Prevention of strokes
Proper diet, increase intake of fruits and vegetables and fish
Reduce hypertension with diet and supplements
Reduce cholesterol with diet and supplements
Reduce or eliminate smoking
Reduce alcohol
Aspirin is a much more cost-effective way to treat patients at risk of having a second heart attack or stroke than the drug Plavix (clopidogrel).
People with symptoms of depression appear to be at increased risk of having a stroke or mini-stroke.

Supplements or herbs that may be helpful
Antioxidants such as those found in fresh vegetables and fruits
Fish Oils, DHA except in cases of hemorrhagic stroke. Fish oils thin the blood and improve circulation
Ginkgo biloba in low dosages of 40 or 60 mg a day. See ginkgo biloba brain for more information.
Vinpocetine pill could improve oxygenation to brain tissue. Limit dosage of Vinpocetine to 2.5 or 5 mg twice daily.

Vinpocetine and Stroke
Could a simple herbal extract have an influence on stroke recovery? Vinpocetine is an alkaloid found in the periwinkle plant. It was introduced into clinical practice in Europe more than two decades ago for its role in cerebrovascular disorders and related symptoms. Experiments with vinpocetine indicate that it can dilate blood vessels, enhance circulation in the brain, improve oxygen utilization, make red blood cells more pliable, and inhibit aggregation of platelets. Vinpocetine even has antioxidant properties.
     A double-blind study was conducted to test the effects of vinpocetine on patients suffering from multiple cerebral infarcts. Twenty-six patients with multiple cerebral infarctions, aged between 50 and 83 years were examined, 14 of whom received vinpocetine and 12 placebo. Three months later, the vinpocetine patients did not show any significant worsening in symptoms, while the placebo group did. Several previous studies have indicated that vinpocetine may have beneficial effects in stroke prevention or therapy.
     We would like to see more studies before wholeheartedly recommending vinpocetine for stroke prevention or treatment. However, the results are intriguing enough that doctors who treat stroke patients should review this literature and decide whether some of their patients could benefit from vinpocetine. As to the dosage, it is difficult to know the long term amounts that are helpful. Our guess is 2 to 5 mg once or twice a day should be fine for most people. Vinpocetine is usually found in 10 mg amounts, so breaking a tablet in half, a third, or smaller portions is an option.

Folic acid and stroke reduction
Efficacy of folic acid supplementation in stroke prevention: a meta-analysis.
Lancet. 2007 Jun 2;369(9576):1876-82. Wang X, Qin X, Demirtas H, Li J, Mao G, Huo Y, Sun N, Liu L, Xu X.
Mary Ann and J Milburn Smith Child Health Research Program, Children's Memorial Hospital and Children's Memorial Research Center, Northwestern University Feinberg School of Medicine, Chicago, IL
The efficacy of treatments that lower homocysteine concentrations in reducing the risk of cardiovascular disease remains controversial. Our aim was to do a meta-analysis of relevant randomised trials to assess the efficacy of folic acid supplementation in the prevention of stroke. We collected data from eight randomised trials of folic acid that had stroke reported as one of the endpoints. Relative risk (RR) was used as a measure of the effect of folic acid supplementation on the risk of stroke with a random effect model. The analysis was further stratified by factors that could affect the treatment effects. Folic acid supplementation significantly reduced the risk of stroke by 18%). In the stratified analyses, a greater beneficial effect was seen in those trials with a treatment duration of more than 36 months, a decrease in the concentration of homocysteine of more than 20%, no fortification or partly fortified grain and no history of stroke. Our findings indicate that folic acid supplementation can effectively reduce the risk of stroke in primary prevention.

Strokes come in two major forms:
1) A blood clot in a blood vessel in the brain which reduces or stops blood flow to parts of the brain
2) A hemorrhage or bleeding in brain tissue.

When blood flow to the brain is disrupted, brain cells can die or be damaged from lack of oxygen. Brain cells can also be damaged if bleeding occurs in or around the brain. The resulting neurologic problems are called cerebrovascular disorders because of the brain (cerebrum) and blood vessel (vascular) involvement. For additional information on stroke.

Insufficient blood supply to parts of the brain for brief periods causes transient ischemic attacks, temporary disturbances in brain function. Because the blood supply is restored quickly, brain tissue doesn't die, as it does in a stroke. A transient ischemic attack is often an early warning sign of a stroke.

In Western countries, strokes are the most common cause of disabling neurologic damage. High blood pressure and atherosclerosis--hardening of the arteries from fatty buildup--are the major risk factors for strokes. The incidence of strokes has declined in recent decades, mainly because people are more aware of the importance of controlling high blood pressure and high cholesterol levels.

How a stroke or transient ischemic attack affects the body depends on precisely where in the brain the blood supply was cut off or where bleeding occurred. Each area of the brain is served by specific blood vessels. For example, if a blood vessel in the area that controls the left leg's muscle movements becomes blocked, the leg will be weak or paralyzed. If the area that senses touch to the right arm is damaged, the right arm will lose feeling (sensation). The loss of function is greatest immediately after a stroke. However, some function is usually regained because, while some brain cells die, others are only injured and may recover.

Risk of mini stroke - TIA
Mini strokes lead to a major stroke within one week in 1 out of 20 people and should be treated as a medical emergency. Patients who are immediately treated for small strokes, called transient ischemic attacks (TIAs) have significantly less risk of a major stroke soon afterward. But people who do nothing about a TIA have a small risk of a major stroke within the next few weeks. TIAs are smaller versions of major strokes and cause similar symptoms such as dizziness, weakness of an arm or leg or visual disturbances. The symptoms are usually mild and transient, so it's easy for people to ignore these episodes. However, TIAs are a warning sign that a larger stroke may be on the way that can cause paralysis, loss of speech, cognitive confusion or death.

Silent strokes common in middle aged people
Routine brain scans in a group of middle-aged people show that 10 percent of them have had a stroke without knowing it, raising their risk for further strokes and memory loss. People with atrial fibrillation, the most common type of irregular heart beat in people over 65, have a higher rate of these silent strokes. Silent cerebral infarctions or SCIs are brain injuries caused by a blood clot that interrupts blood flow to the brain.

Stroke questions
Q. Aggrenox, prescribed as a stroke and TIA avoider is very expensive. Could nattokinase be used instead? Any other substitutes?
   A. We have not seen any studies comparing nattokinase to Aggrenox in terms of stroke prevention or treatment.

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