Having a CT scan involves lying on your back, with your head positioned inside the scanner. It takes about five to ten minutes and is completely painless. The doctor may want a scan done after dye is injected into one of your veins, so the injection might be a bit painful. If you are allergic to iodine, make sure the doctor or radiographer knows – in most cases a scan using a dye is not essential.
An MRI scan also involves your lying on your back, and you go into an enclosed tunnel; the machine is quite noisy. (They may play you your favorite music while the scan is being done, to make it slightly more pleasant.) As with a CT scan, it takes only a few minutes, depending on how many bits have to be scanned. The MRI machine contains a very powerful magnet, so, if you have any metal bits inside you or a pacemaker, you probably won’t be able to have the scan. (It is also very good at wiping clean the magnetic strips on your credit cards!) The tunnel can cause problems for people who get claustrophobic but, because the MRI scan can provide information much more easily than the alternatives, if your doctor advises one, it might be best to grit your teeth and get on with it. If you really think it might be too much, ask if it is possible to have a short-acting sedative to help calm your nerves.
Difference between a CT scan and an MRI Scan
Labels: claustrophobic, CT Scan, MRI, radiographer
Recovery after Brain Hemorrhage
The process of rehabilitation will be specific to you, and will depend on your symptoms and their severity. A team of specialists are available to help, including physiotherapists, psychologists, occupational therapists, speech therapists, and specialist nurses and doctors.
The damage that a stroke causes to your brain can impact on many aspects of your life and well-being, and depending on your individual circumstances, you may require a number of different treatment and rehabilitation methods
- depression - many people find that they experience intense bouts of crying, and feel hopeless and withdrawn from social activities, and
- anxiety disorder - many people experience general feelings of fear and anxiety, often punctuated by intense, uncontrolled feelings of anxiety (anxiety attack).
Labels: Brain, Brain Hemorrhage, Recovery
Brain Hemmorhage - Stroke Treatment
You will also be given a regular dose of aspirin as this makes the cells in your blood, known as platelets, less sticky, reducing the chances of further blood clots occurring. If you are allergic to aspirin, other anti-platelet medicines are available.
AnticoagulantsYou may also be given an additional medication called an anticoagulant. Like aspirin, anticoagulants also prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Heparin and warfarin are two anticoagulants that are commonly used.
Anticoagulants are often prescribed for people who have an irregular heartbeat that can cause blood clots.
Blood pressureIf your blood pressure is too high, you may be given medicines to lower it. Two medicines that are commonly used are:
thiazide diuretic - which reduces the amount of water in your body and widens the blood vessels, which decreases blood pressure, andangiotensin converting enzyme (ACE) inhibitors, which widen the blood vessels and reduce blood pressure.StatinsIf the level of cholesterol in your blood is too high, you will be given a medicine known as a statin. Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.
Carotid stenosisSome ischaemic strokes are caused by a blockage in the carotid artery, which is an artery in the neck. The blockage, known as carotid stenosis, is caused by a build-up of fatty plaques.
If the carotid stenosis is particularly bad, surgery may be used to unblock the artery. This can be done using a surgical technique called a carotid endarterectomy, which involves the surgeon making an incision in your neck in order to open up the carotid artery, and remove the fatty deposits.
Haemorrhagic strokesEmergency surgery is often required to treat haemorrhagic strokes in order to remove any blood from the brain, and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.
During a craniotomy, a small section of your skull is cut away to allow the surgeon to gain access to the cause of the bleeding. The surgeon will repair any damaged blood vessels, and will ensure that there are no blood clots present that may restrict the blood flow to your brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced.
Following a craniotomy, you may have to be placed on a ventilator. A ventilator is a machine that assists you with breathing. It gives your body time to recover by taking over its normal responsibilities, such as breathing, and it will also help control any swelling that you have in your brain.
You will also be given medicines, such as ACE inhibitors, to lower your blood pressure and prevent further strokes from occurring.
Transient ischaemic attack (TIA)The treatment for a transient ischaemic attack involves addressing the conditions that led to it, while trying to prevent those conditions causing a bigger, more serious stroke.
If you have a TIA, the treatment that you receive will depend on what caused it, but typically, you will be given one of the medicines outlined above, or a combination of them. So, if high blood pressure, and high cholesterol levels put you at risk of having a stroke, you may be given a combination of statins and ACE inhibitors.
