What is a stroke?
A stroke is the loss of blood-flow to the brain, and it can have two different causes. Ischemia is the term used if the blood-flow is impeded by some kind of blockage - like a clot, while a haemorrhage is the rupture of a blood vessel that causes bleeding into the brain. Regardless of the cause, an area of the brain is unable to function properly. The most common results are loss of motion in one limb or on one side of the body, the inablility to speak or to understand speech, or loss of sight in one eye. In my case, it was complete paralysis on the right side (initially) followed by the loss of speech - I could still understand perfectly, and the inability to swallow voluntarily. In cases more extreme than mine, affecting the same area of the brain as mine, you can lose the ability to breathe or to swallow completely. These are the cases that are fatal.
What causes strokes - risk factors?
For me, they never did find a cause for the stroke - I have none of the risk factors. In a certain percentage of cases, the doctors are left shrugging their shoulders. We know so very little about the brain, but we have linked certain factors that lead to higher stroke risk. The factors we know about are hypertension or high blood pressure, cigarette smoking, high cholesterol, old age, diabetes, previous strokes or TIA's, and atrial fibrillation or irregular heartbeat. Of all of these factors, the most controllable is high blood pressure (and I would say that cholesterol and cigarette smoking are pretty controllable too). You can't do much about old age, Type 1 Diabetes, irregular heartbeats, or previous strokes - but the important thing to note is that you can influence most of the risks.
Warning signs or symptoms of stroke
I think that the warning signs for my stroke were pretty typical. For me, there was sudden, very apparent weakness in the right side. The year previous, during the TIA I experienced, the signs were a "rubbery" feeling in half by body - leg and arm on the right side, a very slight slurring of speech, and loss of very fine motor skills - I couldn't write legibly and my typing was abnormally slow and full of mistakes.
In general the warning signs that you are having a stroke are more or less agreed upon. I think one of the easiest to remember is a system from the UK developed in 1998 by stroke physicians, ER doctors and ambulance personnel. It's called FAST, which stands for Facial weakness, Arm weakness, Speech difficulty, and Time to act.
Facial weakness determines if the patient can smile without their eyes or mouth drooping. Arm weakness finds out if a person can keep both arms stretched out before them, without one of them starting to drop. Speech difficulty is pretty self explanatory - if you have problems either speaking (slurring, missing words) or understanding speech then you have an issue. The last one, time, reminds you to get to a hospital or seek immediate treatment - time means precious brain cells, and we have drugs and surgery now that can limit the damage of a stroke.
Once in the hospital, there's a pretty standardized test that doctors give in order to rank the seriousness of a potential stroke. Called the NIH Stroke Scale, it's available here. It's interesting to read the kinds of things that they're looking for - and for me it's good to know that all the strange questions they asked me had some reason at their root.
Brainstem Stroke
A brainstem stroke affects the area of the brain at the top of the spinal cord, and at the base of the brain. This area is particularly life threatening as it controls vital functions like heartbeat and breathing. It also controls less critical functions like speech. Symptoms of this kind of stroke can include nausea, loss of coordination, and double vision.
Persistent Vegetive State (PVS) is a brainstem event which is really controversial in definition. In this instance, the patient has lost all forms of communication and may (or may not) be unconscious. Terri Schaivo was a famous (infamous?) case of PVS.
Basal Ganglia Stroke
The basal ganglia are the "messengers" in the middle of your brain. They sort out the information sent from the cerebellum and the spinal cord. Many arteries are connected to the basal ganglia, so if blood is interrupted there, through hemorrhage (bleed) or blockage (clot), the affects can be far reaching.Common results of damage in the basal ganglia can include:
- movement and sensation - muscles become rigid or stiff, tremors are common and there can be an inability to move
- vision and/or speech - loss of coordination between the eyes, loss of ability to speak coherently, language problems
- judgement - attention deficits, ability to make decisions, memory
- motivation and/or personality - loss of interest, angry, depressed, laughing or crying for no reason
Stroke Recovery
This section of this essay will be very personal in nature ... I'm in the middle of recovering from a stroke in my brainstem. At first, my GP told me that this stroke is worst for people who are "Type A" (like me) and active (like me). He explained that this is now a marathon, not some short 10km race. We talk in terms of months, not weeks, for recovery. Much of the recovery will be organic - no matter how hard you work at something, most things will recover on their own time table - and they may not recover to the way things used to be. There will be a "new normal" that your body will settle into.
When he first saw me, the doctor said that we'd have a look at progress in about a year - and he was confident at that point that nobody would be able to tell that I had a stroke. For the most part, he was right. Just looking at me for a few seconds wouldn't tell you anything was out of the ordinary. If I talked, you may think that English was a second language (lots of people have asked me where I'm from). I cannot run (yet) or swim (yet), but these are things most people my age don't do anyways.
I have learned through reading and through introspection, that reaching this "new normal" will take years, not months. True that most quick progress is made during that first year, but improvement continues. The best judge of this improvement turns out to be people who see you infrequently - they have a long enough gap between visits that they can notice differences. I cannot - nor can people who are around me regularly.
So the message is - don't give up. Progress can continue. Progress will continue.
