Stroke FAQ

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What is a stroke?

A stroke is when blood flow to your brain is interrupted for long enough for some brain matter to die from oxygen starvation.

What's the difference between an ischemic and hemorrhagic stroke?

They're both ways for the blood flow in the brain to be interrupted. An ischemic stroke is more common, and is just a fancy way to say "a blood clot got stuck in your brain, it stopped fresh blood getting to part of your brain, which then died." A hemorrhagic stroke is when one of the arteries in your brain bursts, so instead of fresh blood going to bits of brain that need it, the blood just leaks into your brain pan, and then part of your brain dies.

The end result of either kind of stroke is the same: you now have brain damage. The causes, immediate treatment and then pills prescribed are different, but the longer term effect of the stroke itself is identical: brain damage and recovery from the damage.

What's a TIA or mini-stroke?

TIA stands for Transient Ischemic Attack, which is doctor-speak for a blood clot that went away before causing any actual brain damage. The effects are similar to those of a stroke, though, the obvious difference being that the effects are transient: they go away. If you have a TIA, though, it's a warning shot for a real stroke. Treat it as deadly serious, or you will have a stroke, and you don't want that. Trust me. If you have had a TIA get your shit together. Now.

What did you have?

I started with a couple of hemorrhagic strokes, one my right frontal lobe, and a larger one in my pons, which is part of the brain stem. That's where the majority of the resulting brain damage was. Two strokes wasn't enough for me, though, and over the next two days I had many small ischemic strokes dotted all over my brain. They are full-on strokes, not TIAs, but they're small enough that any damage from them is hard to detect.

How old were you?

I was 40 years and 5 months old when I had my strokes. This is fairly young.

Why did you have a stroke?

Boredom? There was no clear cause for the first two strokes, and definitely no known cause for the subsequent clot strokes. That said, it is very likely that my brain popped because I had very high blood pressure (a.k.a. hypertension), which is a fairly common cause of strokes. About 30 minutes after I had the first symptoms, my blood pressure was measured at about 250/160. That's about twice what is considered high for humans. It's the blood pressure of a turkey on Thanksgiving, being chased by the Swedish chef.

Why was your blood pressure so high?

Probably a combination of genetics, a sedentary lifestyle, and stress. I can't do anything about the genetics, but I try to avoid stress and I now have a much more active life. So far, all that exercise has not had a significant effect on my blood pressure, but the benefits of being fitter and thinner are enormous.

What does that mean long-term?

I have brain damage, and will always have brain damage. I can (and do) make jokes about having brain damage. While the damaged bits of my brain will never regrow, the undamaged parts of my brain can and will adapt to take over what the dead bits used to do. This is not a fast process, but it is very much like the process that babies and small children go through as they learn to use their bodies, only with a higher center of gravity.

What deficits do you have?

I have ataxia, diplopia, oscillopsia, one and a half syndrome, dysarthria, dysmetria, left side facial palsy and right side muscle weakness. In English, that's:

  • Ataxia: my balance is bad. It's like being very drunk, without the actual drunkenness.
  • Diplopia: I have (diagonal) double vision. It's a real drag, so I have a foggy lens over my left eye so that I effectively only see out of the right eye, but the left still moves and has some input. Having only one eye to see with has its own problems, but it's better than seeing double.
  • Oscillopsia: my eyes are in constant rapid, short motion. If you can imagine how irritating shaky-cam is in a movie, my sight is like that all the time. This makes reading difficult and slow. A novel that used to take an afternoon to read now takes weeks.
  • One and a half syndrome. Just read the wikipedia page about one and a half syndrome. This is rare enough that many neurologists want to use me for an exam question. Asshats.
  • Dysarthria: difficulty speaking. This has got progressively better, but it's a result of the facial paralysis, and makes my desire to be a voiceover actor ironic. As my cheek, lips, and tongue return to full function, my diction gets clearer. 15 months on, and it's not immediately obvious that I had a stroke, but I don't have the control of my voice that I once had.
  • Dysmetria: I have an intention tremor in my right hand and arm. They shake when I want to do something useful like write, type or carry a cup of tea. More irritating than truly debilitating, although it makes handwriting exceedingly difficult.
  • Left side facial palsy: the left side of my face is paralysed. The effect is like a Bell's palsy, but the cause is damage to the brain, not to the nerve. When I first had the stroke, it was as though I'd had a serious botox injection on the whole left side of my face; it's better now, though, and continues to improve.
  • Right side muscle weakness: that's pretty much exactly what it sounds like. A lot of the muscles on my right side are much weaker than they were, because the bits of brain that gave them orders are now dead. I have to get living brain to control those muscle fibers or improve the function of the muscle that is left.

What drugs are you taking now?

  • Amlodipine, standard blood pressure stuff, gives me fat ankles
  • Benazepril, ACE inhibitor for blood pressure
  • Bendroflumethiazide, a 'water tablet' or diuretic, also for blood pressure: makes me pee more
  • Bisoprolol, a beta blocker, for blood pressure
  • Aspirin, as a blood thinner. This is a compromise for having both kinds of stroke.
  • Lipitor, a statin, not for cholesterol, but it reduces mortality rates after a hemorrhagic stroke.
  • Citalopram. an anti-depressant. Guess what, having strokes at 40 is depressing. Who knew?