miss

my dad has what seems like a mild stroke, his right side is affected and memory, bp was 200 yest
he had a mild one 5 years ago, he smokes rediculous amounts and drinks most nights, what is the outlook, the doc has given him some meds and wants to see him in 2 days, he hasnt been admitted, is this a good sign?

[Joanna Fong, MD]

Hi indianrose,

If his symptoms are back to normal, it is more reassuring.  However, it is best to have more workups to see if there is any intracranial arterial stenosis that needs further treatment.  Imaging studies such as MRI brain stroke protocol, MRA carotids and circle of willis, or CTA brain (angio) are the most common way to look at the brain and it's intracranial/extracranial arteries.

Most common vascular risk factors (risk factors for stroke and heart attacks) are smoking, hypertension, diabetes, hyperlipidemia (high cholesterol).  It is essential to correct all risk factors.  Blood pressure of 200 is extremely high.  He needs more aggressive blood pressure management.  Blood pressure of less than 130 (systolic) is recommended.  If he doesn't have previous workup for hyperlipidemia, he'll need to have fasting lipid panel tested to see if he'll need to take additional cholersterol-lowering agents.  If he's diabetic, he'll need to have blood sugar controlled.  Blood test such as HbA1c is a test to see how well blood sugar is controlled in the past 3 months.  

Antiplatelet agent (e.g. aspirin, aggrenox, plavix) is also preventive of stroke.  If he was on aspirin (baby 81mg daily, or 325mg daily) during the earlier mild stroke, he probably will be best to increase his antiplatelet therapy by either increasing the dosage or switching to a stronger antiplatelet agent.  Some institutes have the aspirin/clopidogrel resistance test (blood test) to see how adequately aspirin and/or clopidogrel suppress platelet.  Please ask your neurologist if this test is available.  We typically want to see at least 70% ADP or arachidonic acid suppression by clopidogrel (plavix) and aspirin, respectively.  

If he is a current smoker, he'll need to stop.  Smoking increases risk for stroke, heart attack, cancer, and many other diseases.  Please ask his primary care physician for smoking cessation therapy.  

Good luck.  Thanks for using MedHelp Forum.

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