Strokes

Remember the lakes and streams representing the nervous system?  Well the vascular system (arteries and veins) is like a bunch of hoses.  The biggest hoses are closest to the heart and taper smaller as they proceed farther from the heart.  Normally, the blood flows through the hose unimpeded.  But, like with your garden hoses, certain conditions can cause the flow to change.  Hypertension (HTN) occurs when the hoses are constricted more than necessary.  That restriction causes the heart to have to beat harder and will eventually cause heart muscle changes and could lead to a stroke (CVA).​

At times, the hose lumen (artery) is narrowed due to plaque buildup.  That build up causes arteriosclerosis or atherosclerosis, big words for plaque buildup.  This is the reason the AMA highly recommends lipid management, both through the use of a statin medication and dietary modification.

There are two main types of stroke: ischemic, due to a lack of oxygen, and the most common; and hemorrhagic (bleeding in the brain).  If there is a buildup in the hose, there is a risk of part of that plaque breaking off, traveling through the vessel, and clogging elsewhere.  If that situation occurs in the brain, the end result is an ischemic or embolic stroke (CVA).  The brain suffers from lack of oxygen in that specific area.  The symptoms will indicate where the ischemic area is located in the brain.  Each hemisphere of the brain controls the opposite side of the body, so if there is weakness on the right side, it is due to a L sided stroke (and conversely).  If the ischemia occurs in the area of speech, speech will be garbled, slurred or non-existent.  A severe stroke may leave “residual” damage, that is, deficits that remain long after rehab has concluded.  A mild stroke with very little damage will result in a complete recovery.  Understandably, a stroke that seriously affects the dominant hand will have a more difficult and probably longer rehabilitation.  Residual damage will of course affect activities of daily living, and even cognition so will ultimately decrease the life expectancy.

The second type of stroke is from a leak in the hose.  The leak can be caused by chronic HTN weakening the artery, aneurysm (weakness or bubble in the hose), and bleeding disorders, to name a few.  Hemorrhagic strokes are more serious, as in addition to the area of ischemia, the excess blood in the brain will have to be evacuated either through surgery or resorbed by the body (slow process).  Again, recovery depends on amount of damage done and the location of the bleeding. 

A “mini-stroke” is termed transient ischemic attack (TIA).  A temporary block of blood flow occurs without permanent damage.  Symptoms may include numbness, tingling, weakness, speech or vision difficulty, and/or difficulty understanding others.  As the damage is not permanent, the TIA does not show on imaging.  Symptoms typically resolve within 24 hours.  The takeaway for you, your family and your business: surviving a severe stroke results in a complete lifestyle change and permanent impairments; minor strokes and TIAs are survivable and should require lifestyle modification (diet, stress, etc).