Am I having a stroke?
By Dr. David Kaminskas
A number of years ago one of my wife’s favorite uncles was visiting us from South Bend and began to have a stroke. Actually, there were quite a few of my wife’s loved ones visiting us that day from South Bend where she grew up on a farm. We still travel frequently to this little farmhouse sitting amongst the 180 acres or so of prime Indiana farmland to visit her 91-year-old mother still going strong. But I digress. This story is about Uncle Bert.
We decided to treat all our company to brunch after Mass. As we were finishing up and sipping our coffee, Uncle Bert was telling us one of his favorite stories and suddenly he could no longer find the right words, and he put together a sentence that made absolutely no sense at all. My wife and I made eye contact and communicated telepathically (as married couples sometimes do). I got out of my chair and immediately walked Uncle Bert out of the restaurant and into my car where I drove him directly to the Lutheran Hospital Emergency Room. After having a stat CT scan of the brain I put him on IV heparin (blood thinner) and ordered a carotid ultrasound, which showed a critical left carotid stenosis (blockage) that had dangerously reduced the blood flow to the left side of his brain.
Uncle Bert was right handed, like most of us, so his speech center is on the left side of his brain. Therefore, the lack of blood to this particular area of the brain caused speech difficulty. He was having a TIA (Transient Ischemic Attack). Thankfully within several hours he was talking to us normally again. I called up one of my favorite vascular surgeons, Dr. Bill Deschner, and the very next day he did a carotid endarterectomy (roto-rooter) and Uncle Bert fully recovered with no evidence of a neurological deficit. His speech was perfect, and we were going to be able to continue to enjoy the wisdom of this special man.
A TIA is temporary lack of blood flow and oxygen to part of the brain. The manifested symptoms are an indication of what part of the brain is affected. In Uncle Bert’s case it was his speech center. So a TIA is transient, while a stroke causes death of brain cells and is permanent. Uncle Bert was lucky he had a TIA, which gave us a warning sign that a stroke was eminent and therefore we had an opportunity to intervene.
Symptoms of a stroke include numbness or weakness on one side of the body like the arm, leg, or both; numbness or weakness on one side of the face, frequently causing a drooping effect; sudden difficulty walking or falling to one side; and, difficulty speaking. Strokes, like many medical problems, can be subtle and tricky. For example a transient loss of vision in one eye (which is called amaurosis fugax … one of my favorite trick questions for medical students) is a classic sign of an impending stroke.
Until recently, the treatment of a stroke was mainly supportive, conservative and frankly frustrating. For much of my career there has not been much we could do, and I have felt impotent watching people complete their strokes. Everything has now changed. Aggressive intervention to prevent brain damage can now be offered. One treatment option is thrombolytics (clot busters) administered intravenously to break up a clot that has stopped or reduced blood flow to the brain.
I recently helped take care of a 96-year-old woman having a massive stroke manifested by right-sided paralysis and aphasia (speechlessness) who received thrombolytic therapy and she completely recovered. Needless to say the patient and family were ecstatic! An even more exciting treatment of stoke is interventional doctors who skillfully place catheters into the cerebral blood vessels to snag clots and remove them, or stent a blocked artery back open.
I can’t even come close to counting how often patients tell me: “I would rather die than have a stroke!” Losing your ability to talk, move, or think clearly is a very scary scenario. If you have signs of a stroke it is an emergency and getting to the closest hospital is imperative. Think of it as a “brain attack” and move quickly!
A favorite Scripture that fits right in is Philippians 4: 4-8: “Rejoice in the Lord always! I say it again. Rejoice! Everyone should see how unselfish you are. The Lord is near. Dismiss all anxiety from your minds. Present your needs to God in every form of prayer and in petitions full of gratitude. Then God’s own peace, which is beyond all understanding, will stand guard over your HEARTS AND MINDS (my emphasis) in Christ Jesus.”