Director, Emergency Services, Bikur Cholim Hospital
Sharon's condition has been in the daily news and there is a
lot of confusion. I will take this opportunity to clarify
what is going on.
We have discussed stroke many times. Stroke comes in two
varieties: ischemic and hemorrhagic. The former is due to
clots, or pieces of cholesterol plaque, that break off and
lodge in the arteries of the brain, causing lack of blood
supply and death of that part of the brain. Since the brain
has distinct areas of control (that is, the back part
interprets what you see, the front part controls personality,
the side part movement, etc.) loss of that area could lead to
inability to speak, or to the loss of the use of a leg or arm
or another impairment.
The source for clots is usually the heart (such as in atrial
fibrillation where the heart does not beat normally and so
clots can form in the heart chambers) or the carotid
arteries, the chief source of blood flow for the brain. These
arteries are located in the neck and can get clogged by
cholesterol. Small clots can also form.
Sometimes the arteries in the brain harden from years of high
blood pressure, cholesterol or age. They can easily rupture
and that can cause the other type of stroke —
hemorrhagic. These are more devastating.
The former type of stroke can be prevented through the use of
aspirin, or occasionally blood thinners, if the source is the
heart, or cleaning out the arteries. There is also a
treatment for this stroke, and physiotherapy is usually very
helpful as well.
The latter stroke has fewer options, and the only available
treatment is surgical if the bleed is in an accessible
place.
In Sharon's case, there was a small hole in his heart from
birth which was enough to slow down blood flow such that
clots could form. As a result he had the first type of stroke
and was put on blood thinners to prevent a recurrence. This
was the correct treatment, and I would still recommend it to
anyone who is not in danger of falling.
However, Sharon turned out to be a poor risk. His age and
poor health status predisposed him to bleeding. I did not see
his CT, but in general in such cases the prognosis for
recovery is poor and the surgeries that were done were very
aggressive and of questionable use. Of course time will
tell.
The take home messages for you are: Take good care of
yourself, keep your weight under control, exercise, and at
first signs of stroke go to a doctor.
This should give you a better handle on all that is
happening. Write me in care of the Yated.
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