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March 22, 2012

Noon - 1 p.m. (EST)

Cleveland_Clinic_Host: Today's Live Web Chat, "Stroke" with Efrain Salgado, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Stroke" with Efrain Salgado, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.

Francois: Four years ago my older sister who has had controlled hypertension had a stroke of the spine that has affected her walking. Like me she easily gets quite stressed. Am I at increased risk of spinal or other stroke? I am male, 74 and in good health. I do not suffer from sustained hypertension but have significant episodic hypertension in which my systolic pressure can rise as high as 200 without me feeling anything abnormal not only in a doctor's office but also in other places including my home.

Dr_Salgado: You are not necessarily at higher risk of stroke because of what happened to your older sister. Risk factors for spinal stroke are a little different than from brain strokes. The most important thing you can do to decrease your particular stroke risk is to make sure that all of your risk factors are well controlled such as hypertension, cholesterol, blood sugars, that you don't smoke, you maintain ideal body weight and that you exercise. All of these will reduce your stroke risk significantly.

Cleveland_Clinic_Host: We have already received some great questions! Dr. Salgado is being as thorough as possible in his answers. Thank you in advance for your patience. We will get through as many questions as possible.

dotinal: How much does atrial fibrillation increase your stroke risk.

Dr_Salgado: Increases stroke risk by 60% to 70% if you have other risk factors like hypertension, diabetes, and if you are over the age of 75. There are excellent ways to reduce this risk if you have atrial fibrillation. This should be discussed with your doctor.

dotinal: Is their a way to compute your stoke risk similar to how you compute your 5 yr risk of heart attack?

Dr_Salgado: You can do it by knowing the risk conferred by each one of the individual stroke risk factors when they are not controlled. For example, uncontrolled hypertension increases risk by 40%, high cholesterol by 30%, atrial fibrillation by 60% to 70%. All of these can be adequately controlled with the help of your doctor.

dotinal: How long does the average TIA last?

Dr_Salgado:15 to 20 minutes.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Efrain Salgado, MD, who is taking your questions about stroke. To ask a question, type in the box below and then click 'Ask.'

Cleveland_Clinic_Host: If you would like to view the entire transcript of this chat after the event, it will be available on the Cleveland Clinic Florida website. If you have logged in during the middle of this chat and want to view what has already been discussed, click on the transcript button on this page.

nance: I am an 80-yr-old woman. On a few occasions in the past few years I have experienced brief episodes where suddenly everything goes black for less than 4 seconds. This has occurred only about 3 or 4 times in the past several years. In 1998 I had mitral valve annuloplasty at the Cleveland Clinic with good result and regular follow up with my doctors My blood pressure is normal. My question is: Does this sound like possible TIAs? Actually, the feeling is similar to that prior to fainting, however, in a few seconds I am back to normal with no other symptoms.

Dr_Salgado: If the feeling is similar to that prior to fainting, it is unlikely to be a TIA, but rather an episode of a sudden drop in blood pressure which is what typically causes people to nearly pass out or pass out (faint). Your doctor should be able to adequately investigate this problem.

clara: My mother died of a hemorrhagic stroke at 53 years old. I have had open heart surgery and now have had 6 stents done. I am on Plavix and 2- 81mg aspirin. My worry is being on blood thinners with 2 family members having a hemorrhagic stroke.

Dr_Salgado: You should not necessarily assume that you are at high risk because they did. It all depends on the cause of their hemorrhagic strokes. There are some genetic/hereditary conditions that can cause hemorrhagic stroke, but these are rare. The most common cause of hemorrhagic stroke is poorly controlled high blood pressure. Therefore by working with your doctor to keep this under control, you will make a significant impact in reducing that risk. The benefit derived from your Plavix in lowering your risk of heart attack probably outweighs your risk of hemorrhagic stroke, provided your blood pressure is well controlled.

songcanary: How strong is the genetic tendency for stroke? I am a 57 year old female. My maternal grandmother suffered an arterial bleed at age 82 from which she died. My mother had several suspected TIAs in her mid life. She died of other causes. Am I at greater risk for a stroke? I eat low fat organic whole foods, have never smoked. I do have 1-2 ounces of alcohol every day. My total cholesterol 2 yrs ago was 274 but I am told the ratio is very good. BP is low at 90/60; I take Florinef to keep it up. I exercise regularly by brisk walking and yoga. Any suggestions would be welcome, thank you.