If the risk of a stroke is very high, due to a build-up of fatty plaques in your carotid artery, a carotid endarterectomy may be required.
Symptoms of Brain Hemorrhage
The symptoms of a stroke depend on what part of the brain and how much of the brain tissue is affected.
Stroke symptoms usually come on suddenly—in minutes to an hour.
There is usually no pain associated with the symptoms.
The symptoms may come and go, go away totally, or get worse over the course of several hours.
If the symptoms go away completely in a short time (fewer than 24 hours), the episode is called a transient ischemic attack (TIA).
A third of all strokes occur during sleep, so people first notice the symptoms when they wake up.
These are the common symptoms of stroke:
- Weakness in the arm or leg or both on the same side: This can range from total paralysis to a very mild weakness. Complete numbness or a pins-and-needles feeling may be present on one side of your body or part of one side of your body.
- Weakness in the muscles of the face: Your face may droop or look lopsided. Speech may be slurred because you can't control the movement of your lips or tongue.
- Difficulty speaking: You can't speak, speech may be very slurred, or when you speak, the words sound fine but do not make sense.
- Coordination problems: You may seem uncoordinated and stumble or have difficulty walking or difficulty picking up objects.
- Dizziness: You may feel drunk or dizzy or have difficulty swallowing.
- Vision problems: You may develop difficulty with vision, such as double vision, loss of peripheral (side) vision, or blindness. (Blurred vision by itself is not usually a symptom of stroke.)
- Sudden headache: A sudden, severe headache may strike like "a bolt out of the blue." Some people have called this the worst headache of their lives.
- Loss of consciousness: You may become unconscious, stuporous, or hard to arouse and could die.
Causes of Stroke - Brain Hemorrhage
Of the 2 main types of stroke, the ischemic stroke occurs 80-85% of the time. With an ischemic stroke, a blood vessel in the brain becomes clogged. With a hemorrhagic stroke, a blood vessel in the brain actually bursts or leaks.
Hemorrhagic strokes tend to be more serious. The distinction between type of stroke can be critical in determining the treatment used.
Ischemic strokes occur when a blood vessel gets so narrow or clogged that not enough blood can get through to keep the brain cells alive.
Plaques (or build-up of cholesterol-containing fatty deposits called arteriosclerosis) in the blood vessel walls can narrow the blood vessels that supply the brain. These plaques build up until the center of the blood vessel is so narrow that little, if any, blood can get past. Many things including high cholesterol and high blood pressure cause plaques. The plaques may occur in small vessels that supply only a very tiny portion of the brain but may also occur in the big blood vessels in the neck (carotids) or in the large arteries to the brain (cerebral arteries).
Ischemic strokes may also be caused by small blood clots or emboli that go through the bloodstream and then get clogged in an artery when the artery narrows. These clots can come from pieces of plaques in the bigger arteries that break off or from the heart.
Hemorrhagic strokes occur when the wall of a blood vessel becomes weak and blood leaks out into the brain.
In addition to having decreased blood flow past the leak, the blood in the brain damages brain cells as it decomposes. If a lot of blood leaks out, it can cause a build-up of pressure in the brain because the brain is enclosed in the skull. There is not room for it to expand, and it can compress and kill important areas of the brain.
Hemorrhagic strokes tend to be more serious than ischemic strokes. Death occurs in 30-50% of people with this type of stroke.
Brain Hemorrhage - Stroke Overview
When the blood supply to a part of the brain is cut off or greatly decreased, a stroke occurs. If the blood supply is cut off for several hours or more, the brain cells, without enough blood supply, die.
Depending upon the amount of blood involved and location of the stroke area in the brain, a person having a stroke can show many signs and symptoms. These can range from barely noticeable difficulties moving or speaking to paralysis or death.
Until recently, doctors were unable to do much while a person was having a stroke or immediately afterward. Now however, treatments for the acute event, while it is happening, are available, which makes recognizing strokes and getting immediate care critically important.
About 750,000 new strokes occur in the United States each year. Stroke is the third most common cause of death (after heart disease and cancer). Strokes occur more frequently in older people but can occur in persons of all ages, including children. African Americans are at a higher risk of stroke than whites. Hispanics have an intermediate risk.
