It is the start of the New Year and I want to begin by wishing all the readers of my blog a very happy and healthy New Year 2013. May you all be blessed with not only a healthy brain but also a healthy mind!.
I decided that my first post in the New Year 2013 should be on strokes and more importantly on how to recognize a stroke in a timely fashion and how to prevent it. After all a stroke prevented is a brain saved.
So let us begin without delay. Keeping things simple the best way to describe a stroke is to compare it to a heart attack. A heart attack occurs when one of the main arteries of the heart suddenly gets blocked. The sudden lack of blood flow leads to ischemia of the heart (basically the part of the heart supplied by that blood vessel does not get blood/oxygen and if the blocked artery is not opened/ recanalized in time irreversible death of cardiac muscle/tissue occurs). Something similar happens during a stroke and hence sometimes strokes are referred to as brain attacks. A blood vessel in the brain either gets blocked (ischemic stroke) or ruptures (hemorrhagic stroke) and if not opened in time the part of the brain supplied by that blood vessel perishes. The signs and symptoms of the stroke depend upon which part of the brain is involved.
Warning signs of a stroke:
1. Sudden onset of weakness in the arm and leg on one side of the body (for example abrupt onset of motor weakness in the right arm and leg usually indicates ischemia/lack of blood flow or hemorrhage involving the left side of the brain). That said strokes may be more subtle or unusual in their presentation–weakness in only one arm or one leg, weakness in one arm and contralateral face and so forth.
2. Sudden onset of numbness (loss of sensation but no marked weakness) on one side of the body. Again presentation may be more unusual–abrupt onset of numbness one side of face or just in one arm.
3. Sudden onset of vision problems–double vision or loss of vision in one eye or loss of vision in one half/part of visual field.
4. Sudden onset of difficulty walking or balance–unable to walk in a straight line, dizziness (not all dizziness is stroke though).
5. Sudden onset of speech difficulty–either unable to speak (words are mumbled, not clear, language difficulty), unable to comprehend speech.
6. Sudden onset of complete loss of hearing in one ear (rare form of stroke).
7. Sudden onset of a combination of the above symptoms-usually this is the case.
One of the major problems with stroke is that frequently the symptoms and signs are very subtle and may be ignored by the patient and his family/friends. By the time the patient seeks medical attention, the stroke is already completed (remember when it comes to stroke–TIME IS BRAIN) and the damage is already done. In the case of a heart attack the signs are hard to ignore–sudden onset of squeezing chest pain along with sweating and a sinking sensation. Patients are forced to go to the hospital and seek attention. On the other hand the brain is far more quieter when it suffers a brain attack–no pain, no sweating just quiet suffering of the ischemia.
So what to do when you or someone close to you is suffering a stroke? The most important thing is not to delay seeking attention. You can only be helped if you reach the hospital in a timely fashion ideally within the first hour to 90 minutes of the stroke. So seek attention at once. It is better to reach the hospital and be told that you misread your symptoms and did not suffer a stroke rather than reach late when nothing can be done to help you apart from supportive care.
So let us start the New Year 2013 by preventing strokes. Remember your brain is your best friend. Protect him, nourish him, take care of him.
Nitin K Sethi, MD
Braindisease's Weblog 
This info. Was straight to the point and clear(easy to understand). Thanks! My husband and I both found it informative. Truely thank you!!!!!
Dr. Sethi,
My 83 year old mother suffers from “Dementia/Alzheimer’s”. She has had 6 mini strokes in the past. She has been on Namenda and Aricept for years now. This past year she and my dad(her primary care giver) moved 600 miles to live with me due to health issues with my dad. They stayed with me for 3 months before moving into an assisted living facility. I have tried to get her into a neurologist since moving her to Columbus Ohio since last January with no success. We are on multiple waiting lists. Her last CT showed significant cerebral volume loss, diffuse decreased vascular flow to the white matter. At this point her PCP is managing her care. My 85 year old dad is at his wits end and is wanting to try “alternative” treatments such as MCT and coconut oil; pycnogenol, and increasing her ketones. While I appreciate his desire to see her get better I am concerned he will make her worse. Is there any documented evidence of alternative treatments that help with dementia? Any ideas on how to get her in to see a Neurologist who specialized in Dementia?
Thank you for your time and for any assistance you might be able to give.
