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Can anxiety cause a silent stroke?

Anxiety is a common mental health condition that involves excessive and persistent worry about everyday situations. It can range from a mild uneasiness to a full-blown panic attack. While anxiety is not life-threatening on its own, some research suggests it may be linked to an increased risk of stroke, including “silent” strokes that cause no obvious symptoms. This article will examine the connection between anxiety and silent strokes and provide an overview of silent strokes, their causes, symptoms, diagnosis, and treatment.

What is Anxiety?

Anxiety is characterized by intense feelings of tension, fear, and dread. It often involves:

  • Excessive worrying about everyday situations or problems
  • Difficulty controlling worries or thoughts about perceived threats
  • Physical symptoms like increased heart rate, sweating, trembling, dizziness, and shortness of breath
  • Avoidance of situations that cause anxiety
  • Disruption to daily activities and relationships

Anxiety disorders include generalized anxiety disorder, social anxiety, panic disorder, phobias, and separation anxiety. Up to 30% of adults experience an anxiety disorder over their lifetime. Anxiety can be triggered by major stress, trauma, some medications, or other medical conditions. Heredity and brain chemistry also play a role.

What is a Silent Stroke?

A silent stroke, also called a silent cerebral infarct, is a stroke that does not result in any immediately obvious symptoms. It usually occurs when blood flow to the brain is blocked for a short period of time, causing brain cells to die.

Unlike a regular stroke, silent strokes do not seem to cause identifiable symptoms right away. People are typically unaware when a silent stroke is happening. However, silent strokes still cause permanent damage to the brain that can build up over time, leading to issues down the road.

Some key facts about silent strokes:

  • Up to 25% of people over age 60 have signs of silent strokes on brain scans
  • They are estimated to be 5 times more common than regular strokes
  • Risk increases with age, high blood pressure, and heart disease
  • Cumulative damage can lead to memory and thinking problems later on
  • MRI scans are needed to detect silent strokes

The only way to diagnose a silent stroke is via neuroimaging like MRI scans. They will show areas of damaged brain tissue. Silent strokes are often detected when screening for other conditions. The damage tends to build up in the hippocampus, cerebral cortex, and white matter.

Silent Stroke Causes and Risk Factors

The causes of silent strokes are similar to those of full strokes:

  • High blood pressure – The #1 risk factor for silent strokes is high blood pressure, also called hypertension. It puts excess pressure on artery walls and can promote blockages.
  • Heart disease – Conditions like atrial fibrillation and enlarged atrium allow blood clots to form, travel to the brain, and cause stroke damage.
  • Smoking – Smoking makes blood more likely to clot and damages blood vessels.
  • Obesity – Being overweight strains the cardiovascular system and promotes high blood pressure.
  • Diabetes – Uncontrolled diabetes damages blood vessels and makes blockages more likely.
  • Sleep apnea – Interruptions to breathing at night stress the cardiovascular system.
  • Family history – Having family members with a history of stroke raises your risk.
  • Ethnicity – Older African Americans have higher rates of silent strokes.

High blood pressure and heart disease put significant stress on blood vessels, making blockages and blood clots more likely to form. Controlling these conditions is key to preventing silent strokes.

Can Anxiety Cause Silent Strokes?

There is some evidence linking anxiety disorders to an increased risk of stroke, including silent stroke. Possible explanations for this connection include:

  • Stress hormones like cortisol released during periods of high anxiety may damage blood vessels and promote blockages.
  • Anxiety could contribute to unhealthy habits like smoking, poor eating, and lack of exercise that raise stroke risk.
  • Panic attacks dramatically increase heart rate and blood pressure, which could trigger ruptures or clots.
  • Anxiety may be linked to higher inflammation levels, which can damage blood vessels.
  • Many anti-anxiety medications list stroke as a potential side effect.

A number of studies have found correlations between anxiety disorders and stroke:

  • A meta-analysis of 20 studies found anxiety disorder diagnosis linked to a 52% increased risk of stroke.
  • One study of over 6000 older adults found phobia diagnosis almost doubled stroke risk.
  • A study of 300 stroke patients found 63% had anxiety months before their stroke.

More research is still needed on whether anxiety medications themselves may promote stroke risk in some patients. But overall, there does appear to be a correlation between untreated anxiety and increased stroke rates.

Symptoms of Silent Stroke

By definition, silent strokes do not cause immediate symptoms when blood flow is disrupted in the brain. It’s typically not until repeated silent strokes cause substantial cumulative damage that the following symptoms may emerge:

  • Memory loss
  • Confusion
  • Difficulty learning new information
  • Personality changes
  • Loss of bladder control
  • Weakness or numbness
  • Trouble walking or loss of balance
  • Vision problems

These symptoms result from eventual vascular dementia as the small strokes continue to damage parts of the brain that control thought, movement, and behavior. Patients may start experiencing cognitive decline that mimics early Alzheimer’s disease.

Silent strokes are sometimes detected when patients come in with these issues but lack other risk factors that would explain the symptoms. Brain imaging can confirm the presence of multiple small infarcts.

