Online Health Chat with Nestor Galvez-Jimenez, MD

June 30, 2015


Description

Each year, about 795,000 people in the United States have a stroke. It is the fifth leading cause of death in the United States and the leading cause of serious long-term disability in the United States. Ischemic strokes, which occur when blood clots block the blood vessels to the brain, are the most common type of stroke. In a hemorrhagic stroke, arteries in the brain rupture, causing blood to flood into the brain which can lead to brain-cell death.

Before a stroke occurs, some may experience symptoms including sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg. Other symptoms include:

  • Sudden vision changes
  • Sudden trouble speaking
  • Sudden confusion or trouble understanding simple statements
  • Sudden problems with walking or balance
  • A sudden severe headache that is not similar to past headaches

While some risk factors such as heredity, age and gender can’t be controlled, making specific lifestyle changes now and taking preventative measures can help prevent you from having a stroke.

Cleveland Clinic Florida conducts free annual stroke screenings including body mass index (BMI) and blood pressure assessments, glucose and cholesterol screenings, four-limb EKGs and one-on-one physician consultations. We also provide questionnaires to patients at our screenings to help assess their risk of a stroke. Join Cleveland Clinic Florida neurologist, Nestor Galvez-Jimenez, MD, to ask your questions and learn how to lower your risk of a stroke.


Let’s Chat About Stroke Risk and Prevention

Welcome to our Online Health Chat "Stroke: Am I at Risk?" with Nestor Galvez-Jimenez, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.


Medical Conditions and Stroke Risk

LZ: I had been suffering from headaches 24/7 for a couple months before I finally decided to make a trip to Ohio (from Southwest Michigan) for some answers. I saw a Neurologist in Cleveland who ordered an MRI and discovered my Left Vertebral Artery was completely occluded. After many more tests and consults I was diagnosed with NDPH and they said the occlusion was not the cause of the headaches. I have awesome blood flow everywhere. My question is, does having an occlusion like that increase my chances of having a Stroke? They said I was lucky NOT to have stroked already but at this point, they'll just "Watch It" since I'm stable. Also, are there things I shouldn't do, like heavy lifting? Thank you for your time.

Nestor_Galvez-Jimenez,_MD: NDPH is a well described headache syndrome for which there are specific criteria for the diagnosis with limited treatment options. Having said this, many patients with NDPH do well when treated appropriately. You need to speak with your doctor regarding what options are best for you. The left vertebral artery occlusion may have resulted from many causes and may indeed be an isolated event. I agree that having as good as collateral circulation as you stated "saved" your day. Therefore, careful clinical follow-up is the best way to be managed. Also, you need to discuss with your physicians what preventive options may be available to you as this occlusion may be an isolated event or may be indicative of an increased odd for further recurrent events. Not knowing your case in detail nor knowing your specifics, you need to carefully discuss this with your local physicians.

miamickey: Good day, I am a Female, 61 years old, CAD, Hyperlipdemia (total cholesterol 600), Psoriasis, Psoriatic Arthritis, Vitiligo, ASD (repaired five years ago), AFib (maze Procedure five years ago, one bypass to main LAD five years ago, also). I had pulmonary emboli in Jan. 2015 a month after being diagnosed with acute onset psoriatic arthritis. I do have HLA-B27 gene mutation. Current meds: Warfarin, several supplements, low dose prednisone, leflunomide, crestor (low dose due to intolerance), I thought I was picture of health until heart diagnosis five years ago. Active, thin build, follow a Mediterranean diet. Question: With Psoriatic Arthritis possible reason for pulmonary emboli, am I a big risk for stroke? And am I a candidate for life-long blood thinners? I had no known PAD - so why I clotted is unknown. Thanks for considering my question.

Nestor_Galvez-Jimenez,_MD: You certainly have a more complex clinical picture/case than average. Therefore answering these questions for you without access to your complete history and examination I will do a dis-service in trying to tackle these questions as stated. I would rather endorse a visit to your neurologist or general practitioner that knows your case well to better answer these questions. A blank statement in your case will be a dis-service to you as mentioned.

mariearc: I have A Fib. When I am not in AFib, am I still in danger of having a stroke? Thank you so much.

Nestor_Galvez-Jimenez,_MD: It seems you may be having paroxysmal atrial fibrillation. That is similar to having the ON and OFF switch being turn ON and OFF. That may lead to emboli dislodging from your heart resulting in cardioembolism. Having atrial fibrillation overall is an indication for anticoagulation to help prevent the development of an embolic stroke (blood clot originating in your heart travelling to the brain) or any other type of embolism.

54558pdc: At what blood pressure should you be concerned? Is it ok to start medication, and then expect to eventually stop if you get more fit, and your pressure is normal again?

Nestor_Galvez-Jimenez,_MD: There is a general consensus that the secondary co-morbid conditions resulting from hypertension can be minimized or prevented by keeping your blood pressure on the normal range. The blood pressure recommendations states that those age 60 and older should be around 150/90, 140/90 in those younger than 60. If diabetes is present is should be kept lower than 140/90. You need to speak with your local or family physician as these are general guidelines recently adopted and are more flexible than those used in the past. Only your doctor can determine what is best for you.


