![]() Given the patient’s healthy medical background and with no actionable treatment planned, a thorough investigation of the etiology of her ischemic event was started. MRI T2-weighted image of lesions consistent with an acute right parietal infarct involving the lateral aspect of the postcentral gyrus, posterior aspect of the right insula, and supramarginal gyrus. An MRI brain scan without contrast was consistent with an acute right parietal infarct involving the lateral aspect of the postcentral gyrus, posterior aspect of the right insula, and supramarginal gyrus, in the arterial region of M3 ( Fig. 1). ![]() A CT angiogram of the head and neck revealed no occlusions, flow-limiting stenosis, aneurysm, or vascular malformation. Her urine drug screen was positive for cannabis. Basic laboratories returned without abnormality. An electrocardiogram illustrated normal sinus rhythm. Her neurologic examination was pertinent for reduced sensation to vibration, light touch, and temperature on her left hemibody including her face with an otherwise normal examination. On physical examination, she was afebrile and with all vital signs in normal ranges. The patient endorsed taking several over-the-counter supplements for a few months to increase her energy and sex drive including vitamin D3, vitamin K2, 200 mg of diindolylmethane (DIM) daily, elderberry gummies, and a caffeine supplement. She reported no cause of ambulatory restriction. She denied the use of cigarettes or other illicit substances. She used cannabis nightly for sleep and alcohol rarely. She denied any history of known cardiac defects, autoimmune conditions, metabolic disorders, or hematologic abnormalities. She was otherwise healthy and denied the use of any prescription medications including estrogen-containing contraceptives. She had a history of a traumatic subdural hematoma multiple years before this presentation and was status post-right partial hemicraniectomy without residual deficit. The patient is a 38-year-old female military dependent who presented to the emergency room with wake-up symptoms of left hemibody sensory changes. This case serves as a reminder of the hazards associated with supplement use and the importance of a thorough investigation of etiology in medical cases of ischemic stroke in the young. 3, 4 This case reports a healthy female with a small patent foramen ovale (PFO) who suffered an ischemic right posterior central gyrus stroke while consuming a supplement. 1 Herbal supplements are also possible causes of coagulopathy. 1 However, in otherwise healthy young adults with no identifiable risk factors, there are many other, often rare, considerations that include vasculopathies, cardiac defects, infection, hypercoagulable states, and metabolic diseases. 1, 2 This rise coincides with an increasing prevalence of obesity, hypertension, diabetes, illicit drug abuse, and improvements in imaging. "DIM slows down the conversion of testosterone into estrogen, so you'll have fewer symptoms of estrogen dominance.The incidence of ischemic stroke in the young is rising, with 1-2 million young adults in the USA suffering from a stroke yearly. "Too much estrogen can lead to irregular, heavy periods, weight gain, problems sleeping, fatigue, depression or irritability, and a low libido," says Cheung. Helps mitigate estrogen dominance: Cheung notes that estrogen dominance can result from poor liver detoxification or obesity, as fat tissue will metabolize testosterone into estrogen. External factors such as birth control, excess meat and dairy, plastics, and other toxins may also contribute to estrogen dominance and resulting symptoms."Since DIM balances estrogen metabolism and receptor activity, and stimulates cellular detoxification, it may help support the prevention of various cancers, including breast, uterine, cervical, and prostate cancers," says Cheung. May prevent estrogen cancers: Taken as a supplement, I3C studies are increasingly showing its potential strength in preventing the development of estrogen-enhanced cancers.DIM and I3C help to maintain this delicate balance, and higher levels of DIM will block androgen pathways to decrease sebum production and acne," she explains. "Hormonal acne results from an imbalance of estrogens and testosterone. Though there's no scientific evidence that DIM supplements fix or cure hormonal acne, Cheung says they can help. Clears hormonal acne: Hormonal acne appears primarily on your chin and jawline, but can occur on the sides of your face and down your neck as well.
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