A transient ischemic attack (known as a TIA or ministroke) is similar to a stroke except that, with a TIA, the symptoms go away completely within 24 hours. People who have a TIA are very likely to have a stroke in the near future.
What is a stroke?
The left hemisphere largely controls the right-hand side of the body, and the right hemisphere the left side. The brain has specific parts devoted to specific functions. For example, the language areas are usually in the left-hand side of the brain, except in a small proportion of left-handed people in whom the language area is on the right. The areas processing information about vision are at the back of the brain. Control of muscle and sensory function is situated near the front of the brain in the frontal and parietal lobes, and co-ordination is controlled by the cerebellum.
The blood to the brain travels from the heart through the aorta (the main artery from the heart) and then into one of four arteries that lead to the brain. At the front are the two carotid arteries that you can feel pulsating in your neck, either side of the windpipe, and at the back, running alongside the vertebral column (the spine), are the two vertebral arteries. Once the four arteries have entered the skull, they are linked together in the circle of Willis this is a very important anatomical feature, because, if one artery is blocked, sometimes there is enough blood provided from the other arteries joining the circle to prevent major damage being done. Leading off the circle of Willis are the six major cerebral arteries – anterior, middle and posterior (one of each on either side), supplying respectively the front, middle and back parts of the brain. Any of these can be blocked, causing a stroke, but the commonest to be affected is the middle cerebral artery.
Labels: Brain, Hemorrhage, Stroke
High Blood Pressure
The pressure of blood in your arteries / blood vessels is blood pressure and is measured in millimetres of mercury (mmHg). Your blood pressure is recorded as two figures. For example, 1450/90 mmHg. This is said as ’145 over 90’.
High blood pressure is a blood pressure that is 140/90 mmHg or above each time it is taken. That is, the blood pressure is ’sustained’ at 140/90 mmHg or above.
Blood pressure reading that is high does not mean that you have ’high blood pressure’. Your blood pressure varies throughout the day. It may be high for a short time if you are anxious, stressed, or have just been exercising.
You are said to have ’high blood pressure’ (hypertension) if you have several blood pressure readings that are high, and which are taken on different occasions, and when you are relaxed.
High blood pressure is a ’risk factor’ for developing a cardiovascular disease (such as a heart attack or stroke), and kidney damage, sometime in the future. If you have high blood pressure, over the years it may have a damaging effect to arteries and put a strain on your heart. In general, the higher your blood pressure, the greater the health risk. But, high blood pressure is just one of several possible risk factors for developing a cardiovascular disease.
Hemorrhagic Stroke
The hemorrhagic stroke occurs when a blood vessel inside the brain bursts. The bleeding damages the surrounding brain tissue. The brain cells are much more gentle and sensitive than any other cells in the human body. The bleeding increases the pressure applied to the brain cells that surround the bleeding and this is what causes the damage.
The most common cause of hemorrhagic stroke is high blood pressure. Another cause is an aneurysm. It causes the blood vessel wall to become thinner and bust at some point. Stroke can also be caused by the accumulation of a protein called amyloid within the artery walls, particularly in the elderly. This makes the arteries more prone to bleeding.
Hemorrhagic strokes form nearly 20% of all stroke cases. It may occur in all ages and the average risk age is lower than the ischemic stroke risk age.
The symptoms of the hemorrhagic stroke include weakness or inability to move some part of the body, numbness or lost of sensation, decrease or lost vision, speech difficulties, disorientation and inability to recognize familiar faces, sudden headache, dizziness, etc.
The hemorrhagic stroke can be treated through a surgery or with medication only. Depending on the severity, treatment includes lifesaving measures, relief of symptoms and repair of the cause of the bleeding. Surgery can help reducing the brain damage caused by the stroke as well as quicken the recovery. Regardless of the treatment chosen a person who has suffered a hemorrhagic stroke needs a serious long term treatment. Most of the patients need physical therapy, other need behavior modification or family counseling.
