Stroke, Brain Principles, and Health Care Proxies

Hope you had a better weekend than I did. While covering two hospitals for three days I was called to see nine patients. Three of them had strokes. Two of those died. One of the stroke patients had an ischemic stroke. Part of his brain didn’t get enough blood. Not enough blood means not enough oxygen and glucose. Many brain cells died. Unfortunately his stroke was very large, and on the dominant side of his brain.

There are two very important principles when talking about the brain. You have probably heard that one side of the brain controls the opposite side of the body. That is how the cerebrum, the upper part of your brain, is mapped out. That is contralaterality. A second extremely important principle is cerebral dominance. Each brain hemisphere controls motor function and sensation of the other side of the face, and the opposite arm and leg. Some functions, like memory, are shared by both sides of the brain. But there are some activities that only one side does. The big function here is language. One side of your brain gives you the ability not only to express yourself, but also to understand others. In 95% or more of right handed people, and 60% to 70% of left-handers, the left hemisphere is dominant for all language functions. That means ALL language. So if your dominant hemisphere, (the left side in most people), is severely injured, you may no longer be able to speak, understand others, read, or write. Usually just a portion of the dominant hemisphere is damaged. The person may be able to speak in broken phrases. Or maybe they can understand but can’t speak at all. Or they speak gibberish and nothing makes sense. Sometimes the person can speak, but obviously can’t understand a word you’re saying. What sort of life would it be if you suddenly lost all ability to communicate?

One of the patients I saw had such a large stroke that he was comatose. The damage was so extensive that it was clear he would never wake up. Because the stroke involved his left dominant hemisphere he would never again be able to communicate. He would never be the person he had been, the father his son remembered. His son and I sat by the bedside and talked about that. I described the extent of his father’s stroke, what the brain CT looked like, and what my findings on his father’s neurological examination meant. Surgery was not going to help. He talked to me about his father. He knew that his father would not want to have his life prolonged on a ventilator. By the next morning his father had died.

What are the lessons here?

Lesson #1: even with all the wonders of modern technology, there are things that we cannot fix. So let’s avoid stroke at all costs. You have only one brain. Take care of it! Follow the 10 steps.

Lesson #2: Speak to your family, a close friend, your doctor, someone. Tell them what you want in the event that you are unable to speak for yourself. Pick a health care proxy and speak to that person. Don’t make family members, friends, and doctors play guessing games.

 

Every Day ….. Say NO To Stroke!

AB Fraser, MD