Stroke Risks: Symptoms, Prevention, and When to Seek Help - Neurology

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Difficulties with complex medical conditions and stroke issues?


Hello, doctor.
I would like to consult you regarding the prediction and prevention of strokes in the elderly.
My mother is 75 years old and has been managing diabetes for over 20 years without any other chronic or major illnesses.
Yesterday, after finishing some household chores, she sat down to rest and suddenly experienced a wave of fatigue.
At that moment, she was repeatedly rubbing her eyelids and began yawning excessively (frequent yawning), approximately every ten seconds.
Additionally, she felt an unusual hunger, but when she saw food, she had no appetite at all.
When I asked her what was wrong, she described it as feeling like her brain was lacking oxygen.
This yawning episode lasted for several minutes, while her lack of appetite persisted for at least half an hour to an hour.
Her blood sugar was normal, but her blood pressure was slightly elevated at around 160/80 (usually about 130-140/75).
This was quite strange to me, as she had never experienced this before.

What was even more peculiar was that later that evening, while watching television as usual, she suddenly noticed visual disturbances.
She observed that her left eye was seeing things unusually bright, and after a while, her right eye experienced a "wavy" sensation.
This feeling subsided within an hour and returned to normal.
I found some articles online that mentioned stroke patients may experience excessive yawning days before an event, although the references were unclear, and this symptom does not seem to be a widely recognized indicator.
Nevertheless, it does suggest a potential correlation between excessive yawning and stroke.
There are a few journal articles discussing this topic as well.

Based on these comments, I would like to ask you if they are credible and to what extent should I consider this information? Additionally, since my mother’s mother also had a history of diabetes and stroke, I felt a sense of urgency when I came across information linking excessive yawning to stroke.
Therefore, my second question is, from your clinical experience, what possible explanations could there be for these abnormalities? Are there specific aspects of my mother’s various "abnormal" discomforts that should be taken seriously, indicating potential pathological factors that warrant further medical evaluation? I am unsure whether to take her to see a doctor for these symptoms, but I am also concerned about missing early warning signs.
Finally, if we were to consult a neurologist, what kind of examinations might be conducted for someone with my mother’s symptoms? Is it true that strokes can only be treated after they occur, or are there certain signs that can be detected through specific tests or medications to achieve preventive effects? If we were to see a doctor, what direction should we take? Thank you for your assistance! I appreciate your help and wish you peace!

Shui, 70~79 year old female. Ask Date: 2023/08/04

Dr. Jiang Junyi reply Neurology


Hello Ms.
Water,
You mentioned that "after finishing household chores, she suddenly felt a wave of fatigue." This may indicate a potential sleep disorder.
I recommend undergoing multiple sleep physiology tests.
Regarding your question about whether a stroke requires waiting for symptoms to occur before treatment, or if there are certain signs that can be detected through specific tests or medications for preventive measures: if financially feasible, I suggest considering a self-funded brain MRI to assess for small vessel disease in the brain.
I recommend consulting with a sleep medicine specialist or a neurologist for further evaluation and follow-up.
Thank you for your inquiry, and feel free to discuss any related questions.
Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares for you.

Reply Date: 2023/08/04

More Info


Understanding stroke risks, especially in elderly patients with pre-existing conditions like diabetes, is crucial for prevention and timely intervention. Your mother's recent symptoms—frequent yawning, unusual fatigue, increased appetite without the desire to eat, and transient visual disturbances—are indeed concerning and warrant careful consideration.


Stroke Symptoms and Risk Factors
Stroke symptoms can vary widely, but common signs include sudden numbness or weakness, especially on one side of the body, confusion, trouble speaking, and visual disturbances. The symptoms your mother experienced, particularly the transient visual changes and unusual fatigue, could potentially indicate a transient ischemic attack (TIA), often referred to as a "mini-stroke." TIAs are temporary episodes that can precede a full-blown stroke, and they should be taken seriously.

Your mother's age (75 years) and her history of diabetes are significant risk factors for stroke. Diabetes can lead to vascular damage over time, increasing the likelihood of both ischemic and hemorrhagic strokes. Additionally, her elevated blood pressure reading of 160/80 is concerning, as hypertension is a major risk factor for stroke.


Understanding Frequent Yawning
The connection between frequent yawning and stroke is less well-established in medical literature. While some anecdotal reports suggest that excessive yawning may precede a stroke, it is not a widely recognized symptom. Yawning can be a response to fatigue, stress, or even neurological issues, but it is essential to consider it in the context of other symptoms. In your mother's case, the combination of yawning, fatigue, and visual disturbances could indicate a neurological event, and it would be prudent to seek medical evaluation.


When to Seek Help
Given your mother's symptoms, it would be advisable to consult a healthcare professional, preferably a neurologist. You should not wait for symptoms to worsen or for a definitive stroke to occur. Early intervention can significantly impact outcomes. When you visit the doctor, be prepared to discuss all her symptoms in detail, including the timing, duration, and any other relevant medical history.


Potential Evaluations
In a neurological evaluation, the physician may recommend several tests, including:
1. CT or MRI Scans: These imaging tests can help identify any ischemic changes or bleeding in the brain.

2. Blood Tests: To check for risk factors such as cholesterol levels, blood sugar, and clotting disorders.

3. Ultrasound: Carotid ultrasound can assess blood flow in the carotid arteries, which supply blood to the brain.

4. Electrocardiogram (ECG): To check for any irregular heart rhythms that could contribute to stroke risk.


Preventive Measures
Preventive measures for stroke include managing risk factors such as hypertension, diabetes, and cholesterol levels. Lifestyle modifications, including a balanced diet, regular physical activity, and smoking cessation, are also crucial. Medications may be prescribed to manage blood pressure or to prevent blood clots, depending on the individual risk profile.


Conclusion
In summary, your mother's symptoms should not be ignored, especially given her age and medical history. While the connection between frequent yawning and stroke is not well-established, the combination of her symptoms suggests that a medical evaluation is warranted. Early detection and management of stroke risk factors can significantly improve outcomes and potentially prevent a stroke from occurring. Please consult a healthcare provider as soon as possible to discuss your mother's symptoms and determine the appropriate course of action.

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