There are different types of hemorrhagic stroke - subarachnoid hemorrhage and intracerebral hemorrhage. The subarachnoid hemorrhage occurs when a blood vessel in the area between the brain and the skull starts bleeding. The intracerebral hemorrhage occurs when a blood vessel deep inside the brain starts bleeding. Both types may be caused by structural problems with the arteries such as aneurysm or Arteriovenous Malformation. The aneurysm is a week area in the blood vessel wall that fills with blood and bulges. High blood pressure or an injury may cause the bulge to rupture and start bleeding. Arteriovenous Malformation is a malformation of the brain’s blood vessels. This kind of malformation is usually present since birth and develops slowly with time. It characterizes with weak blood vessels that increases the risk of a hemorrhagic stroke.
Strokes can be very scary.
Subarachnoid Hemorrhage: When a Brain Aneurysm Bleeds
Spontaneous subarachnoid (pronounced sub-uh-RACK-noid) hemorrhage is rightfully the most feared cause of sudden headache. Usually due to rupture of aneurysms (abnormal, balloon-like outpouchings of arteries) located near the base of the brain, subarachnoid hemorrhages involve bleeding into the space between the brain and its surrounding membrane, known as the meninges. A traumatic blow to the head can also cause subarachnoid hemorrhage, but this is a completely unrelated process and is not the subject of this essay.
About 10% of people with spontaneous subarachnoid hemorrhages die before they even get to a hospital and over a third die within the first four weeks following the bleed. Survivors can have significant impairments due to brain damage.
And while the effects of the initial bleed are bad enough, in the following few weeks individuals with subarachnoid hemorrhage can suffer additional, serious complications. One complication is that the aneurysm responsible for the initial hemorrhage can bleed a second time and cause even more damage. This occurs in 4% of cases within the first 24 hours and there is another 1.2% chance of re-bleeding each day thereafter for the first two weeks. Thus, without treatment 20% of cases have a second hemorrhage within the first two weeks.
The other serious complication is that the blood deposited in the subarachnoid space can cause otherwise healthy arteries passing through this space to go into spasm. The spasm decreases blood-flow to the parts of the brain ordinarily nourished by these arteries and thereby inflicts additional damage. Or, said another way, a blocked artery causes a new stroke, this time of the non-bleeding type. For reasons that are not entirely understood, these spasms of the arteries do not occur within the first few days after the initial hemorrhage. Instead, they typically develop after a delay of 4-9 days.
What can be done to reduce these complications? In the case of blood-vessel spasm, the best treatment is a preventive one. Administering a drug called nimodipine (prononounced nye-MO-dih-peen) intravenously makes spasming less likely to occur. But in order to prevent the other major complication, re-bleeding, the best treatments are those which physically stabilize the aneurysm. In one such procedure, a surgeon places a metal clip across the aneurysm where it joins the otherwise normal artery. An alternative surgery is to wrap the outside of the aneurysm with surgical gauze or plastic sheeting. A newer procedure involves filling the aneurysm with tiny metal coils inserted via a flexible catheter snaked through the arteries.
How can one tell if a particular headache is caused by a bleeding aneurysm? It can be a tough call, but certain features make a ruptured aneurysm more likely. First, a headache due to a ruptured aneurysm is typically of very abrupt onset (often described as a “thunderclap”) and is classically the worst headache of one’s life. In people who already have recurrent severe headaches from other causes, the headache due to a ruptured aneurysm might feel different from the more usual attacks.
Medical evaluation of patients with ruptured aneurysms can turn up additional clues, like a stiffened neck or changes in the backs of the eyes made visible through an ophthalmoscope. Of course, if the patient is drowsy or confused, this might suggest that something serious is going on, as would any new impairment in the ability to move the eyes, an arm or a leg. A computed tomographic (CT) scan of the head performed within the first 24 hours is very sensitive in detecting a hemorrhage, but if the scan is delayed it is less able to detect the bleed. A lumbar puncture (also known as a spinal tap) always detects subarachnoid hemorrhage even when it is a few days old, but if the needle causes bleeding by piercing a blood-vessel on its way to the subarachnoid space, the test might give the false impression that a subarachnoid hemorrhage occurred when it hadn’t.
After discovery of subarachnoid hemorrhage, the next round of testing focuses on where exactly the bleeding occurred. While in over two-thirds of the cases it originates from ruptured aneurysms, other potential sources include tangles of abnormal blood-vessels known as arteriovenous malformations or from bleeds within the brain tissue that secondarily leak into the subarachnoid space. The managing physician can order any of three tests to image the blood vessels themselves and pinpoint the source of bleeding.
