stroke

Stroke is a condition wherein the brain doesn’t get enough blood supply to one or multiple areas of the brain. Without blood to supply that area, the brain doesn’t get the oxygen and nutrients it needs to function. Without blood supply, cells in the brain begin to die within minutes, leading to long-term or permanent disability, brain damage, and potentially, death. 

Stroke Victim Mother

I normally don’t ask for anything from tumblr, but My mom had a stroke and broke her leg in the shower. and the rehab center kicked her out and changed us for the stay when they realized our insurance would only cover 20 days. Worst part is they didn’t let us know until after it was too late.

So we are just asking for a bit of help to pay off the rehab center. We aren’t asking for a lot, just to cover the few extra days she had to spend there when we were getting everything set up for her being home.

http://www.gofundme.com/s8qy5w

Brain’s iconic seat of speech goes silent when we actually talk

For 150 years, the iconic Broca’s area of the brain has been recognized as the command center for human speech, including vocalization. Now, scientists at UC Berkeley and Johns Hopkins University in Maryland are challenging this long-held assumption with new evidence that Broca’s area actually switches off when we talk out loud.

The findings, reported in the Proceedings of the National Academy of Sciences journal, provide a more complex picture than previously thought of the frontal brain regions involved in speech production. The discovery has major implications for the diagnoses and treatments of stroke, epilepsy and brain injuries that result in language impairments.

“Every year millions of people suffer from stroke, some of which can lead to severe impairments in perceiving and producing language when critical brain areas are damaged,” said study lead author Adeen Flinker, a postdoctoral researcher at New York University who conducted the study as a UC Berkeley Ph.D. student. “Our results could help us advance language mapping during neurosurgery as well as the assessment of language impairments.”

Flinker said that neuroscientists traditionally organized the brain’s language center into two main regions: one for perceiving speech and one for producing speech.

“That belief drives how we map out language during neurosurgery and classify language impairments,” he said. “This new finding helps us move towards a less dichotomous view where Broca’s area is not a center for speech production, but rather a critical area for integrating and coordinating information across other brain regions.”

In the 1860s, French physician Pierre Paul Broca pinpointed this prefrontal brain region as the seat of speech. Broca’s area has since ranked among the brain’s most closely examined language regions in cognitive psychology. People with Broca’s aphasia are characterized as having suffered damage to the brain’s frontal lobe and tend to speak in short, stilted phrases that often omit short connecting words such as “the” and “and.”

Specifically, Flinker and fellow researchers have found that Broca’s area — which is located in the frontal cortex above and behind the left eye — engages with the brain’s temporal cortex, which organizes sensory input, and later the motor cortex, as we process language and plan which sounds and movements of the mouth to use, and in what order. However, the study found, it disengages when we actually start to utter word sequences.

“Broca’s area shuts down during the actual delivery of speech, but it may remain active during conversation as part of planning future words and full sentences,” Flinker said.

The study tracked electrical signals emitted from the brains of seven hospitalized epilepsy patients as they repeated spoken and written words aloud. Researchers followed that brain activity – using event-related causality technology – from the auditory cortex, where the patients processed the words they heard, to Broca’s area, where they prepared to articulate the words to repeat, to the motor cortex, where they finally spoke the words out loud.

We’ve all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn’t.

In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people who’ve already experienced such an event, or who are at extremely high risk.

However, many of the people taking aspirin daily have never had a heart attack or stroke.

Maybe You Should Rethink That Daily Aspirin

Photo Credit: iStockphoto

Novel therapeutic procedure helps stroke patient recover three-dimensional vision

Impaired vision is one of the most common consequences of a stroke. In rare cases, patients may even lose their ability to perceive depth. Such patients see the world around them as flat, like a two-dimensional picture. This makes it impossible for them to judge distances accurately – a skill they need, for instance, when reaching for a cup or when a car is approaching them on the street. A patient with this particular type of visual dysfunction has recently been studied in detail by the research team at Saarland University led by Professor Georg Kerkhoff and Anna-Katharina Schaadt in collaboration with colleagues at the Charité university hospital in Berlin. The team has developed the first effective treatment regime and have identified the area of the brain that, when damaged, may cause loss of binocular depth perception. The results of the study have been published in the respected academic journal “Neuropsychologia”.

