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Risk Factors and prevention

Dear Dr. Rubin:

I read in a magazine that 700,000 Americans get a stroke each year, 75% survive, and about 9 out of 10 are left with some sort of permanent neurological impairment thereafter.  First, does this sound accurate?

Second, what are the biggest risk factors for stroke? Clearly, prevention is the best policy, and even at the age of 26, I want to do everything I can to reduce any risk factors I may have. I'm in excellent shape, although I smoke cigarettes(working on quitting), and there's no family history of stroke (but type II diabetes runs in the family, although I don't have it).  

Third, what exactly is an "ischemic" attack, how is it different that a full-blown stroke, and how is it that these can sometimes go unnoticed? In addition, how common is vascular dementia following stroke? How common is aphasia? Finally, does alochol increase or decrease one's risk of developing stroke, or is it dose-dependent?

Reason I ask is because I've read one study that says mild drinking (1-6 drinks per week) has a protective effect against dementia by 35%, whereas moderate drinking (7-14 drinks per week) is associated with increased brain atrophy (which can cause dementia).  Is there such a dichotomous relationship/correlation as far as alcohol and stroke?

Finally, does an MRI at the age of say, 35, have any predictive value?

Thanks for your time and I look forward to your response.


3 Responses
Avatar universal
I have an 70 year old, healthy, uncle who fell (unwitnessed) in his kitchen in January and presented to EMS with altered mental status (confused). The doctors diagnosed the problem as a "stoke" and have diagnosed him with several "small" stokes since. They really offered no hope for his improvment. This month they said they found "fluid" in his brain and drained approx. 30cc of fluid the surgeon described as "old" and being the "color of urine".

Now, after being in the hospital for 81 days, they are saying that his problems are due to an injury and not a stoke at all and that he suffered a "subdural hematoma" that is approx four months old (Janruary) and their treatment has become much more aggressive, but doctors seem to have become "evasive" from her.

My aunt is seventy years old and she does not know how to ask these questions and she lives in Dallas and I am in Houston.

My question is how in the year 2004 with our medical technology and expertise can a subdural hematoma with approx 30cc of blood NOT be detected in a ct scan for four months?

Thank you for your consideration.
Avatar universal
You're going to have to go to "post a question" to get an official response from the doctor.   Normally, they don't respond to comments officially, so try to get a new thread going and hopefully the doctor can shed some light on your situation.

If you ask me, however, the doctors clearly messed up.  Presented with a mentally altered 70 year old, they rushed to judgment and assumed it was a stroke, and not a subdural hematoma resulting from a head injury.  A CT scan right there and then should have picked it up, and if it didn't (as sometimes hematomas take some time to develop) it CERTAINLY should have been picked up at some time during the 81 day stay (a CT at 3 months surely would have detected it).  Sounds to me like you have a winning medical malpractice lawsuit.

To answer your next question (unofficially, of course), even in the year 2004, between 50,000 and 200,000 die of medical errors each year across the nation's hospitals and hundreds of thousands more (literally) are injured by the health care system.  Medical mistakes are very common, but they are usually more subtle and easier to cover up than this mishap that happened to your uncle.

It's an unfortunate thing that happened to him, and I offer my condolences, but the medical staff screwed up here -- big time -- and for what it's worth, you should have no problem whatsoever securing a significant settlement, which, at the very least, would help your aunt immeasurably, from a financial perspective at least.  The settlement would also obviously cover the economic damages (cost of hospitalization, cost of continued care, etc.).  Good luck to you.
Avatar universal
Thank you for your information.  I posted it as a question. Also, I dont think she is interested in pursuing a malpractice suit, she just wants to know what happened to her husband. Thanks!
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