The oldest test--still considered the gold-standard--is known as an arteriogram or, alternatively, an angiogram. An arteriogram is considered an “invasive” test because the doctor must slide a long, flexible catheter through the arterial system (which is under much higher pressure than the veins) so that dye infused through the catheter will enter the arteries in question. Two newer tests are “non-invasive,” though, in truth, they often involve an infusion into a vein. One is magnetic resonance arteriography (MRA) which is performed with the help of an MRI-scanner. The other is computed tomographic arteriography (CT-A) which is performed with the help of a CT-scanner. While the non-invasive tests are getting better all the time, they still occasionally miss aneurysms otherwise visible on arteriograms.
Apart from identifying the bleeding aneurysms, these tests can detect additional aneurysms, when present. About 20% of people experiencing a ruptured aneurysm have one or more co-existing, unruptured aneurysms.
Subarachnoid hemorrhages occur annually in about 10 people out of 100,000. This computes to a 0.01% rate of annual occurrence. Contrast this figure with the 12% of the adult population who have migraine (most of whom have at least one severe headache per year) and it is apparent that the vast majority of severe headaches are not due to ruptured aneurysms. But the concern about missing a ruptured aneurysm means that many people without subarachnoid hemorrhage must receive tests in order to diagnose the few who have it.
What causes aneurysms in the first place? More than one factor is involved. First, there can be an inborn weakening of the artery’s wall. When the wall subsequently deteriorates in ways that can be accelerated by hypertension and smoking, an aneurysm can form.
Actually, aneurysms affecting the brain’s arteries are fairly common. Autopsy and arteriogram studies indicate that about 1-4% of the general population have them. This is many more people than have subarachnoid hemorrhages, so a logical conclusion is that most people with aneurysms go through their entire lifetimes without having symptoms. Studies show that aneurysms less than 5 millimeters (0.2 inches) in diameter have a very low rate of rupture, while aneurysms greater than 10 millimeters (0.4 inches) in diameter have a significant risk of bleeding.
Do ruptured aneurysms run in families? A 2005 report from the Scottish Aneurysm Study Group showed a slight tendency for this trait to be shared by close relatives. The 10-year risk for subarachnoid hemorrhage in first-degree relatives (parents, siblings and children) was 1.2%. The risk was even lower in more distant relatives. In families with two affected first-degree relatives there was a trend toward higher risk. The authors felt that most relatives of patients suffering subarachnoid hemorrhages have low risk of future hemorrhages, and that routine screening of family members is inappropriate unless there are multiple affected individuals in the same family.
Symptoms of High Blood Pressure
Symptoms of high blood pressure may not be noticeable even after it has caused extensive organ damage. Even very high blood pressures, fatal and already causing serious kidney damage, sometimes continue for several months before any symptoms may occur. The only way to know if you have high blood pressure is to have it measured with a sphygmomanometer.
Headaches and breathlessness (dyspnea) on slight exertion occur more frequently in people who have sustained blood pressures of around 180/120 mmHg or higher than in people with ’normal’ blood pressure. Both of these symptoms are common anyway, but they occur more often in people with high blood pressure. Almost everyone gets headaches at some time or another - they can be due to anxiety, tension or minor infections. Such ’ordinary’ headaches are equally common in people with high blood pressure, but a cautious physician will always check your blood pressure first before dismissing associated headaches as insignificant, as they do occupationally signal sudden loss of control. Some of these headaches can be a warning of early damage to the vascular system in the brain or the retina, which will require urgent blood pressure control to prevent fatal complications. Breathlessness in people with high blood pressure is usually a result of being obese. On the other hand, if blood pressure has risen out of control, or has strangely fallen without any change in medication, then breathlessness may be the symptom of early heart failure.
The risk of bleeding from arteries into the brain (thereby causing stroke) or into the retina (causing visual loss if the bleeding is extensive) is magnified by high blood pressure, most especially in people over fifty years old and is one of the main reasons why high blood pressure calls for appropriate treatment. Nose bleeding and subconjunctival hemorrhages occur more frequently in people with high blood pressure, although both symptoms are very common and need not cause alarm immediately. Subconjunctival hemorrhages sound very deadly, but "hemorrhage" is simply the technical term for bleeding of any extent. Subconjunctival hemorrhages are simply a small amount of bleeding in the white are of the eye. They can appear after coughing, sneezing or straining during defecation and show up as a bright red area on the white of the eye, which then disappears over several weeks or so. They are harmless and have nothing to do with retinal hemorrhages.
