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Stroke

MRI Brain - Further Query

04/25/2005

Question:

I am thankful and highly obliged for prompet answer as well proper education about my problem which was like this :I am 47 years and had sever postural vertigo and was given Dimenhydrinate 16 mg thrice a day. MRI Brai done and it revealed RIGHT HIGH PARIETAL LACUNAR INFARCTION WITH MILD CEREBRAL ATROPHY. My doctor increased the dose of aspirin from Aspirin 75 to Aspirin 162.5 mg Whether this is serious. Now I am fully cured but what the MRI finding convey. Sir, you were right in pointing out that postural vertigo had nothing to do with the lacunar infarction since stroke lasts for more than 24 hours whereas I was relieved of symptoms very quickly. Your goodself had mentioned about the Aspirin-162.5. But sir, while I take this dose I have several side effcefts of aspirin like burning irritation on the anal skin etc.It sounds my tolerance to the dose of aspirin-162.5 is poor. Erstwhile I was taking Aspirin 75 as prophylaxis since I am hypertensive aged 47 years. Would you kindly sir, suggest alternative to aspirin to eliminate its side effects so that I will discuss with my internist. When I telked to him about your previous answer, he was thinking about clopidogril-75 alone or with aspirin-75. I am not sure about this.If you can assist me, I shall discuss with my internist. Further, do you think that lacunar infarct can cause problem in future since I am hypertensive and on medicines?

Answer:

The important thing is that you carefully work with your internist to keep your blood pressure under good control, since it is the single biggest risk factor for stroke.  If your blood pressure is well treated and you are taking a medicine like aspirin or plavix to prevent stroke, then this is all you can do.  You could also speak with your internist about other risk factors and how you can lessen your risk for heart attacks and strokes.

Regarding aspirin, make sure that you are taking an enteric coated form.  This has a special lining that prevents irritation of the stomach lining and might ease some of your side effects.  The common doses used by stroke neurologists are 81 mg vs. 325 mg, and both seem to work exactly the same (in terms of stroke prevention).  The 325 generally does not have more side effects and is half the price, so this is what I recommend.  If you can't tolerate the aspirin, then plavix is an excellent choice, but be sure to speak with your doctor about the rare (but important) complications with platelet counts.

I hope this helps.

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati