Brain Awareness: What are Strokes and TIAs?

 “Of 100 people who have a stroke: 10 recover completely, 25 have minor impairment, 40 will have moderate impairment, 10 will require long term care and 15 will die.” David Turkel-Parrella, MD

imgres-1Dr. David Turkel-Parrella, a Neurologist and Neuro-Intervention Fellow at the University of Toronto in Canada, knows about Stroke.  His recent research  investigates factors that contribute to stroke severity and progression.  He serves as a member of the Endovascular-Interventional section of the American Academy of Neurology.  He completed a Fellowship in Vascular Neurology at the New Jersey Neuroscience Institute.

With a clinical background combining the disciplines of neurology and radiology, Dr. Parrella is working to more quickly treat strokes, limit their severity and reduce the disability they can cause.

Ischemic-Strokes-Clots_UCM_310939_Article

“Simply put a stroke is when a part of the brain is deprived of blood and stops working.  Two main ways a stroke occurs: a clot blocks blood flow to a region of the brain, or a blood vessel bursts,” he explains.

Physicians call a clot that blocks blood flow an ischemic stroke.  Blood vessels are clogged by fat and cholesterol that collect to form a plaque.

When a blood vessel bursts, it is called a hemorrhagic stroke.   Bleeding in the brain  “sometimes …[occurs] from untreated hypertension…[or] sometimes

Hemorrhagic-Strokes-Bleeds_UCM_310940_Articlefrom an aneurysm or vascular malformation that ruptures,” Dr. Turkel-Parrella explains.  An aneurysm or vascular malformation is a widening of an artery due to weakness in the blood vessel wall.

Dr. Turkel-Parrella notes that both types of strokes can be equally devastating.  “80 % of strokes are Ischemic (from a blood clot) and 20% are Hemorraghic (bleeding)… on a cellular level, stroke, left untreated, causes irreversible neuronal death,” he says.

 The symptoms of stroke can be sudden and severe:  headache which occurs when the person is lying flat and headaches that wake the person from sleep. “The worst headache of your life is an ominous sign for a possible type of bleeding stroke called SAH.   SAH is Subarachnoid Hemmoraghe, the type of bleeding that occurs when an aneurysm bursts,” says Dr. Turkel-Parrella.  

Other symptoms can be sleepiness, unconsciousness or even coma.  Sudden changes in taste, hearing, balance, vision, coordination and muscle weakness are all signs of stroke.  “If it’s a blockage of an artery, its imperative to give clot busting drugs quickly,“ he explains.

Stroke risk factors include high blood pressure, diabetes, high cholesterol, family history of stroke and being African American.  ”The most vulnerable of society are the most at risk for stroke, ”  Dr. Turkel-Parrella relates.  

Having a stroke is higher among those who are overweight or obese, who eat too much fat or salt, drink alcohol heavily or smokers.  Birth control pills can also increase the risk of stroke in women ages 35 and up.   “Hypertension is a huge contributor to poor cerebrovascular health! But it is a modifiable one!”  Yet “things that cause strokes, hypertension, diabetes, cholesterol all have a genetic underpinning.  Aneurysms also have a familial component.  In Toronto we screen all people with second and first degree relatives with an aneurysm,”  he says.

A Transient Ischemic Attack (TIA) is a warning sign that a stroke may happen soon.  Blood  flow to a part TIA-Transient-Ischemic-Attack_UCM_310942_Articleof the brain stops for a short period of time.     The person has symptoms that are like a stroke.  “A TIA by definition means the symptoms resolve,” says Dr. Turkel-Parrella.

Imaging like  MRI (magnetic resonance imaging), Doppler, CT scans play a large role in diagnosis of stroke.  “Imaging plays a role in the acute phase: what type of stroke is it? That drives treatment decisions in the Emergency Room.  CT is the main modality. MRI is more useful when you are trying to figure out why the stroke occurred,” Dr. Turkel-Parrella relates.

“In acute stroke we give clot busting drugs or use mechanical devices to go in the brains ‘blood vessels and fish out clot.” It is important to get to a hospital, preferably a stroke center, as soon as symptoms arise.  “Time is brain,”Dr. Turkel-Parrella says,  “and if you live far away from a stroke center it can be less than ideal. The percentage of those who survive stroke yet are seriously disabled can be as high as 50 percent….  ”

Dr. Turkel-Parrella has focused his medical career on stroke and he has a very good reason.  “Stroke is the third leading cause of death in the United States, 140K people die each year from url-1stroke in the United States.  Stroke represents a national healthcare crisis, and its a condition that is treatable, but more importantly often preventable.” This is what motivates his work.

“Ischemic Stroke is often caused by modifiable risk factors, social determinants of health and improved health literacy. We need to help people get access to basic primary care.  We need to improve health literacy on a basic level.  Real access to primary care is what will make the biggest impact on preventing stroke,” Dr. Turkel-Parrella says.