Strokes can result in a wide variety of visual impairments. ‘A patient may, for example, be blind on one side so that he fails to perceive obstacles or people on that side or have problems when reading,’ explains Georg Kerkhoff, Professor of Clinical Neuropsychology at Saarland University and head of the Neuropsychological Outpatient Service. In some cases, however, the consequences are even more serious. Recently, the team around Kerkhoff and Schaadt collaborated with Professor of Neurology Dr. Stephan Brandt and his colleague Dr. Antje Kraft, both at the Berlin Charité, in treating and supervising a patient who had lost his stereoscopic visual perception as a result of a stroke. Although the patient was able to perceive all the details of his surroundings, he was not able to assess distances with any accuracy. ‘Everything for him was flat, like on a painting,’ explains Anna-Katharina Schaadt, a doctoral research student who is supervised by Kerkhoff and is the study’s lead author. ‘He moved as if in slow-motion and was very uncertain about how far away a coffee cup was on a table or how quickly a car was approaching.’ Like a blind person, he used a long cane to find his way around.

Kerkhoff and Schaadt’s team at the Neuropsychological Outpatient Service on the Saarbrücken campus began by looking for the cause of the patient’s visual impairment.

‘We discovered that the patient was unable to converge the visual impressions from each eye into a single overall image,’ says Schaadt. In healthy individuals, this process is known technically as ‘binocular fusion’ and is important for three-dimensional vision.

Once the diagnosis had been made, the team of neuropsychologists provided a three-week block of therapy during which the patient undertook daily training to improve his visual perception of depth. Three different training methods were employed. Special visual training equipment (prisms, vergence trainer and cheiroscope) were used to present the patient with two images with a slight lateral offset between them. By using what are known as convergent eye movements, the patient attempts to fuse the two images into a single image. This involves directing the eyes inward towards the nose while always keeping the images in the field of view. With time, the two separate images fuse to form a single image that exhibits stereoscopic depth, i.e. the patient has re-established binocular single vision. ‘It was as if a switch had been thrown; the patient was suddenly able to perceive spatial depth again, judge distances correctly and reach out and hold objects with confidence’, describes Schaadt. The patient has now returned to work as a lawyer. At a follow-up examination a year later, the patient still exhibited good stereoscopic depth perception, and can therefore be considered to be permanently cured according to Professor Kerkhoff.

The procedure could be used in future by therapists to help treat other stroke patients suffering from this extreme form of visual impairment. The results of the study are also of interest to researchers working in the field, as Professor Brandt explains: ‘The results illustrate the very specific functional organization of our brains. Damage to the areas known as V6 and V6A in the parietal lobe is associated with impaired three-dimensional visual perception. This area of the brain has been studied in primates. However, further research is required to understand its function in humans.’

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The Blind Woman Who Sees Rain, But Not Her Daughter’s Smile

Imagine a world that is completely black. You can’t see a thing — unless something happens to move. You can see the rain falling from the sky, the steam coming from your coffee cup, a car passing by on the street.This was the world that Milena Channing claimed to see, back in 2000, shortly after she was blinded by a stroke at 29 years old. But when she told her doctors about these strange apparitions, they looked at her brain scans (the stroke had destroyed basically her entire primary visual cortex, the receiving station of visual information to the brain), and told her she must be hallucinating.

“You’re blind and that’s it,” Channing remembers them saying to her.

Frustrated and convinced these visions were real, Channing made her way from doctor to doctor until she finally found one who believed her: Dr. Gordon Dutton, an ophthalmologist in Glasgow. He told her he’d once read about such a case — a soldier in World War I who, after a bullet injury to the head, could only see things in motion.

Riddoch’s phenomenon, Dutton told her it was called, named for the Scottish neurologist George Riddoch who named it. And then he prescribed her … a rocking chair!

Here’s why: If this is about motion, only being able to see things in motion, she’d be able to see the stationary world, at least a little, if she herself started moving.

