Page 24 - Boca Club News - December '23

Page 24, Boca Club News
Medical Matters: Stroke (Part One)

By Richard Nagler, M.D., a member caused by a small blood clot formed on ruptured plaque in The most important risk factor for a TIA—or full-blown
of Broken Sound Club and retired an artery that supplies blood to the brain, or by a clot that stroke—is the problem of uncontrolled hypertension that
physician. After graduating from the travels to the brain–usually from the heart seen in cases of affects millions of people and is not only a major factor
University of Pennsylvania and New atrial fibrillation (A Fib). This temporary loss of blood supply in strokes, but in coronary artery heart disease and kidney
York University’s School of Medicine, to the brain can last for as short a time as five minutes or up disease as well. Other important risk factors include: a family
Dr. Nagler served his internship and to several hours, after which there is usually a full return to history of strokes; being 55 of age or over, males slightly
residency at Baltimore City Hospital normal. The reason for this is that small clots are likely to greater than females; being an African American; elevated
and Johns Hopkins. He followed that spontaneously dissolve, restoring blood flow to the brain LDL cholesterol, which contributes to plaque formation in
with a Fellowship in Gastroenterology before permanent damage occurs. arteries; diabetes; cigarette smoking; alcohol abuse; obesity;
at Yale University School of Medicine, and was then Chief There is a sudden onset of symptoms that include: insomnia; sleep apnea; physical inactivity, and too much salt
of Gastroenterology at Fitzimmons General Army Hospital weakness; numbness or partial paralysis of the face, arm and and fat in the diet. Drugs like cocaine, methamphetamines
in Denver. He returned to the Yale Medical School for one leg on one side of the body; confusion; slurred or garbled and birth control pills are implicated.
year as an Assistant Professor of Medicine before opening speech; difficulty understanding others; temporary blindness Prompt medical attention is important when a TIA is
his own successful private practice in Internal Medicine in one eye or double vision; vertigo; loss of balance and suspected. Physical examination includes a blood pressure
and Gastroenterology. During that time, he also served for coordination, and a headache. determination where a high blood pressure reading is
ten years as Chief of Medicine at Huntington Hospital in Since symptoms usually disappear quickly and the person expected, palpating the carotid arteries in the neck to
Huntington, N.Y. returns to being completely normal, the person tends to ignore determine the strength of a pulse, as well as listening with a
There are three million new cases of stroke each year the incident, which can prove to be disastrous. That is why a stethoscope for bruits, which are whooshing sounds as blood
with 800,000 deaths, making it a leading cause of death in trusted doctor-patient relationship is so important, providing passes over a partially obstructed area. An eye examination
the United States, but it is the number one cause of disability an opportunity for the doctor to sit down with the patient of the retina can reveal emboli in the tiny blood vessels.
in more than six million people, mostly over age 65. and family and thoroughly explain how serious the incident A blood test for the level of the protein homocysteine is
A stroke is defined as when the blood supply to the is, and that the risk of a full-blown ischemic stroke is likely useful. In addition, an ultrasound examination of the carotid
brain is interrupted or diminished, depriving it of essential without treatment. Diagnostic studies can then begin for the arteries, which can demonstrate narrowing and clots, is
oxygen and nutrients and resulting within minutes of brain cause of the TIA and essential treatment started immediately. advised. A CT scan of the head, an MRI and CTA (CT scan
cells beginning to die. In contrast to most other cells in the TIA is caused by diminished blood flow to the brain from which includes injection of contrast material into the blood
body, brain cells that are dead cannot be replaced; whatever a buildup of plaque, usually in the carotid arteries that are in vessels) are all important to rule out other conditions that can
bodily functions they controlled will be permanently disabled. the front of the neck and the smaller branches close to, and mimic a stroke, such as a brain tumor.
This is why we so often associate people who have suffered in, the brain. Fragments of the plaque, or blood clots that tear An echocardiogram to detect clots in the atrium of the heart is
a stroke as wheelchair bound with paralysis. We must do away from it, block the flow of blood. routinely employed. Arteriography, which involves the injection
everything possible to prevent a stroke, and if it is in progress The other major cause of stroke is a complication of A of dye directly into the arteries followed by x-ray imaging, is
to intervene quickly before there is irrevocable brain death Fib, which affects as many as 20% of seniors over 65 and effective in determining the degree of obstruction. Treatment of
and disastrous consequences. six million people nationwide. It is an irregular heartbeat, a TIA, even when the symptoms have completely disappeared,
There are three kinds of strokes: TIA (transient which may be rapid or slow. When it is rapid most people should include an anti-platelet medication such as Plavix or
ischemic attack); a full-blown ischemic stroke, and a will seek medical attention because of symptoms such as anticoagulants like heparin, Coumadin, warfarin, or such newer
cerebral hemorrhage. palpitations, short of breath, dizziness, weakness and chest oral agents as Eloquis and Xerelto, which are very effective in
One-third are caused by a TIA, also characterized as a pain. It is usually easily diagnosed by a doctor feeling the preventing a subsequent major stroke from a blood clot, and
mini stroke. There are at least 240,000 people in the U.S. irregularity in the pulse, or by listening to the heartbeat and they should be continued indefinitely. When the carotid arteries
each year who have a TIA. having it confirmed by an EKG. are diseased an endarterectomy-–where plaque is surgically
One in five such cases, if untreated, will have a full-blown When it is slow there are usually no symptoms, and the scraped out, or an angioplasty that involves inserting a balloon
stroke within 90 days. Fifty percent will have a stroke, a heart irregular heartbeat so subtle as to escape detection other device into a clogged artery and then a stent to keep it open–is
attack or die within one year. Thus, a TIA is a significant than by an EKG. In A Fib, blood clots form in the heart and a common and very effective preventative treatment.
warning sign that warrants immediate medical attention. It travel to a smaller artery near or in the brain and obstruct In next month’s Medical Matters column: Part Two of
involves a temporary diminution of blood supply to the brain blood flow. Strokes.