Sincerely,
I was told that I have been having mini-strokes. I have been suffering from major left sided headaches at first they were followed by facial numbness but after years the numbness will come on on its own then i feel as if I drooled a little. In Jun 2003 I had my first MRI it showed a couple minor lesions. I had another MRI in Jun 2004 and this time it showed a few tiny lesions, small white matter abnormalities gliosis, vasculitis small vessel ischemic change. So now I went to a Neuro and he has me on Topamax and Remeron but these are not working. I used to get a couple headaches a week but now I am getting 7-9 even 10 headaches a day and the facial numbness is always there and yet there seems to be nothing else that can be done! This last MRI in August 2011 shows multiple lesions with plaque buildup and doc has me taking a small dose of baby aspirin everyday. He says I’ve had a handful of mini-strokes and that we need to get a hold of this before it gets worse…”REALLY” well this morning I woke up my left side of my face was completely numb and I had drooled all over my pillow. I called the doctor and he said to up my topamax thats not an answer for me. Something is causing this and instead of masking the problem with pills I need to know why this is happening?? I’m too young for this…………Please help me………
Dr Sethi, I was hit hard on the head when I ran into a piece of angle iron affixed to an airconditioner. Likely concussion. Days afterwards, my right eye started to be blurry off and on. CT w/o contrast showed no bleeding or fracture in the brain. Within a month, I started getting ocular migraines with aura, I think in both eyes with zizzag edges of a sideways, with a blind spot in front of me in both eyes. The triangle would expand and go away in 30 minutes. This would happen 2-3 times a month, for 9 years after the injury. Then recently, at the end of one of these migraines, I had difficulty speaking, resulting in an MRI with an observation of a few punctuate lesions in the deep white matter, otherwise normal brain MRI–except for some moderate sinus inflamation. I have not had any ocular migraines with aura since (3 months)b ut I have recently been diagnosed with monocular diplopia due to Dot Map Fingerprint with small cataract. Could the migraines, cataracts or DMFP in your opinion have resulted from blunt head injury?
I have a history of stroke in my family. Recently about a month ago I had an episode of vertigo, which now the doctor thinks that is it vestibular neuritis. I still am having problem with gait and now am concerned that about a year ago I had a MRI of the brain due to having headaches all the time which just showed some frontal white matter and sphenoid sinus disease. Could this possible to prelude to MS, I do have a family member that has been diagnosed with this. thanks for you healp
I am 48 year old women and i had MRI of my brain which says multiple foca and patchy areas of altered signal intensity appearing hypointense on T1 weighted and hyperintense on t2 weighted anf flair images are seen in bilateral and periventricular white matter. There is no evidence of restricted diffusion in any of the lesions and rest of the brain parenchyme is normal in signal intensity and other things are also normal and also pituitary gland is homogenous in signal intensity.
I have headache vomitiing problem and also high blood pressure. Doctor says it is common in migraine and these spots may be due to migarine but the mri report says ischaemia demyelination.. please tell me if everything is right or not..
Dear Supriya,
thank you for writing in. As I stated in the post there can be multiple causes of white matter disease/ signal change in the brain. Your doctor shall be the best person to determine what is the cause of the white matter signal abnormality noted on brain MRI.
Personal Regards,
Nitin K Sethi, MD
I read your post on strokes and white matter diseases. Your information are very useful and helpful. You are giving so much of your time to make people aware about these things. Thank you for your message. I was just a bit nervous if there is everything fine or not. I read somewhere that changes in periventricular is the thing to take care off.My CT scan was normal. I hope things are not negative. I read alot on white matter changes, may be this could be the reason which is making me uncomfortable..
It started some three and half years ago I started feeling some giddiness and mild vertigo for one month. After that (nearly 2 months after that) It was feeling like I have less strength in my left hand and leg . I had a CT scan done but nothing unusual was noticed . In between i was treated with some neurobeaon which didnt worked, then 2 years back I again consulted Neuro and was advised for MRI brain and Neck but nothing was noticed in that.
Main problem was to describe my weakness as I always passed physical examination by Neuro, whereas main problem was relative weakness ( i dont know what to say it Muscle weakness of left side, weakness or muscle spasm or what) It came and gone and there had been 5-6 episodes. And best thing i can describe about my weakness is that, I have to bother even my neck muscles if i am trying to lift a jug of water and it felt like i am having all my weight on left leg during those episodes.
Now before one month i had another MRI in which says “Non specific white matter ischemic changes in bilateral frontal lobes”. before that I was having TMJ like symptoms at my right side of face and now since 20 days i am feeling same weakness at my right side to ( right leg right hand and right face too ) it feels like muscles at that side are very tired.
I am not able to compare weakness of left and right as when i am having problem in right side, left surely feels good but one thing is sure left side is also not as good as it used be and neither i can say that weak also.
I just wanted to know whats this and where it is heading. Thanks in advance