Saturday, September 12, 2015

A Mysterious Cause of Young Strokes

Rebecca Dutton
Home After a Stroke
October 25, 2011

Clinicians are concerned about the increased number of strokes in young adults.  Researchers are investigating silent strokes that don't produce recognizable stroke symptoms, but significantly raise the risk for a visible stroke.  Silent strokes are caused by small blood vessel disease.  Unlike clots that interrupt blood flow in large arteries, small blood vessels are plugged up by cholesterol.

Cholesterol creates plaque inside blood vessels.  Plaque has a soft core of dead white blood cells that have engulfed oxidized LDL (the bad cholesterol) and a hard surface that is calcified and stiff.  As plaque grows it narrows a small blood vessel until no blood gets through and a tiny bit of the brain dies.  These small lesions show up as pinpoints of light on an MRI scan.  When enough pinpoints of damaged brain get close to each other they join to form a bigger lesion that causes a visible stroke.

Doctors initially told me "we don't know why you had a stroke."  A year after my stroke I asked for a copy of a follow-up MRI report and learned that there were a dozen tiny lesions in my sub-cortical white matter.  When small blood vessel disease produces a stroke in sub-cortical areas like the brain stem it's called a lacunar stroke (lacuna = lake).  Now I cringe every time I see young children holding a french fry in their little fists.  High cholesterol is not a trivial issue because stroke is the number one cause of physical disability in adults.

Surgeons get an adrenalin rush when they open someone's skull to repair an aneurysm, but surgeons can't get into small blood vessels.  For now controlling blood pressure and taking cholesterol lowering drugs (statins) are the only ways to prevent strokes in small blood vessels.
If I had been able to tolerate the first statin I tried I wouldn't have wasted five years trying different drugs to lower my cholesterol.  When I had my first colonoscopy a gastroenterologist told me about Miralax powder that counteracts the severe constipation statins cause.  Unlike laxatives that gradually lose their ability to stimulate the gut, Miralax powder pulls water into the intestines. Miralax is so effective I take it in teaspoonfuls instead of the capfuls recommended by the manufacturer.  Preventing strokes is as boring as watching paint dry--- until disaster strikes.

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