By Tedler D. Depaynos, MD
The young lady patient was just 25 years old. Every day, she walks 1 ½ km. to her place of work carrying with her an umbrella to shade her from the sun or rain. She never felt anything so she never had any medical consult except in their office where sometimes her BP was routinely taken which was always normal. It was one late afternoon while walking home when she felt a little weakness on her right leg while going down the stairs followed by a weakness on her right arm carrying her umbrella. She was able to reach home but then her home companions were surprised because her speech became slurred. She was then rushed to a nearby hospital where she was diagnosed to have had a “stroke”.
This reminded me of my three surgical colleagues who also had attacks of “stroke”. The first one had his attack while doing surgery. It was a difficult one but with his training he could have breezed thru it. Besides, whenever he did long playing operation, he always took a break so that he is known to be a relaxed surgeon. The other one practically just retired from surgical practice and was concentrating in his wide farm in the lowlands composed of a substantial piggery and vast rice fields. The third one enjoys more of being a professor and did surgery from time to time. What is common to them is that they were all leading a non-stressful existence. All of them abhor smoking and alcoholic drinks. They were all slim looking and they did a lot of physical exercises especially the retired one who opted to be a hands on farmer and the professor who was observed to be having walking exercises either in Camp John Hay or Burnham Park.
From our textbooks, there are a number of factors that make one prone to suffer not only stroke but other diseases. Just like the young lady patient my colleagues apparently observed healthy living but unfortunately, they still felt victims to the unexpected and dreaded disease. As the saying goes “malas kong malas mo” or “if it is your time, it is your time”.
These incidents however should not discourage us to avoid the factors making us prone to the disease especially if you have a family history of “stroke”. Statistics will still confirm that the incidence of stroke is still higher for those who took no extra time or effort to avoid those risk factors than those who took time.
Stroke has something to do with the brain. The brain is divided into two hemispheres, the left and the right. Each side has a specific blood supply with branches to be able to supply its respective area. The blood carries oxygen to the brain and when this is cut off even just for three minutes, the area of the brain deprived of oxygen necroses. The dying brain will initially swell compressing the adjacent brain tissues depriving them likewise of the much needed oxygen before it would eventually shrink and become a scar tissue with time. This is what happens in stroke. So even if only a small blood vessel is involved a wide area of the brain would be affected.
Depending on the severity of the injury, the patient will usually complain of headache, nausea and vomiting, dizziness and even loss of consciousness. If the patient survives, the manifestations will depend on what area of the brain was involved. Since the widest area is responsible for the muscular and sensual areas, the most common manifestation is permanent paralysis and loss of senses. Hence stroke patients could be seen with paralysis or weakness on one side of the body. Rehabilitation may be done to develop the adjacent muscles that are not or partially affected, to increase the blood supply and to prevent contractures.
In the majority of individuals, the right side of their body predominates. Most often they are right sided. If you are right sided, the predominating brain hemisphere is the left. And likewise if you are left sided the opposite brain hemisphere also predominates. Hence if the paralysis is on the right side, the affected brain is the left hemisphere. The nerves from the brain going to the lower parts of the body somehow crosses at the area of the neck going down the opposite side.
Deprivation of oxygen would mean that the blood supply is cut off. There could be blockage of the blood vessel or rupture causing leakage. The liquid blood may also somehow coagulate or becomes clotted causing blockage. The clotting may have occurred somewhere else like in the heart and was thrown into the cerebral blood supply as an embolus.
A rupture called intra cerebral hemorrhage (ICH) may be due to excessive hypertension (HPN) and this may be associated with weakness of a portion of the blood vessel due to age or due to a congenital defect called aneurysm. Intra cerebral hemorrhages in younger individuals like the young lady patient are usually associated with congenital aneurysms. Depending on the amount of blood leakage, the patient may undergo surgical drainage. Most of the time, however, if drainage is contemplated the patient is in coma and the prognosis is poor.
In this case, HPN is a major factor in causing the stroke. Nothing could be done with the weakness but definitely HPN can be controlled.
The blocking of the blood vessel may be due to lipid deposits made up of cholesterol, triglycerides and high density lipoproteins (LDL) along the inner walls of the vessel. The accumulation took years and even decades. It does not happen overnight. The lumen will gradually decrease in size reducing the much needed blood supply causing ischemia. In some studies, it is found out that smoking would cause vascular spasm worsening the decrease in blood supply. Depending on the size of the blood vessels, they may eventually be obstructed. The deposits or plaques may also get dislodged and they may block suddenly the blood vessel. Hence, abnormal level of lipids is another factor. Of course the other diseases that may affect the cholesterol or lipids level like diabetis mellitus should also be considered as risk factors. Hence in treating the abnormal lipid levels, treatment of the concomitant diabetis is a must.
Blood clots forming in the heart are usually associated with irregular heartbeats or arrythmia. It may be associated to a viscous blood which is very prone to clotting. A cardiac examination and evaluation is therefore required and the clotting mechanism determined in the laboratory. Anti- clotting drugs or even aspirin at children’s dosage is usually prescribed to combat this viscous blood.
To control these negative factors medicines are routinely prescribed. They are monitored by regular consultations and laboratory follow ups. Most of the time, the medicines should be taken for life. They are taken for maintenance. With them, strict dieting and exercise are definitely advised. Diseases like osteoarthritis and gout that makes individuals sedentary are also treated. Smoking is taboo and likewise, excessive alcoholic intake.**
