Transporters on strike: Understanding strokes.

Brain strokeThere he sits, perched on high. The little control freak, with his pompous attitude, acts like it’s all about him. Barking out orders, he expects, no, he demands, utter and instant obedience. And, what he wants, he gets. Like the CEO of a complex organization, this leader monitors and makes corrections to be certain that his domain and its components function in perfect harmony. In exchange for the minions’ immediate carrying out of his demands, he makes certain they survive the constant barrage of attacks against the unit.

All is well until there is the tiniest of revolts. One of the transporters within the system decides to go on strike. He stops making his deliveries. Then, the vulnerability of the man behind the machine is exposed. Not as pompous as he pretended, he’s actually quite vulnerable.

For all the control the brain exerts over nearly every aspect of our being, it remains dependent on a constant flow of energy and tasty nutrients to do it’s job well. When one of the arteries supplying this ceaseless transport of blood gets blocked, it’s no longer making deliveries. And that, my friends, is when one starts to suffer a stroke. And, when a stroke occurs, nothing seems to work as it was intended.

I see a lot of misconceptions about the symptoms of a stroke as well as and the underlying cause. So, let’s clear that up.

Actually, there are different types of strokes. We’re talking about ischemic strokes. Ischemia is where a part of the body is not getting an adequate supply of blood. If this occurs for too long, that part of the body begins to die. More accurately, the cells in that area not getting blood flow start to die. This can happen not only in the brain, to cause a stroke, but also in the heart (a heart attack), the bowels, the retina, or a limb.

To the brain, blood must be flowing constantly. The supply of oxygen and glucose is vital for even the most mundane of tasks. When a part of the brain does not get that constant flow, we have symptoms of a stroke. These symptoms vary based on which part of the brain is suffering. Sometimes it’s an arm and a leg on one side of the body that stops working normally. Or, there can be a loss of vision, slurred speech, or the inability to talk or to at least find the right word to say. We call that expressive aphasia.  Sometimes a stroke can simply affect our balance, so that we stumble around like we are three sheets to the wind.

Strokes occur when a blood vessel gets blocked by an embolic clot. Embolic means that this clot originated elsewhere and is coursing through arteries which are like pipes that get smaller and smaller until they reach their final destination. The clot is a clump of blood and platelets that wedges itself into a tight little crevice to keep the flowing blood from getting through. It’s like the collection of hair, Legos, and Matchbox cars your plumber had to snake out of your pipes so the toilet would flush. It’s this clot that is the target of the so-called clot-busting drug, tPA.

Now, forever ago, it was commonplace to give this type of medicine to patients having heart attacks, which are also caused by embolic clots. That worked well until the cardiologists figured out how to go in with little catheters and just remove the clot.

While the idea of using tPA on strokes makes sense, it doesn’t work as well as it did for heart attacks. Brain and heart are different. You see, sick brain, like one that isn’t getting enough blood flow, has a tendency to bleed. So your ischemic stroke turns into a hemorrhagic stroke. And, even if there is no bleeding, the brain has a harder time bouncing back from this insult.

In simple terms, if you have a stroke and it’s severe enough, you may be offered this clot-dissolving drug. First, though, you have to get the drug within the first 3 hours of the onset of your symptoms. Sometimes this window of opportunity can be extended to 4.5 hours. If you wake up with stroke-like symptoms, we have to assume those symptoms started all the way back when you fell asleep, because we just don’t know. That excludes a lot of people from getting tPA.

Now, for some numbers. If 100 people get this drug for their stroke, 12 of them will be improve more than if they didn’t get the drug. 6 of the hundred people, though, will have bleeding in their brains. Half of those who bleed will die. Most patients will not do any better or any worse than they would have without the medicine.

Study after study is underway to figure out if the interventional radiologists can go in and just remove the clot. So far, that’s not been perfected. Every day, some new catheter and protocol is being developed to try to make that happen without doing more harm. So far, it’s not ready for prime time.

To increase the confusion, there are things that mimic strokes. Low blood sugar, complex migraines, Bell’s palsy are a few things that come to mind. You see, there has to be some reason you still need us doctors.

Unlike most of my posts, this is not a place to save money. If you notice part of your body revolting against the orders being given by your brain, don’t hold it against the site that’s misbehaving. More than likely, the corpuscles supplying the brain with it’s tasty goodies got log jammed. Don’t wait. Come see us and we’ll figure if a little dynamite is in order to get the pipes flowing again.

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