Palpitations, tension headaches and hyperventilation are symptoms of anxiety and so are common in people who are anxious or frightened. If they already have these symptoms and are then unfortunately found to have high blood pressure, then the diagnosis may confirm their fears and reinforce the symptoms. Others may get palpitations for the first time after they have been told that they have high blood pressure. They are not caused by high blood pressure itself, but by fear of it and what the diagnosis means. The symptoms usually disappear, although not always immediately, with adequate explanation of what a diagnosis of high blood pressure really means.
Neuronal Cell Death during Development
A central problem in developmental neurobiology is the understanding of the regulation of neuron survival and death. The neurotrophic theory provides a basis for understanding several features of neuronal development, including the question of why, in many populations of developing neurons, only a proportion of the original number of postmitotic cells survives. It is well known that in many regions of the nervous system large numbers (approx. 50%) of postmitotic neurons degenerate and die by a process of naturally occurring neuronal death. It has been repeatedly demonstrated that in most populations of neurons this normal cell loss occurs during the period when neurons are establishing synaptic connections with their targets. This temporal coincidence, together with the demonstration that manipulations of the availability of putative synaptic targets alters the number of surviving innervating neurons, led to the proposal that neurons compete for a target-derived factor that is supplied in limiting amounts by the targets and thus adjusting neuron numbers so as to provide sufficient innervations for their targets. However, there is growing evidence that other mechanisms may be involved in regulating cell death.
First Few Days After Stroke
When someone is suspected of having had a stroke, tests will be done to confirm this or to rule it out. Often a brain scan will be done – either CT or MRI. ‘CT’ is short for computed tomography. Introduced in the 1970s, CT scanning revolutionized the investigation of brain disease, because it was now possible to see what was going on inside the brain without difficult, painful and hazardous tests. It has improved enormously, giving much clearer pictures much more quickly. ‘MRI’ stands for magnetic resonance imaging. This method is better than CT scans at showing up very small infarcts, particularly if the doctor thinks the problem is in the cerebellum or the brain stem. The reason for this is that CT scan pictures get distorted, but this is not a difficulty with MRI. The MRI scans can also show up the arteries very clearly (magnetic resonance angiography), and can therefore be used to see where the root of the problem might be. Other tests may be needed, such as an arteriogram, an echocardiogram or lumbar puncture, and we discuss these too. The results obtained from the investigations will indicate which treatment is likely to be the best for any particular person. This includes rehabilitation as well as drugs to help recovery.
Labels: arteriogram, brain stem, cerebellum, echocardiogram, tomography
Programmed Cell Death
The term "programmed cell death” is used for developmentally occurring cell death, where cells are "programmed" to die during normal development. As cell death seems to follow an intracellular "program" programmed cell death is sometimes also used as a synonym for apoptosis.
Apoptosis is a cell autonomous genetically defined program, in which cells respond to internal or external signals by actively participating in their suicide and organization of their disposal. Originally, the term "apoptosis" was defined by a characteristic pattern of morphological changes and is now increasingly used to describe the underlying molecular mechanisms.
Any cell death lacking the features indicative for active cell death is referred to as necrosis. Necrosis presents a passive form of cell death with relatively slow disintegration of the cells.
The morphological changes, by which apoptotic cell death can be characterized and identified, occur in a consecutive fashion. Dying cells start to detach from neighboring cells and extra cellular matrix and round up. The cells start to show pertrusions from the plasma membrane, referred to as blebs. Many dying cells show nuclear condensation and disintegration of the nucleus into several fragments. Organelles are generally intact, but may be affected at later stages. Mitochondria have been described to either swell or condense; there is dilatation of the ER, release and aggregation of ribosomes and the occurrence of cytoplasm vacuoles. Whole cells condense and reorganize into so-called apoptotic bodies, which are membrane bound vesicles containing cytosolic elements, organelles and parts of the condensed nuclei in various combinations. Apoptotic cells are rapidly engulfed and digested by neighboring cells, which makes it quite difficult to study morphological changes in vivo.
Where has the blood clot that caused my stroke come from?