It helped. In the weeks and months after her visit (after employing other techniques like shaking her head), Channing began to see the world more vividly. And when she finally visited a team of neuroscientists in Canada (five years after her stroke), they filled in the picture. It turns out that one area of her brain ’s cortex — an area reserved specifically for processing motion (visual area MT, for middle temporal area) — had been preserved. So even though information wasn’t going through the primary visual cortex, somehow it was still getting out to the part of the brain that can register objects in motion.

Cue the cars. And the rain. And the coffee steam. Channing was truly seeing them.

But here’s the catch. Though this compartmentalized nature of vision may have been Channing’s blessing, it’s also proving to be a quiet curse. Just as there seems to be an area of the brain that processes motion, there is one for faces; and as much as Channing’s vision continues to improve, she still can’t recognize — even perceive — a face.

Channing says that every now and then, that hard boundary of what she can and can’t see frustrates her. “Who does she look like?” Channing wonders, as she gazes straight at her daughter’s face.

For an artist’s rendition of Milena Channing’s world, watch the video above, which also explains a bit more about the modular nature of vision.

from NPR

Are bilingual stroke patients more susceptible to aphasia?

Aphasia is a condition that commonly affects stroke patients, and leads to problems with the ability to speak, read, and understand language. Patients with aphasia suffer disproportionate levels of anxiety, depression and unemployment, at just the same time as their most basic coping mechanism – talking with family and friends – is being undermined. Stroke patients want to know whether, when, and in what respects they might hope to recover lost language skills - questions that have motivated a great deal of research into the factors that predict better or worse recovery from post-stroke aphasia.

Whether bilingualism (speaking more than one language) affects the severity of aphasia compared to monolingualism (speaking just one) is unclear, but bilingualism is the norm rather than the exception in many parts of the world. Many would assume being able to speak more than one language would lessen the effects of aphasia, as there is a greater understanding of language to draw on. New research suggests however, that bilingual stroke patients are actually more susceptible to aphasia than monolingual stroke patients.

“Comparing language outcomes in monolingual and bilingual stroke patients” via Brain.

Image: Leukoaraiosis by Jmarchn. CC BY-SA 3.0 via Wikimedia Commons.

A Game-Changer for Stroke Treatment

Stroke is the leading cause of severe long-term disability in the United States, and less than 40 percent of patients who experience the most severe form of stroke regain functional independence if they receive the standard drug intervention alone. Now a study by an international group of stroke physician-researchers has found that removal of the clot causing a severe stroke, in combination with the standard medication, improves the restoration of blood flow to the brain and may result in better long term outcomes.

The findings of the Swift Prime trial (Solitaire With the Intention For Thrombectomy as PRIMary Endovascular treatment) were reported April 17 in the online edition of the New England Journal of Medicine and are scheduled to be published in the journal’s June 11 print edition.

“These findings are a game-changer for how we should treat certain types of stroke,” says Demetrius Lopes, MD, surgical director of the comprehensive stroke center at Rush and a co-author of the study. “These outcomes are the difference between patients being able to care for themselves after stroke and being dependent.”

Rush was one of the 39 centers in the U.S. and Europe that participated in the Swift Prime trial.

Out, damned clot!

More than 795,000 people have a stroke each year, according to the U.S. Centers for Disease Control and Prevention. About 87 percent of these incidents are ischemic strokes, which result from clots in vessels supplying blood to the brain.

The standard treatment for ischemic stroke within the first three to four and a half hours of symptoms is intravenous tissue plasminogen activator (IV tPA), a medication which dissolves the clot. However in the approximately 20 percent of cases in which one of the major arteries is blocked, resulting in a severe stroke, IV tPA alone may not be sufficient to dissolve the clot. If a patient experiencing a severe stroke is brought to a qualified hospital in time, doctors also may be able to perform a minimally invasive procedure called thrombectomy to remove the clot.

During thrombectomy, a neurovascular surgeon threads a catheter through an incision in the patient’s groin, snaking it through the blood vessels and into the brain. The doctor then uses a device attached to the catheter to grab and dislodge the clot and pull it all the way out through the incision, a bit like an angler reeling in a fish.

