is easier to talk to a stroke sufferer about his or her personality behavior when that person is relaxed. One way to relax a stroke victim is to use distractive methods such as calm music or watching the television.
4. Reinforce Positive Behavior – A family or loved one can significantly help in positively altering a stroke survivor’s mood and personality by positive reinforcement. Rewarding a stroke patient when he or she exhibits positive behavior with something significant helps a lot in stroke behavioral recovery. Making this a practice can then be a significant tool in hastening the stroke recovery process.
5. Minimize Distraction and Stimulation – A family or loved one should be aware that a stroke victim is physically impaired when it comes to simple activities such as getting dressed. Minimizing distractions during these moments such as turning off the television may help tremendously. Otherwise, the stroke victim may get frustrated and eventually emotional.
6. Encourage Social Interaction – Finding a support group for stroke victims is easy. A support group like this can help the stroke victim be more open to his condition and encourage a more stable positive behavior from then on. It also allows family members and loved ones to interact and share experiences with other people that can also be mutually beneficial.
7. Exercise Caution – Some stroke victims can be physically abusive and violent during a personality episode. Frustration can lead to temper tantrums. It is best to protect both the stroke victim and the people around from injury. A professional doctor can help in learning how to cope and treat this kind of behavior in stroke victims.

Caring for a recovering stroke victim is not easy. It is as hard as what the stroke victim is experiencing. But having the right mindset and being informed about what to do after a stroke and what to expect after a stroke can be very beneficial in a stroke victi

Photo from the Internet Stroke Center

According to the website of the Internet Stroke Center, the World Health Organization’s (WHO) latest statistics estimated that every year there are about 15 million people who had experienced a stroke. It is also estimated that of these large number of stroke victims, at least 5 million succumb to their stroke and that at least another 5 million people are left with permanent disability.

A stroke victim can be left with one or several disabilities depending on the gravity inflicted by their stroke such as problems with mobility, speech, logic and others can arise after a person experiences a stroke.  These disabilities target certain parts of the body – the face, the upper extremities, the lower extremities, etc.  However, what is not seen by other people is that the stroke has a lasting imprint on the brain of the stroke victim.

Aside from the noticeable disabilities identified another potential problem patients and caregivers should be wary about are seizures and epileptic attacks after their stroke. Among the elderly, experiencing a previous stroke is the usual cause of experiencing a seizure attack in the future.

What are seizures?
The brain works in a systematic way. It receives data from our five senses (sight, smell, touch, hearing and taste), collects these data, analyzes them and then sends out corresponding “reactions” back to our five senses.  However, during a seizure, the electrical activity in the brain becomes disorganized which causes a person’s body to spasm. Instead of giving out the correct message (reactions) to specific body parts, the brain is now causing the body to spasm.

There are two types of seizures: those which can happen spontaneously (primary seizures) and those which are caused by damage to the brain, usually a stroke (post-stroke seizure).

The National Institutes of Health (NIH) of America estimates that at least 11.5% of stroke patients are at risk of developing post-stroke seizures. These seizures can happen immediately after the stroke or may lie dormant for up to 5 years, thus the term post-stroke seizures.

Seizures after a stroke
A post-stroke seizure can either be a single episode or multiple convulsive episodes regardless of when the seizure initially occurred. It is related to either a reversible or irreversible damage to the frontal part of the brain, the cerebrum. It is different from and should not be confused with post-stroke epilepsy. Post-stoke epilepsy, on the other hand, are also recurrent seizures after a stroke but they are confirmed by healthcare providers with a diagnosis of epilepsy. The only difference between the two is that post-stroke epilepsy had been diagnosed and had been confirmed by a physician.

Post-stroke seizures are either classified as early or late onset. Early onset seizure occurs as early as 24 to 48 hours after the stroke up to 14 days after the stroke. Late onset seizures occur after two weeks of the initial onset of the stroke.

The NIH affirmed that post-stroke seizures and post-stroke epileptic episodes are the most common causes of hospital admissions. They consider these seizures as a complication of their previous stroke. These seizures are not a recent development brought about by their increased age but as a result of their stroke.

Some studies had observed that patients who had suffered an ischemic stroke were 10% more likely to experience a seizure after their stroke and that they could experience at least one seizure up to the 5^th year post-stroke. Hemorrhagic stroke patients fared worse than ischemic stroke patients, the risk of seizures post-stroke ranged from 27% up to 34%.

What to do during a seizure
There is a saying that “Knowing is half the battle” and knowing what to do when faced with the dilemma of a loved one having a seizure after a stroke is the best “remedy.”

If a person you know or a stranger you just met suddenly experiences a seizure while you are outside of the house or if the person is in a standing position:

1. You can try to help that person by slowly placing him or her on the ground.
2. If there are other people who can lend a hand, let them call the nearest hospital or ambulance for help.
3. The next thing to do is to try to keep the space around the person experiencing a seizure free from unnecessary objects. Since the person experiencing a seizure may experience some jerky movements, stray objects may fall and hit the person.
4. If you could guide the person into a recovery (side-lying) position, then do so. This prevents saliva and other oral secretions from causing unnecessary blockage of the person’s airway. It also keeps the tongue from obstructing the breathing of the person experiencing a seizure.
5. If you can’t place the person in a side-lying position while the seizure is happening, you may wait until the seizure stops and then place the person in the recovery position.
6. If there were no other people besides the two of you when the seizure happened, now is the best time to call for medical help.

If the seizure happened while the person is in bed:

1. Try to place a pillow underneath the person’s head to keep the head from banging into the bed.
2. Again, if there are other people around, let them call the ambulance ASAP.
3. Keep the bed from unnecessary objects which may fall on the person.
4. Again, try to place him or her in a recovery/side-lying position

Keep in mind
Remember to never place any hard object such as a spoon or a stick into the person’s mouth while he or she is experiencing a seizure. Previously, such practice was done to prevent the person who is having a seizure from cutting his or her tongue with his or her teeth. It has been proven otherwise.  Such practice would only cause more harm than good. Spoons and other hard objects were eventually broken in half by the biting motion of the mouth during a seizure. These objects were found to either cause oral lacerations or even worse blocking the airway of the person. The best thing to do is to let the seizure run its course and place the person in a recovery position if possible.

Also, never try to hold on to the extremities of the person experiencing the seizure. In the past, such practice was done to prevent the person from hitting other people and objects around him. However, such practice had been deemed as unnecessary, again, since it can cause more harm than good. Holding the person’s arms and legs can lead to fractures if the person holding the extremities is not knowledgeable on where to properly place his or her hands on the person having a seizure. Again, the best thing to do is to let the seizure cease on its own and have the person undergo a thorough evaluation by his or her doctor.

Reference:
Stroke.about.com
Strokecenter.org
Postgraduate Medical Journal
Medterms.com
Archives of Neurology