Diagnosing Silent Strokes

Silent strokes cannot be diagnosed based on symptoms alone – brain imaging tests are required to detect the associated brain damage:

  • Magnetic resonance imaging (MRI) – An MRI scan can reveal areas of the brain damaged by silent strokes. This is the most accurate test.
  • Computerized tomography (CT) scan – A CT scan may show silent stroke damage but is not as sensitive as MRI.
  • Carotid ultrasound – This can detect fatty plaque buildup in the carotid arteries supplying the brain.
  • Cerebral angiogram – Dye is injected into the brain’s blood vessels to spot narrowing or blockages.

Brain scans in at-risk patients with a history of hypertension, heart disease, or anxiety disorder may incidentally reveal silent strokes. They may also be detected in those with emerging cognitive problems.

Preventing Silent Strokes

The best way to prevent silent strokes is to minimize your risk factors:

  • Control blood pressure through diet, exercise, quitting smoking, and medication if prescribed.
  • Take medications properly if you have atrial fibrillation or enlarged heart.
  • Lower cholesterol through statins if recommended.
  • Manage diabetes through diet, physical activity, and maintaining healthy blood sugar.
  • Get screened and treated for sleep apnea.
  • Eat a diet high in fruits, vegetables, and whole grains.
  • Exercise for 30 minutes per day at minimum.
  • Maintain a healthy weight.
  • Limit alcohol to 1-2 drinks per day maximum.

For anxiety specifically:

  • Get cognitive behavioral therapy (CBT) to manage anxiety symptoms.
  • Don’t abruptly stop anti-anxiety medications without medical supervision.
  • Try relaxation techniques like meditation, yoga, or deep breathing.
  • Avoid recreational drugs and limit caffeine.
  • Get enough sleep and learn to manage stress effectively.

Making heart-healthy lifestyle choices and keeping risk factors like blood pressure under control offers the best protection against silent strokes.

Treating Silent Strokes

There is no treatment specifically targeted to repairing damage from silent strokes. But prompt treatment of underlying conditions can help prevent additional silent stroke episodes. Key tips include:

  • Take medications to control high blood pressure, cholesterol, heart arrhythmias, and diabetes.
  • Have carotid artery blockages surgically repaired if indicated.
  • Get stents or angioplasty to open clogged arteries.
  • Take aspirin or anti-platelet medications to prevent blood clots.
  • Enroll in a cardiac rehabilitation program after heart attack or procedures.
  • Follow diet and exercise recommendations to achieve weight loss if needed.
  • Quit smoking and avoid secondhand smoke exposure.

For cognitive symptoms emerging later, cholinesterase inhibitor medications used for Alzheimer’s may help slow further decline. Physical, occupational, and speech therapy can also help manage functional disability.

But there are no treatments that can reverse brain damage from silent strokes that has already occurred. That makes prevention extremely important.

Can You Recover from a Silent Stroke?

Unfortunately, it is not possible to fully recover lost brain tissue from silent stroke damage. However, some degree of recovery is possible:

  • Remaining healthy brain cells may take over some lost functions through neural plasticity.
  • Prompt treatment can limit accumulative damage from repeated silent strokes.
  • Good collateral blood flow may sustain some oxygen supply to damaged areas.
  • Neuroplasticity from physical and cognitive rehab may compensate for some deficits.
  • Healthy lifestyle choices boost brain resilience to damage.

With extensive silent stroke damage, substantial recovery is unlikely. But the brain has remarkable ability to reorganize itself that can mask some effects. Strictly controlling risk factors gives the best chance to limit future impacts.

Silent Strokes and Dementia

The multiple, tiny brain lesions caused by repeated silent strokes put people at increased risk of vascular dementia and related disorders.

Silent strokes damage memory, thinking, and reasoning ability through their effects on:

  • Frontal cortex – Decision making and personality.
  • Temporal cortex – Language and memory.
  • Hippocampus – Memory formation and retrieval.
  • White matter – Coordinates information flow.
  • Basal ganglia – Movement control.

This damage can accumulate over time, leading to progressive cognitive decline that mimics Alzheimer’s. Extensive silent strokes in strategic brain regions ultimately result in dementia.

Up to a fifth of dementia cases have mixed Alzheimer’s disease and vascular pathology. Preventing silent strokes can help delay or avoid dementia onset.

Silent Stroke Outlook

Silent strokes significantly raise the risk of future strokes, cognitive decline, and dementia. But following doctor’s orders for treating contributing conditions can help limit damage.

With proper control of risk factors like hypertension, the outlook can be good. Having silent stroke damage puts you at increased risk but does not mean dementia is inevitable if you take preventive action.


Anxiety involves physical stress pathways like elevated blood pressure that appear to increase susceptibility to silent strokes. Cumulative damage from repeated silent strokes in the brain is linked to higher dementia risk in those with untreated anxiety.

However, following professional mental health treatment, having healthy coping skills, and controlling other medical conditions can help lower this risk substantially. Silent strokes are not an inevitable consequence of anxiety.

By getting blood pressure and heart issues under control, avoiding smoking, eating well, exercising, and managing stress, it’s possible to prevent anxiety from leading to irreversible stroke damage. Work closely with your doctor and mental health professional to reduce your risks.