Based on #HCHLITSS twitter chat March 14, 2013

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Marijuana and Brain Development

How does one take the leap from this clip to marijuana use?  Crush’s description of Marlin’s journey through the “jellies” seems to be  the view of many  toward marijuana.  Laughing off “smoking a j” during high school and college with I “had some serious thrill issues.”

Thrill issues, risk taking or sensation-seeking are all attributes associated with the period between childhood and adolescence.  Usually risk-taking decreases between adolescence and adulthood.  (Although there are some people who are perpetual thrill seekers but they are in the minority.) What’s going on during this time period?

One review of the literature by Steinberg (2008) explains risk-taking as a feature of brain development.  Specifically risk-taking behavior occurs because of dramatic changes around the time of puberty in the dopaminergic system of the brain.  What’s this mean?  There are nerve cells in the mid brain called dopaminergic neurons that produce dopamine.  Dopamine is a chemical that controls voluntary muscle movement as well as mood, stress or experience of rewards, in fact quite an array of behaviors, including addiction.

Research suggests that the brain is not fully developed until age 25 (Lenroot, 2006). Between adolescence and adulthood (the fully developed brain) risk-taking behavior slows down as the dopamine system settles down.  This allows adults to self-regulate that is, think this through, control themselves, make considered choices.

Development is at a different pace for different people but these 15 or so years are important because of heightened vulnerability to recklessness.

So why have we taken this trip?  Because of a  study published this August in the Proceedings of the National Academy of Sciences.  This longitudinal study ,done in New Zealand, followed individuals from birth until they were 38 years old.  Participants took neuropsychological tests at ages 13 and again at age 38.  They were interviewed about their use of marijuana at ages 18, 21, 26, 32 and 38.

The findings were striking.  Those who used marijuana regularly, especially those who started using it as adolescents, showed a significant decline in IQ.  Additionally, family and close friends noticed the difference in their cognitive function.

So, where does this study take us?  Supporters of marijuana for casual use might say that IQ tests are questionable tools to base decisions on whether or not to use marijuana.  Others might point to a variety of other factors that might reduce people’s IQ, from environmental exposures to television or video gaming.

Though marijuana is an incredibly useful prescribed medication, this study may cause one to pause and wonder about it’s recreational use, especially during adolescence.  In the end, it is no laughing matter.

Kuehn, B. (2012).Marijuana Use Starting in Youth Linked to IQ Loss. JAMA.308(12):1196.

Lenroot, R. (2006).Brain development in children and adolescents: insights from anatomical magnetic resonance imaging. Neuroscience Biobehav Review 30(6):718-29.

Steinberg, L. (2008) A Social Neuroscience Perspective on Adolescent Risk-Taking
Developmental Review. 28(1): 78–106.

Alzheimer’s Disease

When you think about yourself…you think of your personal characteristics, how you look, how you feel.   And you think about the people you have known, your family, your friendships, locations,  where you have lived.  All those memories that make you, *you*.

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Your body’s most important organ weighs just 3 pounds.  The brain.  The storehouse of memories.

More than 5 million Americans are losing their sense of who they are.  They are losing themselves.  Fifteen million Americans are watching this happen, losing their loved ones slowly.  They are the caregivers.

Alzheimer’s is a terrible, terrible disease.  For a terrific description of our brain and what happens during Alzheimer’s, go to the Brain Tour.  After you’ve had a quick review on that site, take a look at this video  (unfortunately not developed with Plain Language in mind) which also describes the processes.

A Slice of Life?

Have you ever been to a brain slicing? 

I have and I must say it is as gruesome as it sounds.  I attended brain slicing one summer in college at UNC Medical School.  The chief slicer was a pathologist with the bushiest eyebrows I have ever seen.  He would waggle them at me just before he put the person next to me on the spot with a question.  Often he would waggled those wooly worms at a student and hand over the knife.  That poor med student had to cut the brain of someone whose pulse they had taken the day before. 

Needless to say, brain slicing was one reason I decided not to go to medical school.  However I digress.

The reason I’m going into all this is because of the recent study on strokes, in the journal Stroke.  Apparently, the shuffling gait that we have associated with “old age” may not actually be a phenomenon of age but of cardiovascular disease.  Tiny strokes in the brain may be the cause of a loss of balance, rigidity and loss of mobility.   These changes can’t be seen at the macroscopic level of a brain slicing session.  These changes are microscopic but significant.  So how does this study forward health or our existence?  Well, according to Aaron Buchman, the lead author of the study, what we thought was an inevitable result of getting old may not be inevitable but may be preventable and could be treated. 

In the meantime, the one thing I learned from my experience in brain slicing was to stay away from men with bushy eyebrows…they creep me out.

See the NPR story here.