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Altitude related ? / Treatment

  Had a mild stroke(left arm & leg) on Aug 3 at a copper mine in UT, at 7K feet. Just after noticing foot and arm effects spotted EMT personnel who checked vitals and call ambulance. Was in ER within 1 hour of first sympton. After 2 CAT scans (w and w/o dye), sonogram of carodid arteries, leg and arms, eckogram of heart, EKG and EMG no cause or effect was found. Was given one 325mg asprin within 15 min of arrival, Heprin IV for 2 days and then cumindinfor 6 days. BP rose to 190/100 within 6 hours of admission, was given 4 329mg asprin a day as well as 20 mg of Prinivil.
  Utah hospital could not identify what the cause was ! My BP has been less than 125/75 for 30 years; cholostrol is less than 150 and LDL is less than 110 for past 2 years( am taking Zocor 10mg per day). Had been hiking the Tetons for the previous 6 days prior to going to Salt Lake City.
  Released on 6th day, returned to Baltimore(home) and went directly to a stroke rehab hospital for intensive PT and OT. Two weeks there did wonders, walking w/o aid and arm is about 90%.
  At discharge doctors there found no cause but stated if had to list probable cause they thought the altitude in the Tetons(>8K ft) may have thicken the blood and it clotted in a minor artery. QUESTION - are there any references to altitude as a cause of a STROKE ?
  After rehab release 4 weeks ago; I am still on 4 325 mg of coated asprin  daily along with 20 mg of Prinivil and 10 mg of Zocor. My BP is 115/70 !
  Question - is this a typical short term treatment ? or a long term treatment ?
  Quantity of asprin seems quite high for the long term.
  Question - can a stroke cause the BP to go up ?
  Any comments welcome! I am scheduled for next PCP visit in 2 weeks; saw him after rehab release and he kept me on original meds for 6 weks!

Dear Bill:
1.  Prolonged high altitude stay and exercise and stay (at least several weeks, and usually at altitudes well above 7k feet) can cause a rise in the hemoglobin in blood due to an increase in the number of red blood cells (RBCs). This can increase blood viscosity amd incrase the risk of a stroke (in contrast to CAUSING one). I do not think this is a major factor in your case.
2.  Dehydration (from exercise or whatever) can likewise concentrate blood and somewhat increase the risk of stroke, if other causes exist.
3.  The precise cause of a stroke may remin undetermined in 1/4 to 1/3 of all comers. The extent of work-up is determined by the patient's age (younger usually means far more extensive), and the presence of risk factors. I do not know if you have had an adequately exhaustive work-up.
4.  Experts in stroke may choose to use a very wide range of aspirin doses (82mg to 325mg to 1300mg per day), and I am not wrong in stating that there is more personal preference involved in this decision than hard science! It is my impression that dose most neurologists in the US prefer is 325mg (one adult ASA) per day. Higher doses are often less well tolerated than lower doses. ASA is a long-term treatment.
5.  Neurologists do not tend to be very aggressive in blood pressure treatment early after stroke, because of the hypothetical risk of reducing blood flow to vulnerable areas of the brain. In the long term, good control of BP protects against new stroke.
I hope this answers your questions. I suggest visiting a stroke neurologist at a major academic center (Johns Hopkins, for instance), to address diagnostic quations and understanding future risks etc.

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