One more out of every four

The Swift Prime study randomly divided patients with severe ischemic strokes into two groups, one receiving IV tPA alone, and the other receiving combination therapy of IV tPA and thrombectomy within six hours of the onset of stroke symptoms. (IV tPA currently is the only treatment for ischemic stroke approved by the U.S. Food and Drug Administration, but the use of thrombectomy is allowed in clinical trials.) In all, 196 patients — 98 in each group — at 39 centers in the U.S. and Canada participated in the study between December 2012 and November 2014.

The researchers assessed each patient’s level of disability after 90 days using a standardized measurement. The study found that the patients who received IV tPA plus thrombectomy exhibited reduced disability across the entire range of the measurement, with a functional independence rate of 60 percent compared to 35.5 percent for those patients who received only IV tPA.

“For every 2.6 patients treated, one additional patient had an improved disability outcome; for every four patients treated, one additional patient was independent at 90 day follow-up,” the New England Journal of Medicine article declares.

The study also found that patients who received thrombectomy had better cerebral blood flow rates: At 27 hours after treatment, 82.8 percent of those patients had blood flow that was 90 percent of normal or better, versus 40.4 percent of patients who only received IV tPA. The study’s findings depart from three previous trials that did not find thrombectomy provided greater benefits than IV tPA alone. “The Swift Prime trial used better technology, better imaging and quicker intervention, and we obtained a different result,” Lopes says.

In fact, Swift Prime was one of four recent worldwide studies that evaluated newer thombectomy devices and techniques. The result of the first study, reported in the New England Journal in December, found such strong evidence of the benefit of thrombectomy that the other trials were halted.

“Ethically, we can’t deny patients a treatment when we have such strong evidence it’s better for them,” Lopes says. At Rush and other study locations, thrombectomy now is a standard treatment within the first few hours for patients with severe strokes.

‘Time equals brain’

However, time remains crucial in stroke treatment. For every minute that a stroke is untreated, a patient loses 1.9 million brain cells and 14 billion connections between brain cells – a phenomenon underlying the stroke awareness adage “time equals brain.”

“The majority of the positive results of these trials were found in patients treated within four hours, six hours tops,” observes James Connors, MD, medical director of the Rush comprehensive stroke center.

Of all the participating sites in the Swift Prime trial, Rush was found to provide the fastest times from patient arrival to insertion of the catheter and from initiation of the procedure to restoration of blood flow, both of which are critically important to improving patient’s outcomes.

The Rush stroke team also was recognized for having the best workflow among a larger group of 203 sites in the U.S., Europe, Canada and Australia that participated in Swift Prime and two other affiliated stroke studies. Workflow refers to the coordination of the stroke team – including emergency medicine personnel, neurologists, neurosurgeons and neurointensive care specialists – to provide quick treatment.

Time for a change

Lopes and Conners believe the results of these studies demonstrate the need for a different approach to stroke care. Conners notes that nationwide, the average usage of IV tPA in U.S. stroke cases is only about five percent. “It’s far below where we need to be,” he says.

He believes that educating people to recognize signs of stroke and call 911, and taking steps to make sure they’re taken to the right facility, would improve usage to 50 percent. “We’re constantly working with the city’s Emergency Medical Services division and the emergency department at Rush to get the stroke recognized and treated as soon as possible,” Conners says.

Lopes points out that Rush currently is one of only a few hospitals in Chicago that can perform thrombectomy. “Many of the stroke patients who could benefit from it can’t be brought here in time,” he says. “We need to make the treatment standard.”

In addition, Lopes feels that paramedics need additional training and equipment that would enable them to screen stroke patients in the field and determine which ones would benefit from thrombectomy.

“Rush is doing great from getting our patients from the door of the hospital to fixing the problem,” he says. “We can do even better as a city if we can get patients who need thrombectomy even faster to the hospitals that can provide that care.”

