Anorexia And Strokes: What's The Link?

Anorexia nervosa is a serious eating disorder characterised by low body weight, a distorted body image, and an obsessive fear of gaining weight. It is associated with a range of symptoms, from dry skin to heart failure and brain damage. Anorexia has the highest mortality rate of any mental illness, and half of all anorexia-related deaths are sudden cardiac deaths.

Anorexia involves severe restriction of food and fluids, which depletes the body of essential nutrients and electrolytes. This can lead to hardening of the arteries and venous stasis, which makes it difficult for blood to return to the heart from the legs. This malnourishment severely impacts the body's electrolytes, such as potassium, which plays a crucial role in helping the heartbeat and muscles contract. Electrolyte imbalances can lead to irregular heartbeats and possibly heart failure and death.

In addition to cardiac issues, individuals with anorexia may also experience stroke. Ischemic strokes, which occur when a vessel supplying blood to the brain is obstructed, have been observed in patients with anorexia. This is due to the tendency of individuals with anorexia to experience vascular issues, putting them at high risk for ischemic stroke. Dehydration and arteriosclerosis, in association with severe malnutrition, could also predispose individuals with anorexia to the development of ischemic stroke.

Therefore, it is important to be aware of the risks associated with anorexia and to seek professional help if needed.

Dehydration and arteriosclerosis

Anorexia nervosa is a serious eating disorder characterised by a fear of weight gain and extreme steps to avoid it, often resulting in starvation. Anorexia involves severe restriction of food and fluids, which depletes the body of nutrients and electrolytes necessary for optimal function. This can lead to severe medical complications, including cardiac events and stroke.

Dehydration

Dehydration is a common consequence of anorexia, as individuals with the disorder restrict their fluid intake. Dehydration can lead to orthostatic intolerance, which causes a decrease in cerebral blood flow and can trigger a stroke. Dehydration also increases blood viscosity, which impairs cerebral blood flow and is linked to an increased risk of ischemic stroke.

Arteriosclerosis

Anorexia nervosa is associated with a high risk of developing vascular diseases, including arteriosclerosis. Arteriosclerosis refers to the hardening of the arteries, which can restrict blood flow to the brain and cause an ischemic stroke. The restricted food intake associated with anorexia can lead to hypoperfusion, or low blood flow, due to dehydration and arteriosclerosis. This hypoperfusion can result in oxygen deprivation and tissue death in the brain, leading to an ischemic stroke.

The combination of dehydration and arteriosclerosis in individuals with anorexia nervosa can significantly increase the risk of developing an ischemic stroke. A case study of 19 female patients with severe anorexia nervosa found that two patients had developed ischemic strokes. These patients exhibited neurological deficits such as dysesthesia, linguistic impairment, and hemiplegia. The findings suggest that dehydration and arteriosclerosis, coupled with severe malnutrition, may predispose individuals with anorexia nervosa to the development of ischemic strokes.

High risk of cardiac events

Anorexia nervosa is a serious eating disorder characterised by an intense fear of weight gain and a distorted body image. Those with the disorder often eat very little and exercise excessively. This can lead to severe malnutrition, which can have dangerous consequences for the body.

Anorexia has the highest mortality rate of any mental illness, with half of all deaths being sudden cardiac deaths. The restriction of food and fluids depletes the body of essential nutrients and electrolytes, which are necessary for the body to function properly. This can lead to a range of cardiac issues, including:

• Bradycardia
• Heart attacks
• Strokes

The heart is the body's most important muscle, and when the body is starved, it breaks down its own tissue for fuel, starting with the muscles. This causes the pulse and blood pressure to drop as the heart has less fuel to pump blood and fewer cells to pump with. Malnourishment also impacts the body's electrolytes, such as potassium, which plays a crucial role in helping the heart beat and muscles contract. Electrolyte imbalances can lead to irregular heartbeats and possibly heart failure and death.

In addition, anorexia behaviours can lead to early arteriosclerotic damage and venous stasis, making it difficult for blood to return to the heart from the legs. This puts individuals with anorexia at a high risk of developing cardiac events and suffering an ischemic stroke, which occurs when a vessel supplying blood to the brain is obstructed.

Dehydration is also a common issue for people with anorexia, as they often restrict their water intake. This can lead to orthostatic intolerance and decreased cerebral blood flow, which can increase the risk of ischemic stroke.

The physical consequences of anorexia can be devastating, and it is important to seek treatment as early as possible.

Malnutrition and hypoperfusion

Anorexia nervosa is a serious eating disorder characterised by inadequate food intake and an intense fear of gaining weight. The condition can lead to severe malnutrition, which can have dangerous consequences for the body and brain.

Malnutrition can cause hypoperfusion, a reduction in blood flow to the brain. Hypoperfusion is a significant cause of strokes, particularly when it occurs alongside embolism (the blockage of a blood vessel by a foreign body). When hypoperfusion and embolism occur together, they can cause multiple, small infarctions (tissue death due to a lack of blood supply) in the brain.