Dr_Salgado: There is a genetic tendency, but this is typically not as strong a risk factor as others such as poorly controlled high blood pressure, diabetes, high cholesterol, excessive alcohol consumption, and cigarette smoking. Therefore, we have been given the opportunity to make changes in our lives to minimize the stroke risk regardless of our genetic makeup.

scg369: I have had two mini strokes in the last few months and am nervous I will have a full blown stroke. I take Coumadin for my artificial heart valve and baby Aspirin. Is there anything else I should be doing to lower my risk of having another mini stroke, or even a regular stroke? Any advice is appreciated. Thank you.

Dr_Salgado: There are other issues that need to be assessed by your doctor such as your bad cholesterol levels, your blood sugar, the status of your carotid arteries, etc. If you are obese, weight loss. If you live a sedentary life, exercise as allowed by your doctor. If you smoke, quit. If you drink excessively, cut back.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link to submit your questions.

dotinal: About 5 years ago while driving I had an episode of blurred vision in both eyes that lasted about 1 1/2 minutes and then my vision returned to normal. Could this have been a TIA? I regret I did not go to my doctor right then because I have atrial fibrillation and know a prior TIA would increase my CHADS 2 score to require coumadin. Is there any way to determine this much later if it was a TIA? I've heard previous TIAs do not show up on MRIs or CT scans.

Dr_Salgado: The diagnosis of TIA is a clinical (symptoms and signs) one that is made by your doctor. Whatever testing is done is done to rule out other causes including an actual stroke which could happen even if your symptoms totally resolved. Coumadin is not the only alternative for reducing your risk from atrial fibrillation. There are newer agents available that appear to be better than Coumadin that do not require periodic blood monitoring, that do not interact as much with other medications, and that do not have as many dietary restrictions. Therefore, you should not be afraid of these medications if your doctor deems that they are indicated for your particular situation. You should discuss this with your doctor.

jimT: What is the difference between a mini stroke, TIA and a regular stroke?

Dr_Salgado: I have never been certain about the meaning of "mini stroke". It is not a medical term. Some people may mean by this term a stroke that did not cause too much damage and others may use it to mean a TIA, meaning a transient focal or limited neurological deficit lasting a few minutes without any residual deficit, and without evidence of any damage to the brain as seen on brain imaging study such as CT or MRI. A stroke typically leaves damage to the brain that can be detected by CT or MRI.

shana351: My mother, age 74, has had diabetes since she was a child. She experienced a stroke about a year and a half ago. So far everything has been okay, but I am worried that she will experience another one. Once you experience 1 stroke, how likely is it that you will experience another one (or more than one)? Are there different levels of a stroke? Can one stroke be much worse than another?

Dr_Salgado: Having had a stroke is a risk factor for having another one. However, a great deal can be done to minimize that risk as I have previously mentioned in this web chat.

billdaws65: Does TIA leave you at a higher risk to have a stroke? If so, after having a TIA, what preventative measures can you take to prevent a stroke?

Dr_Salgado: Yes. TIA IS A MEDICAL EMERGENCY. Therefore, it is very important for people to seek immediate medical attention if they have a TIA because the short term (first month after TIA) risk is high. A rapid evaluation will often times clarify the cause and appropriate measures can be taken to ward off an actual stroke.

Cleveland_Clinic_Host: I'm sorry to say that our time with Efrain Salgado, MD is now over. Thank you again, Dr. Salgado, for taking the time to answer our questions today about Stroke. To make an appointment with Dr. Salgado, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at