Multiple Sclerosis and Stroke: Does MS Raise the Risk? | MyMSTeam

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Multiple Sclerosis and Stroke: Does MS Raise the Risk?

Posted on April 20, 2023

People living with multiple sclerosis (MS) have an increased risk for stroke, which can be life-threatening. Complicating matters, stroke and MS flares share symptoms, which can make it difficult to get an accurate diagnosis and necessary treatment. Knowing the signs of stroke and when to seek emergency treatment might just save your life.

Read on to learn what causes stroke, why people with MS are more likely to experience stroke, and what you can do to protect yourself or your loved one.

What Is Stroke?

There are two main types of stroke. The most common type is an ischemic stroke, which occurs when some of the brain’s blood supply is blocked. These happen when an artery that delivers blood with oxygen and nutrients to the brain becomes blocked for any reason. Because of the blockage, the part of the brain fed by this artery no longer receives the oxygen it needs to survive. This causes death to brain tissue within minutes. Ischemic strokes are often caused by cardiovascular disease.

Less common is a hemorrhagic stroke, caused by a blood vessel in the brain bursting.

There are two main types of stroke. Ischemic strokes, which are more common, involve a blocked blood vessel in the brain. (Adobe Stock)

Emergency Treatment

If you’re living with MS and suddenly experience new or worsening, severe symptoms, you should go to the ER — even if you think it may just be a relapse. Symptoms that may indicate stroke and not an MS relapse:

  • Sudden numbness or weakness, especially on one side of the body
  • Sudden vision loss, especially in one eye
  • Slurred speech, confusion, or nonsensical words
  • A rapid and dramatic increase in walking difficulty
  • Sudden severe headache

How Can You Tell the Difference Between Symptoms of MS and Stroke?

The symptoms of an MS relapse are unpredictable, but they often involve:

  • Vision problems
  • Difficulty walking
  • Weakness
  • Numbness or tingling
  • Paralysis
  • Pain
  • Balance problems
  • Loss of bowel or bladder function

Most people with relapsing-remitting MS (RRMS) have periods of time in which they experience symptoms, followed by subsequent periods of recovery.

Stroke symptoms depend on where the brain is damaged, but these symptoms can be almost identical to those of an MS relapse.

Sudden vs. Gradual Onset

A noticeable difference between MS flares and a stroke is the sudden onset of stroke symptoms. While symptoms of an MS relapse can sometimes come on suddenly, they usually emerge over a couple of days. It could be one symptom or several symptoms, ranging from mild to severe. A relapse could also be the worsening of an MS symptom you already live with.

Stroke symptoms usually come on suddenly. However, they can sometimes emerge progressively over days or weeks. As such, it can be difficult to tell if you’re having a relapse or a stroke when you experience a new or worsening MS symptom.

If you suspect a stroke, contact emergency services immediately. Successful interventions for stroke should happen within four hours of the start of your symptoms. If you’re in doubt about whether you’re experiencing stroke or MS relapse symptoms, seek emergency medical care.

One member of MyMSTeam described repeated evaluations for stroke: “Over the years I had headaches, numbness, tingling, fatigue, foot drop. I fell and broke my kneecap. Each time, the local doc said, ‘No stroke. Good news.’”

Sometimes people experience stroke-like symptoms for a short period of time (typically less than an hour), and then symptoms disappear. This is known as a transient ischemic attack (TIA). It can be a warning sign of a future stroke or more TIAs, so it’s important to follow up with your doctor.

Age, Ethnicity, and Sex at Diagnosis

People with MS usually get a diagnosis between 20 and 50 years old, with women three times more likely than men to have it, according to the National Multiple Sclerosis Society. People of all racial and ethnic backgrounds can develop MS, but it’s most common in white people, per the National Multiple Sclerosis Society.

On the other hand, older people are at greater risk of stroke, with 75 percent of strokes occurring in those over 65 years of age. Men are more likely than women to have a stroke, according to the National Institutes of Health (NIH). African Americans are almost twice as likely to have a first stroke as compared to white people, according to the NIH, and Hispanic Americans and American Indian/Alaska Natives are also at a greater risk than white people.

Regardless of your risk factors, never delay seeking immediate care if you suspect a stroke.

Does MS Raise the Risk for Stroke?

Several neurology studies have found that people with MS have a higher risk for stroke than the general population. One study found that people with MS had a 2.78 times greater risk of stroke when compared to healthy controls matched by age, sex, and stroke risk factors such as hypertension (high blood pressure), diabetes, and high cholesterol.

In 2020, a study of 12,000 people with MS evaluated their risk for stroke, cardiovascular disease, and death compared to people without MS. The researchers found that people with MS had a 59 percent increased risk of cerebrovascular disease — which can lead to stroke. Further research is needed to understand why people with MS are at higher risk and how to reduce that risk.

There is currently no evidence to suggest that having a stroke increases your risk of ultimately having MS. Nevertheless, certain risk factors for MS and stroke overlap.

Shared Risk Factors for MS and Stroke

Some risk factors are common to both MS and stroke. Smoking contributes to a higher risk of MS and stroke, and low levels of vitamin D are associated with both. One study found possible shared genes between MS and stroke risk.

MS is a chronic inflammatory condition, which can foster a hardening and thickening of artery walls due to damage to the lining of blood vessels. Hardening of the arteries can lead to an increased risk of stroke.

Other autoimmune diseases, such as rheumatoid arthritis and psoriasis, are also known to increase the risk of stroke. This is worth noting, since MS is also an immune-mediated condition. If you have an autoimmune comorbidity (another health condition at the same time as MS), you may have a higher risk for stroke and heart disease.

Lowering Your Risk of Stroke

If you have MS, you have an increased risk of dying if you have a stroke. For this reason, lowering your stroke risk is critical.

Medication, moderate physical activity, and healthy diet changes can help protect you against vascular disease. If you have high cholesterol, a cholesterol-lowering medication, specifically statins, can be an effective treatment.

If you’re concerned about your risk for stroke and other cardiovascular diseases, talk to your doctor or a health care professional about how to manage that risk.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 197,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS and worried about your risk for stroke? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on April 20, 2023
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    Luc Jasmin, M.D., Ph.D., FRCS (C), FACS is a board-certified neurosurgery specialist. Learn more about him here.
    Remi A. Kessler, M.D. is affiliated with the Medical University of South Carolina and Cleveland Clinic. Learn more about her here.

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