Tag Archives: Strokes

Strokes: Subarachnoid Hemorrhage Treatment

Subarachnoid hemorrhages account for approximately 1.2 million cases of stroke each year, and nearly 40% of those cases are fatal. Dr. Rabih Tawk, a Mayo Clinic neurosurgeon explains the early signs of a subarachnoid hemorrhage and how it’s treated.

Bleeding in the space between the brain and the tissue covering the brain.

Subarachnoid hemorrhage, a medical emergency, is usually from a bulging blood vessel that bursts in the brain (aneurysm). It may lead to permanent brain damage or death if not treated promptly.

The main symptom is a sudden, severe headache.

Hospital care is needed for supportive care and to stop bleeding and limit brain damage. Treatment may include surgery or catheter-based therapy.

Stroke Care: Deep Brain Stimulation ‘Pacemaker’ Restores Hand Movement

Deep brain stimulation for patients who experience a stroke.

Deep brain stimulation is a surgical procedure that involves implanting electrodes in the brain, which deliver electrical impulses that block or change the abnormal activity that cause symptoms. (Courtesy: Cleveland Clinic)

“He had limited use of his hand. It really wasn’t functioning,” explains Andre Machado, MD, PhD, who is Chairman of the Cleveland Clinic Neurological Institute. “He couldn’t do as much manual work, with both hands, and that was a limitation for his quality of life.”

For the study, Joe first underwent two surgical procedures — one to insert the DBS device under the skin of his chest, just below the collarbone, and the other, to implant the DBS electrode in a part of the cerebellum called the dentate nucleus. Once activated, the device, called an implantable pulse generator, serves as a specially-calibrated pacemaker for the brain, stimulating it to try and enhance motor rehabilitation.

COMMENTARY:

Many times in science, application precedes understanding. Deep brain stimulation, either by electrical or magnetic pulses is a good example.

It is not at all understood how the brain really works, much less how electrical and magnetic stimulation in the brain works. It may stimulate or slow down neural impulses, or interrupt the incoming signals or the outgoing messages. Are there any other possibilities?

At least it does work, Apparently.

One thing for certain is that deep brain stimulation is preferable to previous treatments, which produced small, destructive, irreversible lesions in the brain. At least these stimulations can be stopped if they don’t work.

I enjoyed this posting, since it reignited my interest in the cerebellum. This amazing Organ has more neurons than the rest of the brain combined, represented by innumerable small granule cells. I wasn’t even aware of the dentate nucleus, which is an island of cerebral cortex-like neurons in the white matter of the cerebellum. Apparently the action of the cerebellum is orchestrated through this and a couple of other islands of neurons. All of the coordination, movement, and thought processing accomplished in the cerebellum takes place through these nuclei.

It was also fascinating to learn of a patient who has complete lack of a cerebellum, and suffers only some mild incoordination and speech problems. Apparently, absent the cerebellum, the rest of the brain is largely capable of taking over the function of the missing cerebellum. Once the brain is formed, However, and dependent upon the cerebellum, damage to this organ causes a great deal of coordination, movement, and balance problems.

I’ll put another plug-in for sleep, diet and exercise, as well as being careful with your body. Prevention is far better than treatment.

—Dr. C.

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Hospital Tech: The Johns Hopkins Stroke Center

The mantra of The Johns Hopkins Hospital’s Comprehensive Stroke Center is “time is brain.” Innovations and teamwork help ensure that this mantra applies to all stages of stroke recovery. Take a peek into the multifaceted treatment strategies offered by the center’s team of experts.

These include stroke risk screenings, hyperacute emergency treatments, innovative hospital care such as digital therapeutics, early rehabilitation, programs to ensure smooth transitions to home, and cutting-edge clinical research. The Stroke Center team is on a mission to improve the life of every patient who has had a stroke. #Stroke #JohnsHopkins

Emergency Care: Flying Intervention Team Use In Acute Ischemic Stroke

In a nonrandomized controlled intervention study published in JAMA, researchers in Germany assessed whether deployment of a flying interventional team, consisting of a neurointerventional radiologist and an angiography assistant, was associated with a shorter time to endovascular thrombectomy for patients in rural or intermediate population areas in Southeast Bavaria.

This video explains the study design. Click https://ja.ma/FIT for full details.

COMMENTARY:

Stroke prevention by a healthy lifestyle, including a good diet, regular exercise, and sleep is of course preferable to treatment.

However, stroke still claims more than 100,000 lives per year in the United States, and is a major factor in disability.

Recognition of a stroke is the first crucial step, and has been discussed in DWWR previously; FAST is the Menmonic and guiding principle. Ask the patient to smile, and it may be assymmetric, with one side drooping. Ask the patient to raise both arms, and one may drift down. Ask the patient to repeat a simple sentence, and he may be unable to do so. And above all be speedy, since time is of the essence, and treatment must take place within a very few hours.

Modern medical centers in large cities frequently have a team dedicated to treating stroke. The patient goes for a CT or MRI while  the Catheter team assembles. An intravenous clot dissolver, tPA, is often used, or possibly a catheter is inserted into an artery and guided to the  proper location. Sometimes the clot is mechanically removed as in the accompanying video.

The helicopter stroke response team featured in the posting is one aspect of the speed that is so essential; any delay will result in death, sometimes permanently, of brain cells.

Acute Heart attack treatment is basically similar to stroke, and was the pioneering venture into the interventional radiology described above. Also, the heart may be the source of the clots that lodge in the brain, especially from atrial fibrillation.

Please enjoy the following video which shows how mechanical clot removal is achieved.

—Dr. C.

Neurovascular Disease: Stroke Awareness & Care

Mayo Clinic’s Eugene L. Scharf, M.D., Robert D. Brown Jr., M.D., M.P.H. and Harry Cloft, M.D., Ph.D. discuss how the team at Mayo Clinic provides each patient individualized care to help maximize quality of life. 700,000 to 800,000 people in the United States have a stroke each year. Many people can lower their risk of stroke with medical risk factor modification. When a stroke occurs, prompt treatment is crucial. Every minute counts and can reduce brain damage and other complications. “Some patients who would have had a devastating stroke come out of the hospital with no deficient, no difficulties whatsoever,” says Robert D. Brown Jr., M.D., M.P.H.

Studies: Salt Substitutes Lower Stroke, Death Risks

Heart Health: What Is Cholesterol? (AHA Video)

There are two types of cholesterol: LDL cholesterol, which is bad, and HDL, which is good. Learn why too much cholesterol and elevated triglycerides can lead to heart disease and stroke. Make it a priority to have your cholesterol checked.

Brain Health: How To Recognize Strokes (Video)

If you don’t know the signs of a stroke, you’re not alone. Thirty percent of people under the age of 45 don’t either. The key is to B.E. F.A.S.T. Learn how this acronym can help you save a life. The information in this video is accurate as of 9.17.21 and is for information purposes only. Consult your local medical authority or your healthcare practitioner for advice. Resources: Stroke: Causes and Prevention: https://cle.clinic/3hIHtab Stroke Signs & Symptoms: https://cle.clinic/3oLyQhc Stroke Risk Factors: https://cle.clinic/3hJ8r1s