In people with anorexia, malnutrition can lead to a deficiency in electrolytes such as potassium, which plays a crucial role in helping the heart to beat and muscles to contract. This electrolyte imbalance can cause irregular heartbeats and possibly heart failure and death. Malnutrition also impacts the heart, which is a muscle, by causing it to break down its own tissue for fuel. This can lead to a drop in blood pressure and pulse, further reducing blood flow to the brain.

In summary, anorexia nervosa can cause malnutrition, which impacts the heart and electrolytes, increasing the risk of hypoperfusion and stroke.

Neurological signs and symptoms

Anorexia nervosa is a complex psychiatric illness that can lead to severe complications, including hepatic dysfunction, respiratory failure, and cardiac disease. The condition is associated with symptoms that range from dry skin to loss of muscle mass, heart failure, and brain damage.

Anorexia has the highest mortality rate of any mental illness, and half of the deaths are sudden cardiac deaths resulting from cardiac arrhythmias. The restriction of food and fluids associated with the disorder depletes the body of nutrients and electrolytes necessary for optimal body function, increasing the risk of vascular issues and ischemic stroke.

• Aphasia and facial droop: Aphasia is a language disorder that can affect comprehension and expression. It can lead to difficulties in speaking, understanding speech, reading, or writing. Facial droop is characterised by asymmetry or paralysis on one side of the face. These were the symptoms that led to the hospital admission of a 19-year-old patient with anorexia in a case study.
• Motor aphasia and dysarthria: Motor aphasia is a type of aphasia that specifically impairs an individual's ability to speak. Dysarthria is a motor speech disorder characterised by poor articulation of speech sounds, often caused by muscle weakness. These were observed in the aforementioned 19-year-old patient following her ischemic stroke.
• Neurological deficits: Anorexia can cause subtle neurological deficits, such as hemiplegia and linguistic impairment. These may sometimes be overlooked in clinical settings, especially during refeeding therapy.
• High-intensity areas in the brain: Brain imaging of a 50-year-old patient with anorexia revealed a high-intensity area in the white matter of the left temporal-parietal lobe, underlying the left supramarginal gyrus and the left transverse temporal gyrus. This explained her phonological errors and word-sound deafness.
• Infarctions in the brain: Brain imaging of a 31-year-old patient with anorexia revealed disseminated infarctions in the cortex bilaterally. However, these did not fully explain her motor symptoms.
• Increased risk of ischemic stroke: Due to the high risk of vascular disease and malnutrition associated with anorexia, individuals with this disorder are at an increased risk of developing ischemic stroke. This is particularly true for those with severe and enduring forms of the disorder.
• Neuropsychiatric symptoms: Anorexia is associated with various neuropsychiatric symptoms, including apathy, preoccupation with food, insomnia, denial, and social withdrawal. These can be indicative of co-occurring mental health conditions such as depression and anxiety.

It is important to recognise these neurological signs and symptoms of anorexia to facilitate early diagnosis and intervention. Clinicians should be vigilant in monitoring individuals with anorexia for the development of any neurological symptoms, especially during refeeding therapy.

Hypercoagulable state

A hypercoagulable state, also known as thrombophilia, is a condition in which an individual has an increased tendency to develop blood clots (thrombosis) due to the presence of one or more predisposing factors. These factors can be either inherited or acquired.

In a hypercoagulable state, the body's natural balance between prothrombotic and anticoagulant mechanisms is disrupted, leading to an increased risk of blood clot formation. Primary hypercoagulable states are inherited disorders, such as factor V Leiden, prothrombin gene mutation, protein C and S deficiency, and antithrombin III deficiency. Secondary hypercoagulable states, on the other hand, are acquired conditions or risk factors that increase the risk of thrombosis. Examples of secondary hypercoagulable states include antiphospholipid syndrome, cancer, and prolonged immobilization.

The development of blood clots within blood vessels can have serious consequences. Deep vein thrombosis (DVT) occurs when a clot forms in a deep vein of the lower or upper limbs, causing pain and swelling in the affected limb. If a part of the venous blood clot breaks off and travels to the lungs, it can result in a pulmonary embolism. Arterial clots can travel to vital organs such as the brain, heart, liver, and kidneys, cutting off blood flow and causing infarction.

Individuals with anorexia nervosa often exhibit severe food and fluid restriction, which can lead to dehydration and malnutrition. This depletion of nutrients and electrolytes can have significant impacts on the body's functions, including the cardiovascular system. Anorexia nervosa is associated with an increased risk of cardiovascular complications, including vascular issues and arteriosclerotic damage, which can contribute to the development of ischemic stroke.

While there is a recognized link between anorexia nervosa and an increased risk of vascular issues and ischemic stroke, the exact mechanisms underlying this relationship are not yet fully understood. Further extensive group studies are needed to elucidate the etiology of ischemic stroke in individuals with severe anorexia nervosa.

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