Ischemic Strokes and TIA

Transient Ischemic Attack

According to the American Heart Association, around 600,000 Americans each year have either an Ischemic Stroke or a Hemorrhagic Stroke, either of which might be extremely serious as they each involve a reduction of blood flow to part of the brain. Stroke is the third leading cause of death. About 25% of those Strokes are fatal. If this reduction of blood flow persists for more than a few minutes, the deprivation of oxygen in the blood flow can cause brain cells to die. Such damage is irreversible and that brain tissue has permanent damage. Depending on which part of the brain that was impaired, paralysis of part of the body or many other important body functions can be lost. If brain tissue in some parts of the brain die, partial or nearly complete memory loss can occur, or major medical problems.

Approximately 80% of all Strokes are Ischemic Strokes. These are caused by an obstruction in an artery or in a blood vessel in the head or brain, which is most commonly a blood clot. The clot may have been caused somewhere else in the body but as blood proceeds away from the heart, the arteries and then blood vessels and then capillaries get smaller and smaller and narrower, and eventually the blood clot can get stuck. That artery or blood vessel or capillary then stops being able to carry oxygen-rich blood, FROM THAT POINT ON. If the obstruction occurs in a major carotid artery in the neck, massive blockage of blood can occur toward the brain and death might be an urgent danger.

However, if the blood clot is smaller, as most commonly are, it can make it through the carotid arteries and then continue into any of the various blood vessels which supply different portions of the brain.

During the past four years, I have experienced several dozen Ischemic Strokes, so I have gotten far more knowledge and experience regarding them than I would have preferred. I have been dismayed and surprised that Hospital Emergency Rooms seem to have limited capability regarding knowing whether a Stroke was in progress! Emergency Room Doctors seem to need to rely extensively on comments by the Patient!

One reason for that is that there are so many different possible symptoms of a Stroke, essentially depending on which part of the brain was being affected and was in the process of dying. So the Emergency Room initially makes an educated guess whether the Patient was correct or not in the claim of having a Stroke. I am sure that Lawyers were involved in their never neglecting such a claim outright, as if they did not quickly have a CATscan and a Patient actually had a Stroke. So the mere mention of the word Stroke seems to inspire Emergency Room Staff to immediately schedule a CATscan or an MRI analysis. Unfortunately, these tests involve multi-million dollar equipment so the tests are rather expensive to perform.

It is sad to realize that no one really knows whether a Stroke is occurring until such very expensive tests are done! I think I have another 'Tool' to provide to Emergency Room Doctors to enable better and quicker initial analysis.

The various areas of the brain have been 'mapped' over previous decades. The image here shows a crude example of such mapping, but far more comprehensive mapping has been done.

There are other 'maps' which exist which show the locations of the various carotid arteries, the blood vessels in the head and the capillaries which carry blood to specific exact locations within the brain.

My intention is to combine these two different mapping procedures. As far as I have discovered, no one has ever yet done this!

What I propose to do is to map EACH blood vessel and its branches, and list the specific functional regions in the brain that that specific vessel or branch passes through (and supplies with blood).

Say that a specific blood vessel is known to pass through TEN specific regions within the brain. I want to provide that information to all ER Doctors, including the SEQUENCE of areas that the vessel passes through.

So when a Patient arrives and announces a possible Stroke, with the claimed symptom being 'a numbness in the left little finger' (just an example here), the Doctor could consult this Tool to quickly see which blood vessel provides blood to the part of the brain which monitors the sensory input of the left little finger, and also the (possibly different) blood vessel which supplies the part of the brain which activates the muscles in that left little finger.

The Doctor would then immediately see WHERE along the blood flow path the possible affected brain tissues are. If that area happens to be the very last brain tissue supplied from that blood vessel, it might be an indication that the blood vessel had gotten rather narrow by that point and that NO OTHER SERIOUS CONSEQUENCES might be likely.

If instead, that area happened to be the very first brain tissue supplied by that blood vessel, either of two possibilities might exist. Either a much larger blood clot might exist in the main blood vessel, which might imply great urgency, as the other nine functional regions downstream in that blood vessel might also possibly also have restricted blood flow, which might be an extremely urgent problem. Or there might be a small branch vessel which only supplies blood to the one small area that the Patient was currently aware of.

My Tool would provide the Doctor with a listing of the nine other areas of brain tissue which may or may not now have restricted blood flow. The Doctor could ask the Patient whether there was anything unusual in 'the left thigh' or the other eight areas of brain tissue which are known to be supplied by that same blood vessel.

Very quickly and easily, the ER Doctor should be able to either narrow down the Stroke-affected area to that of just the left little finger, or to learn that additional areas of brain tissue might also be being affected or about to be affected.

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This presentation was first placed on the Internet in January 2013.

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C Johnson, Theoretical Physicist, Physics Degree from Univ of Chicago