An ischemic stroke happens when a blood vessel (artery) supplying blood to an area of the brain becomes blocked by a blood clot. About 80 out of 100 strokes are ischemic strokes.
A hemorrhagic stroke happens when an artery in the brain leaks or bursts (ruptures). (Source)

-> Learn more: American Heart & Stroke Association

For teaching: neuroscience

Scientists make surprising finding in stroke research

Inflammation is activated in the brain after a stroke, but rather than aiding recovery it actually causes and worsens damage. That damage can be devastating. In fact, stroke is responsible for 10% of deaths worldwide and is the leading cause of disability.

Therefore, understanding how inflammation is regulated in the brain is vital for the development of drugs to limit the damage triggered by a stroke.

Dr David Brough from the Faculty of Life Sciences, working alongside colleagues including Professors Dame Nancy Rothwell and Stuart Allan, has studied the role of inflammasomes in stroke. These inflammasomes are large protein complexes essential for the production of the inflammatory protein interleukin-1. Interleukin-1 has many roles in the body, and contributes to cell death in the brain following a stroke.

Dr Brough explains: “Very little is known about how inflammasomes might be involved in brain injury. Therefore we began by studying the most well researched inflammasome NLRP3, which is known to be activated when the body is injured. Surprisingly we found that this was not involved in inflammation and damage in the brain caused by stroke, even though drugs are being developed to block this to treat Alzheimer’s disease.”

Further studies using experimental models of stroke demonstrated that it was actually the NLRC4 and AIM2 inflammasomes that contribute to brain injury, rather than NLRP3.

This discovery was unexpected, since NLRC4, was only known to fight infections and yet Dr Brough and colleagues found that it caused injury in the brain. This new discovery will help the Manchester researchers discover more about how inflammation is involved in brain injury and develop new drugs for the treatment of stroke.

The research was funded by the Wellcome Trust and Medical Research Council and has been published in PNAS.

As well as identifying new targets for potential drug treatments for stroke Dr Brough points out how little we currently know about how the immune system works in the brain.

He says: “We know very little about how the immune system is regulated in the brain. However, its important we understand this since it contributes to disease and injury. For example, in addition to stroke, Alzheimer’s disease has an inflammatory aspect and even depression may be driven by inflammation.”

(Image caption: Glyconanoparticles resulting from fullerene spheres chemically coupled to amino sugars. Credit: MPIKG)

Sweet nanoparticles target stroke

The majority of stroke occurs when the blood vessels that reach the brain are blocked by clots or fatty deposits which decrease the flow of blood towards its cells. It is then that an ischemic attack occurs, a pathology that leads to the degeneration of neurones, which can be fatal and not many drugs can treat.

Now, German and Swiss scientists have discovered that the combination of two substances help to reduce inflammation and the brain volume affected after a cerebrovascular accident. This is glucosamine, an amino sugar commonly used to treat arthritis and arthrosis; and certain derivatives of fullerenes, hollow and spherical structures formed by many carbon atoms.

Before now it was known that the fullerenes capture chemical radicals well which makes them act as neuroprotective agents, while the glucosamine brings down the inflammation.

What the researchers have done is chemically bond the two compounds to produce what is known as ‘glyconanoparticles’. These have subsequently been administered to laboratory rats which then had a cerebrovascular accident induced.

The results, published in the journal ‘Experimental Neurology’, conclude that this combination of fullerene derivatives and glucosamine reduces cell damage and inflammation after a stroke, according to the MRI scans of animal brains and the improvement of their neurological symptoms.

“Our study confirms that it is possible to couple fullerenes with sugars in order to combine their protective effects and in this way, to obtain new materials which may help to prevent and to treat Stroke,” says Guillermo Orts-Gil, a Spanish researcher at the Max-Planck Institute of Colloids and Interfaces (Germany) and co-author of the research.

“Although the present study was carried out on mice, the results indicate that these sweet buckyballs are potential new drugs for treating Stroke also in humans. However, this must be taken with caution, since what works in mice does not necessarily will work in the same way in humans,” declared Orts-Gil.

This work is the continuation of another previous piece of research, published last year in the journal ‘Nano Letters’, in which the researchers also confirmed that a protein called E-selectin, linked to the chain of events that occur during a stroke, is distributed throughout the brain and not only in the area where the stroke originates, as previously thought.