Courtney Litchmore, MD | Shawn Moore, MD

 Caitlin Whyte (Host): Welcome to another episode of Flourish. The podcast where we delve into health and healing advice from the renowned experts at PRISMA Health. I'm your host, Caitlin Whyte. Today, we are joined by two distinguished neurologists, Dr. Shawn Moore and Dr. Courtney Litchmore to shed light on the crucial topic of strokes. This episode will offer valuable insights into the causes, signs and prevention strategies for strokes.

Well, Dr. Moore, I'll begin with you today. What is a stroke and what causes it?

Shawn Moore, MD: So in terms of what is a stroke, there are two major categories. The main one, which is when we say stroke is what we mostly think of is when there's a blockage in an artery that we call an ischemic stroke. But there's also a hemorrhagic stroke, which we think of as a brain bleed, where there's a bleed to the brain that can also cause damage just as much if not more than whenever there's a blockage to the brain. But essentially the main one that we think of is when there's a blockage to an artery that's supplying a part of the brain that causes significant impairment in your function such as weakness, numbness, things of that nature.

Host: And what increases your risk for a stroke Dr. Litchmore

Courtney Litchmore, MD: That's a good question. So there are multiple risk factors out there that increase the risk for a stroke, and 80 to 90% of these risk factors if controlled, the strokes are preventable. The common risk factors that we see is hypertension, diabetes, high cholesterol, patients that are chronic smokers, sedentary lifestyles. Some of those are the like, the major risk factors that we see for stroke. Some patients with cardiovascular disease, especially atrial fibrillation, chronic kidney disease, those patients are at additional increased risk for strokes.

Host: And what about stress? Dr. Moore? Can stress cause a stroke?

Shawn Moore, MD: Not directly, but kind of a byproduct of stress, which stress does increase your cortisol levels, which can affect your ability to, affect your metabolism, it can affect your blood pressure. All things that are important in terms of controlling your stroke risk factors as well. So more so indirectly long term with effects that stress has on the bodies.

It can increase your risk for the different risk factors such as high blood pressure, high cholesterol, and diabetes as well as other mechanisms that people use for coping, such as smoking, to help cope with stress and as well as alcohol use.

Host: Of course. Thank you for that. And Dr. Litchmore, can sugar substitutes increase your stroke risk at all?

Courtney Litchmore, MD: Yeah, that's a very good question and maybe a controversial discussion in some arenas. So sugar substitute has been around since the 1800s , and there's significantly been an exponential increase since the 2000s, and the American Heart Association actually recommended potentially doing short term substitute from sugar sweetened beverage to artificial sweetened beverage in 2018. But since then, a lot of information has actually come out to suggest that these artificial sweetened beverages actually increase your cardiovascular risk, including a stroke. There was like a large French study that came out in 2022 with over a hundred thousand patients, and it was showing that there was increased risk of cardiovascular and cerebrovascular disease.

So while it seemed like counterintuitive that these have lower caloric content and might reduce obesity is actually trending towards the opposite, where we're seeing more diabetes, more high cholesterol, obesity, and cardiovascular risk. So for our patients, we actually advise significant reduction in these artificial sweeteners that are presenting thousands of our product to overall minimize stroke risk.

Host: Well, I had no idea the history of sugar substitutes went back that far. Thank you so much for sharing.

Courtney Litchmore, MD: Oh yeah.

Host: Now, Dr. Moore, what are the signs of a stroke and do symptoms come and go?

Shawn Moore, MD: Yeah, so that's a good question. So, there is actually an acronym that's very commonly used that can help you remember not only the signs of the stroke, but just kind of an overall awareness that you need to seek medical attention immediately once you're developing any of these signs. This acronym is BFA.

The B is for balance. So any issues in terms of your balance, able to stand up straight, sit up straight, or feeling off balance as you're walking, as well as affecting your coordination. E is for eye, so it can either have complete loss of vision in one of your eyes or losing half of the vision, and whether it's the right side or left side.

The F is for face, so noticing that one corner of your mouth may be a little bit more droopier than the other, mostly it's if there's any abnormal symmetry that's different from usual. A is for arm weakness, which in general can be either arm or leg weakness on half of the body. Then the S is for speech, whether that's difficulty getting your speech out, your speech seems more slurred, or you're having trouble finding the words that you want to say.

Then the T, which is the last part, is for time because time is very important when it comes to stroke. With that being said, there are multiple therapies that we are able to do in the immediate period, but it is important to present as quickly as possible, due to the fact that they're time sensitive.

And that's why the whole terminology BFAST. Just as a reminder that you need to present as quickly as possible.

Host: And Dr. Litchmore, are there warning signs that can show up in your body even weeks prior to having a stroke?

Courtney Litchmore, MD: Yeah. I, I like that. That's a pretty important question for patients and from the 1960s we knew of this condition called stroke warning signs. And essentially these are symptoms that patient experienced prior to the onset of a stroke.

So it's what we call a transient ischemic attack. So it's just like a stroke that the symptoms tend to resolve within 24 hours. And when we do the scans, there's no stroke on the scans. So these patients, they tend to present with recurring symptoms, so that they'll present with weakness on one side, drooping of the face or slurred speech, and then this will spontaneously resolve and they feel completely normal.

And then a day or two later they have recurrence of the exact same symptoms, and maybe three days later they have recurrence of the exact same symptoms and by the end of the week, they're presenting with an acute stroke. So we want to reassure our patients not to have a false sense of security when you're having these acute symptoms and they're resolving to say that you're fine because they are what we call stroke warning syndrome or stroke warning signs.

