SAVING THE BRAIN DURING A STROKE
By Arlyn M. Valencia, M.D.
When Joe woke up that chilly night, he knew something was terribly wrong. He tried to stand
up but instead, he suddenly slid to the floor as if his right body pulled him down. That’s when
he realized the right side of his body had gone “dead” on him. He tried to verbalize, orient
himself to his surroundings. He concluded his mind was still working. He tried “shaking off”
the problem on his right side but it would not go away. “Maybe”, he sighed, “I’ll sleep it off. It
should be OK by tomorrow.”
Joe just had a stroke which affected solely the motor pathway in his left brain. He got lucky
that the speech center, which is also on the left side (on right-handed individuals) was spared,
thus, his ability to talk and comprehend remained intact.
Stroke is a toofamiliarword for everyone. It is unfortunate, however, that the majority
of Americans do not know the symptoms of stroke or those who knew do not know
the significance of early medical evaluation and intervention.
Stroke affects 750,000 Americans each year. It is the fifthleading cause of death and
the leading cause of serious longterm disability. The cost of care for strokevictims
approximates $43 billiona year and a significant proportion of this is spent on long-term
rehabilitation and nursing home care.
A stroke occurs when the blood flow to a part of the brain is impeded due to sudden
blockage of an artery supplying that area of the brain. The needed glucose and
oxygen will not reach that particular brain tissue which eventually will suffer and die
if the blood flow is not immediately restored. The result will be loss of function of the
part of the body which that part of the brain controls. This is called ischemic stroke.
Another cause of stroke is sudden bleeding into the brain substance when a
weakened wall of an artery ruptures. This is called a hemorrhagic stroke.
Stroke is also called “brain attack” to connote the necessity of seeking immediate
medical attention, that is as soon as the symptoms occur. However, compared to
heart attack in which the symptom seems universal (chest pain), a stroke can have
different manifestations, depending on what part of the brain is ailing or dying. For
example, if the verbal speech area on the dominant side of the brain (which is left on
righthanded individuals) loses blood supply causing death to the brain cells, the
patient will suddenly lose the ability to talk .
Some of the more common warning signs of stroke are: sudden weakness or
numbness of the face, arm and leg on one side of the body, sudden blurring of vision
or blindness in one or both eyes, sudden incoordination, trouble walking, dizziness,
sudden confusion, trouble speaking or understanding or sudden severe headache
with no known cause. Of course there are other less obvious signs of stroke like
suddenonset double vision, difficulty with swallowing, nausea and vomiting. These
latter signs are more commonly seen in brainstem strokes.
There is a nationwide campaign to improve stroke awareness. Every stroke must be
treated as a lifethreatening emergency. The available stroke treatment modalities can
only be administered if the patient is brought for evaluation and treatment within four
and a half hours of stroke onset for the intravenous clotbuster
(tissue plasminogen
activator, tPA) and within six hours of stroke onset for the intraarterial
clotbuster.
At comprehensive stroke centers, a procedure called thrombectomy/clot retrieval can be
done or the stenosed artery can be stented to restore blood flow. After acute intervention,
aggressive medical management later, towards stroke prevention. Not all stroke patients are
candidates for these treatments. It is very important that the emergency room (ER) physician
and the neurologist adhere to the protocol and weigh the risk versus benefit. If given
appropriately to eligible patients, the treatment can decrease or even reverse the neurologic
deficits that the patient had at the onset.
Better understanding of the causes of stroke and the changes that happen in the
brain before, during and after stroke has led to better overall patient management. Even if
the patient is not a candidate for the clotbuster therapy, emergent medical
intervention can easily be started that may protect or save the ailing brain. It may be
as simple as maintaining a good diastolic blood pressure, controlling fever, treating
concomitant infections as soon as recognized (the latter is considered a risk factor
for stroke), normalizing the blood sugar, improving oxygenation especially on those
with preexisting lung conditions. These measures may help “protect the ailing brain
cells”. If these cells are not rescued, they will eventually die resulting in increased neurologic
deficits, thereby, increased disability.
Control of other risk factors should also be started acutely, such as treatment for
high cholesterol, diabetes and homocysteinemia. Cessation of smoking, controlling
other risk factors and compliance to stroke prevention treatment (taking the
appropriate antiplatelet medications and blood thinners), can not be overemphasized.
Healthy lifestyle, and consumption of food rich in antioxidants have a role in stroke
prevention.
Young people who suffered from a stroke should be worked up for clotting disorders
(hypercoagulable state), congenital or acquired heart problems or connective tissue
disorders as well as blood vessel inflammation (vasculitis). Drug abuse especially
methamphetamine and cocaine, especially the alkaloidal form (crack) CAN cause
strokes. Another important cause of stroke for young people is dissection of the
arteries supplying the brain either from trauma or from an inborn defect of the wall of
the arteries. Recently, there is a noted increased incidence of strokes occuring in young
adults with the same risk factors more common in the adult population namely hypertension,
diabetes and high cholesterol.
Each stroke patient is different. Joe, the patient I mentioned earlier, is my father. He
improved dramatically. It could be that the ailing part of the brain got rescued by
blood supply from other territories.
Our brain, although gifted with the power to autoregulate its own blood flow, can be
chronically challenged by several medical insults like hypertension, diabetes, heart
disease, cigarette smoking. This power of the brain can get exhausted. We still have
time to correct such things before our brain gives up on us.
Take care of our brain. Control the risk factors, help in disseminating information to
improve awareness. And at the first sign of stroke, seek immediate medical attention
(call 911). The faster we act the better chance we have of saving or protecting the
brain from the effects of stroke.
UPDATE: My father passed away. He initially survived a massive cerebral hemorrhage
and after recovering some functions, succumbed to rupture of aortic aneurysm.
Arlyn M. Valencia, M.D. is Neurologist, Stroke Subspecialist. She is a Diplomate of
the American Board of Psychiatry and Neurology, fellowship-trained in stroke and
neurorehabilitation.
From "The Daily Dealings" By Arlyn M. Valencia, M.D.
Dr. Valencia is a board certified neurologist. She is
an Official Member of the INTERNATIONAL HIGH IQ SOCIETY.
She served as the stroke director at Sunrise Hospital and Medical Center in Las Vegas,
Nevada and as an associate professor of neurology at University Of Nevada School Of Medicine.
She completed neurology residency at Montefiore Medical Center, Albert Einstein
College Of Medicine in Bronx, NY and fellowship training in stroke And neurorehabilitation
at the same institution. She did her post‐graduate internship in internal medicine at Metropolitan
Hospital in Manhattan, NY, the teaching hospital of New York Medical College.
She is also an artist (oil, watercolor and acrylic painting; charcoal and pencil sketching), a writer and
a musician (vocals, piano, guitar, songwriting).
