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(@jeanne-mayell)
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06/14/2020 2:06 pm  

Given all the talk about the president's alleged neurological condition, @Laura-f  -- a wonder of many talents and skills -- has started a discussion of strokes for your information that promises to explain in easy-to-understand terms this complex medical condition. Thank you, Laura! 


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(@laura-f)
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06/14/2020 12:44 pm  

Get your notebooks! Time for class!

I worked extensively with stroke patients. This is an area of science I have long adored, still find fascinating, and have some expertise in. The official name is Cerebrovascular Accident (CVA). Like many accidents, they are somewhat preventable. There are several different kinds of strokes, but the main categories are:

  1. Ischemic - a blockage in a blood vessel in the brain due to partial or complete obstruction, can be due to the vessel walls themselves, arterial plaque, or a thrombosis (clot). TIAs fall into this category. Can be caused by underlying medical conditions (blood pressure, heart, diabetes, etc.).
  2. Hemorrhagic - blood escapes the blood vessels and floods the brain, usually due to a ruptured aneurysm. These always cause swelling of the brain, tend to be more fatal, and usually result in greater damage. Can be caused by the same medical conditions, but can also be caused by undiagnosed defects in the blood vessels in the brain, including aneurysms, which many people have tiny ones but don't discover til it grows or ruptures.

Then you have to consider the 2 hemispheres of the brain:

  1. Left - the majority of strokes occur on the left side of the brain, tend more towards ischemic. These strokes affect the sensorimotor parts of the cortex, and so movement and in particular speech are usually affected. There has been mention of apraxia (defined as the inability to move speech muscles adequately), usually apraxia is on this side.  Cognitive deficits are not as severe on this side, but motor impairment is usually worse. So you would see more difficulty with things on the right side of the body - like lifting a cup of water or writing with your right hand. Walking becomes problematic due to unevenness/dyscoordination.
  2. Right - Can be ischemic or hemorrhagic, but tend slightly more towards hemorrhagic. Motor skills tend to be slightly less affected, and are usually seen more on the left side of the body. Cognitive skills usually suffer the most. TBH, I found these strokes the most challenging to work with. The cognitive impairments are downright bizarre, and different from dementia*.  Most fascinating is that the patient will have lack of awareness. They will be more compulsive, will think they are doing everything right when given a task, and are not able to recognize their deficits. Deficits include: inability to read or write, problems with time (telling and managment), dyscalculia, severe memory loss, inability to complete ADLs (Activities of Daily Living - e.g., put on clothes, lock the door, drive the car, tell time from a clock).
  3. Global - self-explanatory - involves both hemispheres, usually severely, usually fatal, but if the person survives the damage is severe and permanent and they will have a shorter lifespan as a result.

TIAs- @ghandigirl- yes @dhyanaji is right- Transient Ischemic Attack. Emphasis on Transient. People with diabetes and high blood pressure are most at risk. They can last anywhere from 10 minutes to a few hours. The person will have slurred speech, may stumble, may feel weakness or tingling in limbs, feels lightheaded.  They are never fatal in and of themselves. They can be managed with medication, and if not tend to get more severe and closer together over time, usually leading to one big fat stroke. Think of a TIA similarly as you would a mild heart attack, only it's in the brain, not the heart.  Once someone has a TIA, it literally becomes a sword of damocles hanging over them (or an anvil, @Lawrence). Eventually it does fall, only a question of when and how, not if.

A note about Aphasia: Aphasia results from any damage to the cortex (stroke, trauma, disease). Because language is actually networked throughout the neurons in the brain, it an occur from damage anywhere and from any cause. Aphasia is a language disorder but with a cognitive component. In expressive aphasia, the patient understands most things but has difficulty expressing that comprehension through any form of language. In receptive aphasia, the patient doesn't understand things, but is able to express themselves verbally, and if the deficits are not severe, can even cover them up.  Receptive aphasia is where we see "word salad" - language with no meaning. Keep in mind that speech and language are two different skill sets.

With both strokes and TIAs, patients tend to exhibit lability - extreme mood swings (but not like in depression), increased impulsiveness (yeah, nuclear codes are probably not a great idea), decreased executive function (including inability to foresee consequences of one's actions), among other things.

*Something I learned working in a medical science is that just because you have one serious diagnosis doesn't mean you don't have another (or a few more).  So when we discuss A Clodwork Oranges symptoms of decline, do not fall into the trap of trying to identify them as ONE thing. I'm not a doctor, so I'm only guessing, but if asked for a list of possible conditions with all of the things I have heard over the years, I'd list: Addiction (cocaine and adderall), Dementia (fronto-temporal, possibly syphilitic in nature), Coronary Artery Disease, High Blood Pressure, Hypogonadism (hormonal imbalance), TIA. I'll leave the [considerable] list of psychological diagnoses to others.

Pencils down. I hope this has been helpful. I believe that focusing on factual science helps dispel the clouds of rumor, conspiracy, etc.


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(@laura-f)
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06/14/2020 6:43 pm  

@jeanne-mayell

Thanks!!


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(@lawrence)
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06/14/2020 8:49 pm  

@laura-f

As I reflect upon the anvil dropping,  I am now hearing "the end of T."  His time has come and gone. Finished. He's a relic, supported by the confederacy. 


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(@laura-f)
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06/15/2020 1:42 am  

Well, in case anyone should ever need it, I'll post the mnemonic for strokes (all types):

FAST

F = Facial drooping

A = Arm weakness

S = Speech difficulties

T = Time is of the essence!

If you observe any of these signs, call 911 or get to your doctor immediately.  There are strong medicines for ischemic strokes, but they're time sensitive and delaying means they won't work.

Thanks @dhyanaji! Namasté!


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(@elaineg)
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06/19/2020 9:52 am  

@laura-f When I had my mini stroke, from taking a BP pill for five days, my face , arm, and left leg got numb. I ran to the doctor and -nothing. He said "Well, maybe you don't need blood pressure pills."


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(@laura-f)
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06/19/2020 1:18 pm  

@elaineg

OMG I'm so sorry that happened to you. I do hope you found a better doctor after that.


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(@lovendures)
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06/19/2020 4:49 pm  

@elaineg

That is totally unacceptable!!  I agree with Laura.


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(@elaineg)
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06/19/2020 5:33 pm  

@laura-f  Well, no. The next doctor wanted to treat my no-no bobble head, but then I noticed one side of my neck  looked different. I worked my neck for a while, and it got better. No more bobble head.


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(@bluebelle)
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06/24/2020 5:44 pm  

@laura-f

Well done.  You are truly a treasure.  Years ago, I worked in a university medical center in public relations, working with print and video reporters and writing medical news.  Looks like you could have done my job as well as your own!


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(@laura-f)
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06/24/2020 5:51 pm  

@bluebelle - One of the things I honestly did excel at was explaining stuff to my patients without condescending. I would draw diagrams and do whatever I had to to help them understand. That and advocating for non-English speaking patients.


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(@lowtide)
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06/24/2020 6:24 pm  

@laura-f

Thanks for posting this important acronym! Now,

B - sudden loss of balance or staggering, and

E - sudden loss or change of vision, double vision or loss of peripheral or midline vision

have been added. So now it's BEFAST.

Medical acronyms have a way of growing.


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(@laura-f)
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06/24/2020 7:05 pm  

@lowtide

Thanks for the update!

Took me a sec to get that E is for EYES, LOL


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(@lowtide)
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06/24/2020 7:57 pm  

@laura-f

LOL!  🙂


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