And you should present to your doctor immediately for assistance to prevent a stroke because this suggests you are increased risk of developing a stroke. And this has been known as I said, since the 1960s.

Host: And are stroke symptoms different in different genders? Dr. Moore?

Shawn Moore, MD: Overall they're typically the same. I wouldn't typically separate the typical stroke warning signs for different genders. So essentially the same signs that you have in males, you should have in females, and usually the signs that you have of stroke are just due to the territory of the brain that is affected in terms of the blocked artery.

Host: Alright, and I'd love to talk about Bell's Palsy as well, Dr.  Dr. Litchmore. And why is it often mistaken for a stroke?

Courtney Litchmore, MD: So Bell's palsy essentially is the facial nerve that supplies the muscles to allow you to move your face that nerve becomes damaged. And when that nerve is damaged, the patient present within a day or two with symptoms where they have difficulty closing the eyes the lower face is drooping. They have difficulty chewing or maintaining food or water within their mouth, so that symptoms can look like a stroke because as Dr. Moore alluded to earlier, patients with stroke initially, one of the initial symptoms is that a facial droop that is also seen in a stroke patient, but they tend not to have the difficulty with eye closure. So for those patients, we also implore to come to the attention of physician as soon as possible because treating Bell's palsy within the first two to three days can increase the chance of a recovery. And also sometimes patients, with stroke can present looking like Bell's palsy, but they have additional features.

So we'd ask the patient to come in immediately for us to evaluate them because sometimes it's difficult to differentiate from a stroke.

Host: Dr. Moore, what can you do to prevent a stroke?

Shawn Moore, MD: So, as Dr. Litchmore mentioned earlier, the major risk factors that you have are the main thing in terms of preventing strokes. So, controlling your blood pressure is important, as well as making sure your cholesterol is well controlled. Your, if you, you have history of diabetes, making sure that's controlled, if you're a smoking, smoking cessation is of utmost importance.

Typically after 15 years of smoking cessation, you do reduce your stroke risk to that of a non-smoker. So that's also very huge, but it also depends on also other risk factors that you may have, such as if you do have a known history of atrial fibrillation, making sure you are on blood thinners such as Eliquis or Xarelto if you're a high risk patient.

As well as other things such as if you do have significant blockages in the arteries in your neck called carotid stenosis, there are procedures to help clean up that artery as well.

Exercise is another big component as well.

Host: Well,let's talk about diets as we come to the end of our show. Dr. Litchmore, can your diet help reduce your risk of stroke?

Courtney Litchmore, MD: It can. As we said earlier, 80 to 90% of strokes are preventable with modification of our risk factors. There's about 8,000 new stroke patients in America every year, and the diet is one of those risk factors that has been identified and that has led the American Stroke Association in their latest prevention guideline to recommend what we call a medi Mediterranean diet to prevent stroke.

And what that is is from the 1960s, they realized that patients from Mediterranean countries like Italy and Greece, they had a lower cardiovascular risk, and when they start doing studies, we realized that the diet was playing a major role. So this Mediterranean diet is a plant-based diet that is high in fruits, vegetables, legumes, nuts, and olive oil that is utilized as a major fat substitute.

And what we have found is that utilizing this diet, not just reduces stroke incident, but also reduces other cardiovascular disease including myocardial infarction.

Caitlin Whyte (Host): And Dr. Moore, what treatments are available for stroke now? Is there anything new on the horizon?

Shawn Moore, MD: Yeah. So when it comes to management of stroke, there's two major categories. The first one is sort of managing things in, the initial period in terms of like the immediate onset. So when it comes to the management, there's. One what we call a clo busting medicine, that can be given within four and a half hours of the last time a patient was seen normal.

that can be either out to place or tecta place. that has to be of course administered in a hospital setting, which is why we always urge patients as soon as you or a loved one, if you witness any stroke-like symptoms should go to the hospital right away and we usually urge 'em to call 9 1 1, not even going by a personal vehicle.

then the other treatment strategy within the initial onset, is a procedure called mechanical thrombectomy, which is basically a procedure where you go in through the arteries in your, either your arm or your leg, to get up to that clot and retrieve it with either a device that, can suction it out or by placing a stent that drags the clot out directly, or sometimes a combination of the two therapies.

Piece then afterwards. It's kind of just depends on what your risk factors are. very commonly patients who come in with a stroke are placed on a statin medicine that helps with, reducing your cholesterol levels as well as has neuroprotective properties as well. And then, most patients are placed on aspirin unless there's other known risk factors such as atrial fibrillation or if we see a clot in the heart or somewhere else in the body.

that we think may have, propagated and went up to the brain that would require stronger blood thinners. like I mentioned, there's also treatment with the procedure, to clean up any blockages in the arteries of the neck either surgically remove it or placing a stent inside as well.

And then there's also, if there's any abnormal connections between the heart, between the right and left side that we call A PFO. There's also procedures that can close that up. these are all pretty well known and established procedures, but in terms of anything that's kind of new and on the horizon, it's mostly kind of refining the equipment, especially for thrombectomies in terms of things on the horizon and trying to increase the amount of patients that we can treat as well.

Caitlin Whyte (Host): Well, I'd like to thank Dr.

Lich Moore and Dr. Moore for joining us today and for sharing their expertise on such a vital topic. If you would like to learn more about stroke prevention and health tips, visit prisma health.org/flourish. Remember, awareness and prompt action can save lives. And join us next time here on Flourish. For more enlightening discussions, I'm Kaitlyn White.