Brief Answer:
Most important risk factor for stroke= Increasing Age

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am an Adult Neurologist and Headache Specialist practicing in XXXXXXX Ohio.

I have read your other questions regarding your mom's stroke to other doctors and their responses so I believe I understand the situation as you've detailed it to others. She is an otherwise healthy 70 year old woman in excellent physical shape who suffered a moderate ischemic stroke. One point to clarify for you in terms of risk factors for stroke and that as EVERY HUMAN BEING has at least 1 risk factor for stroke and that their AGE. The older a person is compared to another person- the higher the risk is for suffering from a CVA compared to the younger person based exclusively upon the difference in ages between 1 person and the other. In fact, AGE is the #1 risk factor among people with respect to risk of stroke.

I also understand she has been placed on blood thinners but it does not seem she's been fully worked up in terms of finding the source of what appears to have been some type of embolic stroke event.

Any type of infectious process in the body is considered to represent a risk factor for stroke due to an increase in hypercoagulability issues more than anything else. However, we don't really consider mild viral illnesses as being nearly as "bad" as heavy duty bacterial infections...such as a bacterial pneumonia, an abscessed tooth, an endocarditis, decubitus ulcers, etc.

Therefore, I would keep your mom well hydrated so as to flush her system which will give her the best chance of getting that viral illness out along with the "bad humors".....no kidding....we call it the "milieu." I would not recommend giving her a whole lot of medication to treat the viral illness with the exception of some Tylenol perhaps if she's complaining of nasal congestion and/or headaches. I would not give her any cough suppressants and utilize nebulization treatments to help clear her system of the viral infection.

I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.

Don't forget that my webpage to keep me abreast as to how you're doing is:

bit.ly/drdariushsaghafi

All the Best

This query has required a total of 47 minutes of physician specific time to read, research, and compile the return to the patient.

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Brief Answer:
Embolic stroke workup

Detailed Answer:
Thank you for the additional questions which I am happy to address.

In a patient such as your mother where there appears to be good evidence for embolic stroke my workup would include a "search" for the source of the stroke or the source of the blood clots in this case which is what the MRI appears to show.

Therefore, I would start by making sure her thyroid functions were normal (independent of how healthy or not she was prior). In the early hours after presentation I would also look for lab results that could help confirm the fact that she most likely suffered an embolic stroke by getting things such as PT, PTT, fibrinogen, fibrin split products, d-dimer, ESR, and CRP.

Diagnostic studies would've included an MRI with perfusion and diffusion weighted imaging (more helpful in the early period after a stroke), 30 day Event Monitor (looking for cardiac arrhythmias), and TEE as opposed to a 2D echocardiogram especially due to the fact that this stroke sent pieces of clot into what is known as the posterior circulation which is the common playground for things such as clots that are ejected from the heart (especially the left atrial appendage which is poorly visible using surface echo technology).

I would avoid the use of ANTICOAGULATION (eg coumadin (warfarin), Lovenox, other similar products) if that's what you mean by "blood thinners" unless a specific source of clots can be proved. Studies have shown that unless we know exactly from where a clot comes such as the heart or a deep venous thrombosis which is passing through an opening in the heart (PATENT FORAMEN OVALE; PFO), or that the patient has a specific blood clotting defect which tends to lead to coagulation of the blood within organs (eg Atrial Fibrillation) and blood vessels itself that the use of blood thinners such as coumadin confers MORE RISK than benefit to patients. This is especially true in the elderly who are believed to have brains more susceptible to bleeding complications (especially after stroke when tissue breakdown has occurred, etc.) as well as the fact, they are more susceptible to complications such as falls and so forth.

Therefore, unless a source can be identified in strokes such as these the use of agents called ANTIPLATELETS such as Plavix

As far as the risk of future stroke when discussing the presence of infections I'm not aware of specific numbers associated with various infectious types but I can tell you that things such as colds with flu like symptoms, run of the mill viral infections which don't cause much trouble other than the usual symptoms of upper respiratory distress and clear up with a little supportive therapy run the lowest levels of risk whereas more fulminant types of infection where pus or high fevers with high white counts, UTI's that border on septic conditions, etc. all run the HIGHEST RISK of causing stroke (through supposed hypercoagulable mechanisms). This is the reason that people with infections should hydrate very well, control fevers, and keep nutritional status up so they don't run the risk of becoming dry or circulating elements of the infection into the systemic circulation that could possibly reach the brain (such as what could happen in an abscessed tooth, endocarditis, decubitus sores or other open wounds that don't heal properly, etc.).

I am not overly concerned of infection in your mother causing more complications based on the MRI findings so long as it's nothing out of the ordinary as I described above. The body is able to take care of many things....even complicated things....what's very important to all stroke patients is good hydration, good nutrition, preventative measures against future strokes, good workup in this case to identify the possible embolic sources, and rehabilitation of any residual problems she may have of motor coordination, walking, balance, etc.

Thank you in advance for committing to providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful to me for processing your question expeditiously and allowing others to use this archived information to their advantage as well.

Don't forget that my webpage to keep me abreast as to how your mom is doing is:

bit.ly/drdariushsaghafi

Cheers!

This query has required a total of 79 minutes of physician specific time to read, research, and compile the response to the patient.

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Brief Answer:
What you see at this point is what you get

Detailed Answer:
As the saying goes, "What you see is what you get" is probably fairly descriptive of what your mother will have in terms of clinical deficits. I must admit that based on the damage seen on the scan vs. how you describe her I would've expected a bit more problems with balance and consequently ambulation as well as some incoordination but it seems that she has somewhat avoided that realm of things.

I do believe that following this event your mother should be seen and followed now by a neurologist as they are more qualified and trained to LOOK FOR those deficits which neither you nor the primary doc may be able to recognize or pick up on. But again, you've described her return to "normal" in the beginning of this set of questions and so I take that to mean that at present she really walks, talks, and moves her limbs as if nothing happened.

She may have some headaches that could persist as a result of this type of stroke having occurred...but again, those should be easily recognized and properly treated (especially if a neurologist comes on board to follow her).

My hope is that your mother continues to do well at age 50, did you say? That makes her slightly my junior! LOL! I have a mother who is very similar.....81 these days and aside from the nasty effects of forgetfulness which is a bit more than just annoying these days....she is free from heart disease, diabetes, hypertension, and continues to run long distances. She took up marathoning at age 55 and not too long ago she and I did a 5K run in one of her favorite running places so in point of MEDICAL FACT, I would've been surprised as well had she or if she should develop a stroke.

But again, both of us have to remember that AGE is the most important (and clearly uncontrollable) risk factor when it comes to stroke...so no matter how healthy and free of disease one is...we ALL face that as a possibility as we climb the ladder of chronological maturity and success! LOL.....just gotta keep her cholesterol under better control, her thyroid in check, and keep her cardiovascular system as active as possible. Hey, you never know...perhaps, she'd like to take up running? Never too late if she doesn't suffer from arthritis, bursitis, or those sorts of joint problems, etc.

Thank you once again for committing to a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will be most helpful to me so that this transaction can be processed and the information accessed by colleagues for future use and dissemination.
If you have further questions on virtually any topic (Hey, I even was in a position to deliver my daughter when she was born because there was no OB/GYN in the hospital at the time--no kidding--and this was a large academic institution! Lucky for me I'd already delivered about 560 babies prior); My webpage to keep me abreast as to how your mom is doing is:

bit.ly/drdariushsaghafi

Tally HO! (No, I'm not a Brit nor anything close to that....I just find their expressions attractive!)

This query has required a total of 93 minutes of physician specific time to read, research, and compile the response to the patient.

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