Stroke

  1. Carotid atherosclerosis – this is a major cause of stroke and the reason the carotid scanning is being offered. In my opinion, However, it is being offered in the wrong setting by the wrong people.
  2. Lacunar infarction – this is typically a different type of stroke with a very dramatic presentation but in many cases almost complete recovery or the person being left with minimal disability. The real cause here is a bout of poorly controlled blood pressure. The management is of course better control of the blood pressure.
  3. Cerebral embolism – although there are many causes of cerebral embolism, the major factor is atrial fibrillation. Atrial fibrillation is where the top chambers of the hearts develop a chaotic rhythm where these chambers quiver without effective contraction. Because there is then sluggish flow within these chambers, small clots can form which may then break away and travel up to the brain potentially causing a stroke. It has been estimated that around a third of strokes are related to atrial fibrillation which is not always present at the time of the stroke.
  4. Paradoxical embolism – the commonest cause of this condition is a Patent Foramen Ovale. In utero, this communication between the right and left atrium in the heart is open because we derive our blood supply and oxygen from the umbilical vessels. When we take our first breath, the pressure on the left side of heart increases typically closing the flap but in around 30% of cases a small communication is left. If a clot forms on the venous side of our circulation with situations such as prolonged immobilisation, it may break away and travels up towards the lungs. If it is going through the right atrium at the wrong time and for some reason the pressure increases on the right side of the heart such as seen with straining, coughing or sneezing, the small clot can be forced across this patent flap and again can travel up to the brain where it may cause a stroke.
  5. The final relatively common cause of stroke is a disorder of blood clotting. Any condition that makes the blood thicker may precipitate the formation of a clot and thus a subsequent stroke, if this occurs in the cerebral circulation. There are eight relatively common genetic causes of excessive blood thickness, the commonest cause being a condition known as Factor Five Leiden but there are also acquired causes that typically occur as one ages. This is especially so over the age of 50 and is commonly associated with medical therapy such as hormone replacement therapy, chronic inflammatory conditions and even cancer.
Image source: MedicineNet

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Dr Ross Walker

Dr Ross Walker

Dr Walker is an expert in the field of preventative cardiology and has published seven books. He gives lectures nationally and internationally.