Medication Therapies for Stroke Prevention

Judy1958: I'm taking two baby aspirins daily since I have AFib. I also take Multaq. Is this adequate? I'm afraid to take Coumadin since so many of my friends have negative experiences.

Nestor_Galvez-Jimenez,_MD: Although aspirin provides some benefit in patients with atrial fibrillation, warfarin is your best choice given the history of AFib. Well monitored, the use of warfarin should be safe and is effective. You need to discuss this with your doctor.

Ed95: I'm a 59-year-old male with permanent AFib, on Warfarin, and a CHADS2 score of 1 (hypertension). Two questions if I may: 1) what is my risk of stroke in my current situation, and; 2) how safe is it for me to come off of my blood thinner for a surgical procedure? Thanks.

Nestor_Galvez-Jimenez,_MD: The main indication for anticoagulation use (Warfarin in your case) is the presence of atrial fibrillation. How safe it is for you to come off it for a surgical procedure is dependent upon your overall risk assessment which given the limited nature of this type of broadcast cannot be completely answered for you. The risk of stroke based on the information you provided is low to moderate and in general terms antiplatelet or anticoagulation therapy is recommended. You are already on warfarin due to AFib which is the best treatment option for you.

beverlybje: I am a 73-year-old female with atrial fibrillation without symptoms. It was a complete surprise to me when told three years ago that I had an irregular heartbeat. Normal blood pressure, not diabetic but overweight even though I exercise five times per week at the YMCA. In January 2015, I had blurring in one eye with no other symptoms. At the time I didn't think anything of it so didn't pay attention. I increased from a baby aspirin to a full aspirin. I am hoping not to have to go on a blood thinner and that aspirin will keep my blood thin. I used to eat a lot of vitamin K veggies before I knew of my condition, but now I eat those lightly. My nuclear stress test was normal and my heart efficiency is 60%. I'm not on any prescription medications but do take 1 or 2 Aleve everyday (12 hours before my nightly aspirin) for arthritic pain. What is your opinion Aspirin vs blood thinner? Thank you in advance if you can reply.

Nestor_Galvez-Jimenez,_MD: Not knowing all details of your case and not having the opportunity to examine you I can only make general comments. The presence of atrial fibrillation is an indication for anticoagulation especially with warfarin or related products as the preferred treatment of choice for stroke prevention. Although aspirin is a great antiplatelet agent, patients with atrial fibrillation do better on warfarin than aspirin. Therefore, warfarin is the drug of choice.

faride: Hi. In 2010, because of Atrial Fibrillation, I had surgery (hybrid Maze and Ablation), but in 2012 I was diagnosed with atrial flutter. I've been taking for three years Metoprolol and Xarelto, but three months ago doctor suspended the Metopropolol, I'm only taking Xarelto since then. In September, I have follow-up with my cardiologist and we agreed maybe suspend the Xarelto. Do you think I could be at risk of stroke if I do not take anything to prevent it? I've been feeling really good, without arrhythmia.

Nestor_Galvez-Jimenez,_MD: Only your doctor can answer that question completely. The indication for warfarin anticoagulation is the presence of atrial fibrillation. You had ablation to treat such process and according to what you state your cardiologist saw no further indication for the use of Metoprolol. Presuming your cardiologist and PCP are in agreement that the likelihood for you to develop AFib is low, the need for anticoagulation is less. Discuss this very carefully with you PCP.


Stroke Symptoms

Tiradore: My wife is feeling a light pressure on her left side of her chest, no pain or fatigue, it has been two days. What could be causing this?

Nestor_Galvez-Jimenez,_MD: Unable to be certain given the limited information you provided and there could be many causes. I suggest you call your primary care provided and pay him a visit immediately or go to the nearest ER for an evaluation.

dayglowst: Are the signs of a stroke the same for men and women?

Nestor_Galvez-Jimenez,_MD: For the most part yes.


Stroke Recovery

jc7: I have a cavernous malformation in the brainstem and have had at least three hemorrhagic strokes. I have had full recoveries from the first two for the most part, but this last one that happened a year ago has been a very slow recovery. I still have motion, balance and nausea issues. Couple of questions: If it’s been a year and I have not recovered yet, is it still possible or will this be my new normal? Can you explain how the brain absorbs the blood and recovers (or not)? Have you heard of any success with syntonic phototherapy for stroke victims? Thank you!

Nestor_Galvez-Jimenez,_MD: As a general rule, but is it not absolute, most of the recovery that occurs within the first year is considered the best the person will do. In other words, once you hit the year anniversary of the event, what you have recovered may be considered your maximum improvement. Having said this, it is also clear to us that recovery, likely, at a slower pace continues to occur after the year mark. The quicker a person recovers, the better their outcome. Blood products metabolize in the brain just as it happens in any other soft tissue. Think of the "black and blue" skin marks you see after a fall or a minor trauma. Blood is metabolized and absorbed and there are cells in the body in charge of "cleaning" and swallowing all debris left from death cells.


For Appointments

To make an appointment with Nestor Galvez-Jimenez, MD, Neurologist or any of the other specialists in the Department of Neurology at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at my.clevelandclinic.org/florida.


For More Information

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