Blood is more likely to form a clot if its normal smooth flow is disturbed and becomes turbulent – rather like the water in a river when it hits rocks. This can happen in the heart if its rhythm becomes irregular in a condition called atrial fibrillation, or in the aorta (the main artery from the heart) or the carotid or vertebral arteries if they become narrowed due to atheroma (a build-up of cholesterol in the wall of the artery) – see Figure 5. If
a blood clot forms in any of these places, it can either block the artery where it has formed or break off and travel up with the blood to the brain (embolism). The clot comes to rest where the artery becomes narrower than the clot, thus preventing any blood getting past it. Sometimes the clot forms in one of the arteries inside the brain itself.
Labels: Blood Clot, Brian, Damage, Stroke
Top Most Brain Surgery Institute of Pakistan
In the General Hospital in Lahore, in the top most brain surgery institute of Pakistan, people lie in verandas in unhygienic conditions. As it is – they are either about to go in for a surgery that has low chances of success even under normal circumstances or perhaps they are trying to recuperate from one. But never do they dare ask for more since they fear being thrown out into the street – they, having already exhausted all their worldly connections to gain this limited space in the first place. Or it could be that they don’t expect more. Maybe, they simply don’t know if there can be more, that such a possibility may exist – that there can after all be more to expect.
Helpless as they are, everything is God’s will – they must only somehow pass the time until the transition to the next world where there will not be any pain, no more putting them to tests, no disappointments – where there will be justice, rivers of milk and honey and tranquility and nothing less. And this alone makes them go on. It is the only light at the end of the tunnel in an otherwise joyless life, bliss in this transitory imperfect world being nothing but a fallacy.
It is not as if they are not vaguely aware that human endeavours can change life conditions – it is just that they know that it would be too much to expect in their case – that never will they ever have the opportunity. And hence, resigned to their fate, the patients thank God for what they receive.
And their visitors secretly thank God that it is not they who are lying in their place in the veranda – and yet, they nurture this secret guilt also. The lives of the visitors are nonetheless marred with fear and dread. From nowhere comes this fear of the unknown that engulfs them. They cannot understand how they have been reduced to the point where an absence of misfortune – and that alone by itself, seems as ultimate good luck, that why expecting more is greed.
And once in a while, the patients are removed from the veranda and are hidden out of sight irrespective of their condition. The walls are then whitewashed and the corridors cleaned and scrubbed. It is the day when the dictator is scheduled to pay an official visit along with his entourage in screaming cars that ply on hastily carpeted roads.
Later in the day, the dictator claims in front of the international press that Pakistan has surplus hospital rooms and one of the best doctors in the world. That, in short, Pakistan has one of the best medical facilities for the common man......
Labels: Brain, General Hospital, Hemorrhage, Lahore, Pakistan
What actually is a stroke?
A stroke is what happens when the brain is damaged as the result of a problem with its blood supply. Each part of the brain is responsible for a particular function, so the symptoms that result will depend on which part of the brain is deprived of its blood supply.
By noting down exactly what the problems are and examining you, it is usually possible for the doctor to be reasonably accurate in identifying where the stroke is. Strokes can be large or small, depending on which artery and which part of it has been affected. The damage can occur in two major ways. The commonest, occurring in about 80% of cases, is where one of the arteries becomes blocked with a blood clot. This can be due to ‘furring up’ of the artery with cholesterol, which results in the lining of the artery becoming rough and allowing blood cells and platelets to stick to it. (Platelets are the fragments in the blood that stick together when necessary to form a blood clot.) Alternatively, a clot can be formed further downstream, then becoming dislodged and traveling up the artery until it reaches a point where the clot is bigger than the artery, where it becomes stuck. These clots can come from the heart or the aorta (the main artery from the heart) or from the carotid or vertebral arteries. The blockage causes the part of the brain supplied by that artery to be deprived of oxygen and nourishment, resulting in damage to the nerve cells. The remaining 20% of strokes are due to hemorrhage (bleeding) into the brain – intracerebral hemorrhage – or onto the surface of the brain – subarachnoid hemorrhage. Intracerebral hemorrhage can occur from any of the arteries in the brain, but most commonly affects small arteries deep inside the brain. A hemorrhage causes damage as a result of the escaped blood squashing the surrounding brain tissue.