STROKE

STROKE



The cells of the brain which form every thought, every movement, sensation, and every function of organs throughout the body. They are exquisitely sensitive to the blood which flows to them. Brain function falls off in a matter of seconds when it is deprived of oxygen, and minutes when it is deprived of glucose. Function falls off proportionately otherwise, depending on the amount of blood flow compromise. When there is a specific area of brain damage following a distinct episodic lack of blood flow to the brain, we say that a stroke has occurred. Probably everyone has seen others with the aftermath of a stroke. Perhaps one half of the face sags and is immobile. Maybe the person is unable to speak, or move an arm or a leg. Perhaps he is confined to a walker, or a wheel chair, or even a nursing home due to the consequences of the stroke. The long term effects of stroke can range from barely perceptible to catastrophic, and anywhere in between.

Broadly speaking there are basically two kinds of stroke. The first and most common type is called "ischemic", in which there is simply a lack of blood flow through a specific vessel or group of vessels. The second type is called "hemorrhagic" because there is an actual rupturing of a blood vessel within the brain or brain cavity. Because the brain is enclosed in a tough fibrous sheath called the Dura mater, which is in turn enclosed by the skull bones, hemorrhage in a certain area causes buildup of pressure which in turn squeezes the blood vessels shut. Therefore, the actual effect of the hemorrhage is the same as that of ischemia. It becomes critically important, however, to determine which is which before entering into a treatment plan. An ischemic stroke is treated with blood thinners and "clot-busters". If this was given to a hemorrhagic stroke, the results would be disastrous. It is usually possible to distinguish ischemia from hemorrhage with the use of a head CT x-ray device.

The ischemic stroke usually occurs secondary to underlying medical conditions. One of these is atherosclerosis, where arteries become stiff, calcified, and blocked with a sludge-like buildup within their interior surfaces. This condition occurs naturally with increasing age. It may prematurely form with the effects of cigarette smoking, lack of exercise, diabetes, high blood pressure and elevated amounts of cholesterol in the blood. Often, the actual event of the ischemic stroke is the breaking off of a cholesterol plaque, causing a spot of bleeding within the vessel wall, and setting off the clotting mechanism which, in turn, throws one or more clots to the vessels beyond it on the way to the brain. The clot can come from within the heart or heart valves. Sometimes, the vessel is so blocked with atherosclerosis, that if there is a drop in blood pressure for any reason, blood flow to the brain simply becomes inadequate a stroke occurs.

Now, concerning the subject of hemorrhagic stroke, one aspect of a blood vessel within the cranial cavity suddenly becomes critically weakened and gives way under pressure. This can occur with significant elevations of blood pressure. It can occur because there is a tiny arterial sac called a "Berry aneurysm" which essentially pops under pressure. Likewise, any other part of a compromised artery can burst, allowing the free blood to flow around and within the brain tissue. Sometimes watchful waiting is done as treatment for a hemorrhagic stroke to make sure the bleeding has stabilized. Sometimes it is actually necessary for a neurosurgeon to make repairs and drain the accumulated blood from within the cranium.

The point I’m trying to make is that once a stroke has occurred, it’s anybody’s guess what the ultimate outcome may be. Prevention is ultimately the way to go whenever possible. First step: don’t smoke. This damages the delicate cells which line your arteries. It can raise blood pressure, and lower the moment to moment oxygen content of your blood. Have your blood pressure measured regularly, and work with your doctor to bring it under optimal control. Know your cholesterol numbers: you want your total cholesterol to be less than 180, your LDL cholesterol to be less than 100, and the good HDL cholesterol to be above 40. This will do worlds to take care of your blood vessels and brain. Regular exercise is critical for maintaining a healthy cardiovascular system, which is ultimately your brain’s lifeline.



John Drew Laurusonis

Doctors Medical Center 

www.doctorsmedicalctr.com