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Stroke in cerebral part of brain

My aunt had a stroke yesterday adn the dr's said that the cerebal part of her brain is dead is this really
serious and long term or is it something that can be fixed with rehab? Also she is only 45 and they are now saying that there maybe something wrong with her heart that cased this stroke,Does anyone know what some possible reasons/ problems with her heart maybe? Im not too sure on what exactly it was called but I think it was cerebal, she is alert but having slurred speach and partial loss of vision, she is able to walk but is very weak. She now has regained most of her vision but they have found through some physical assesments that she does have some problems using her left side extremities
Asked On : Sat, 19 Dec 2009
Answers:  1 Views:  328
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  User's Response
A stroke, or Cerebro Vascular Accident (CVA) to give it a proper title, is complex issue, but there are two basic types. Type 1> The cerebal haemorrhage is when a tiny artery in the cerebrum has ruptured, allowing blood to leak into the space occupied by the cerebrum (higher brain). It displaces the brain tissue and causes varying degrees of damage to the brain tissue. It is probably too early to tell how severe the condition is just at the moment. Type 2> Ischaemia, is when a blood clot, usually from the heart, has passed along an artery, to the brain and has occluded, (blocked) the artery, preventing blood from flowing to the brain, and causes death in that part of the brain which has been 'starved' of blood. In either case, it is likely that only a portion of the cerebrum will be affected. Slurred speach and paralysis are common in either type1 or type 2 CVA. Did the Doctors give any indication of which type of CVA you're dealing with? Haemorrhagic, or Ischaemic. Since you are talking in terms of 'cardio-vascular' problems, it would seem likely that you are dealing with an ischaemic attack. There are a number causes of blood clots (embolism) and I would not like to attempt to try to determine its exact cause, that's the job of the physicians. The treatment of each type is quite different, and the probable outcome can be quite markedly different. The fact that your Aunt is alert is GOOD. It is far too early to expect a prognosis, and her condition could yet deteriorate, or could indeed, improve. I assume the symptoms have persisited for more than 24 hours? If so that would rule out a TIA (Transient Ischaemic Attack) or mini stroke. Therefore let's assume we're talking about a stroke of as yet unknown type. An ischaemic CVA would be treated with anticoagulant/clot dissolving medication, and if administered in time, ideally within an hour of onset, the damage would have been minimised, but depending upon the size of the embolus, a greater or lesser amount of brain tissue will have been affected. It is this, that will determine the severity of the stroke. The smaller the embollus, the further it will have travelled into the cerebrum, and the smaller the area of the damage. A large embollus would lodge further back in a larger part of the artery, and would occlude the blood flow to a greater area of brain tissue. An haemorrhagic CVA is a different story. The haemorrhage will have been caused by the rupturing of an aneurism (a weak spot in the wall of an artery) and over a period of time, if the hamorrhage persists, her condition will deteriorate, though it will of course be monitored by her physicians, an I'm sure they have already taken steps to mitigate the bleed, and to control futrther bleeding. In any event, and providing her condition does not deteriorate over a 24 - 48 hour period, you can reasonably expect her to survive. She will need a good deal of help in the coming weeks, and referral to an Occupational Therapist, Physio Therapist, and probably a Speach Therapist, who, together, will be able to assess her condition, and work out a treatment plan. The chances of surviving a CVA are quite good these days, though the extent of the damage, and the degree of permanent damage that results is still unpredictable. The level of recovery will depend entirely on how much brain tissue has been destroyed. The brain has a remarkable capacity to recover lost function, and if the area of damage is small, a 'near complete' recovery can, but not always, occur. Unfortunately, it isn't a simple matter, and I don't want to fill you with false hopes, but nor do I want to fill you with fear and dread. The main thing to set your mind at ease right now is this; If your Aunt is 'alert', her cerebrum is NOT dead. In any case, the whole of the cerebrum is never affected, if it were, she would be clinically 'brain dead'. Clearly, this is not the case, because you have already stated that she has slurred speach. That means she can at least communicate, and therefore, that part of her cerebral cortex may be damaged, but it is not dead. She may well regain the capacity for normal speach in the long term, but this will depend on many factors, not least of which is that she does not suffer any further CVA over the next few days. Then there is the matter of the severity of the CVA, and providing that she received medical attention as soon as possible, the condition will have been stabilised quickly. Unfortunately, once damaged or destroyed, brain tissue does not 're-grow' or heal in the sense of a 'physical' external tissue injury, however, there is capacity for 'collateral mitigation', where one part of the brain can 'take-over' the functions of the neighbouring damaged area. This of course depends on the initial CVA not being large enough to destroy all of the tissue in a specific area of the brain, and since different parts of the brain have specific tasks, ie the visual cortex is exclusively dedicated to sight, it cannot take-over, for example the task of motor control, or vice versa. However, since motor function is by far the largest part of the cortex, it is the most likely to experience some degree of recovery. Vision will depend on how quickly the condition was stabilised, and on the extent of the initial damage. Sadly, no two strokes are identical, and it would not be wise to try and second guess which way things will go. It is best to engage your Aunt's physicians in frank and open discussion since they are the team at 'ground zero', and will be the one's best equiped and qualified to help her through this difficult time. I guess you're really looking for some form of explanation, or reassurance? For the moment, be very thankful that your Aunt has made it this far. The further you can get away from the initial event (time wise), the better her chances. In any event, the first two to three days are the worst and most difficult, and, most unpredictable, but if she can walk, albeit with difficulty, and can talk, albeit slurred, then the damage is limited, and hopefully, there is a good chance of significant recovery. There are any number of books that you can buy, or can borrow from a library, that cover CVA. I would recommend seeking out and reading several of them. There are books intended for professionals, and books intended for the lay-person. I'd try both, if I were you. I'm sorry if this has been rattled off in a hurry, but it seemed to me that you needed to get a realistic response. I worked with stroke patients during my OT training, some 15 years ago, and did have a fair amount of information on the subject. Trouble is, I'm not involved at present, and I can't find my notes, so this is recalled from memory, and I am even now questioning my own limited knowledge. If you keep this question open, and/or use the EDIT feature to extend the EXPIRATION of the 'time left to answer' I will endeavour to dig out my notes, and get more info posted. <><><><><><> ADDENDUM <><><><><><> I'm gald to hear that she's regaining more of her faculties, and that's excellent news. Be aware though, that in most stroke patients, the recovery is fastest at the beginning, and slows progressively over the coming weeks and months. You can expect the greatest improvements over the next week or so, then, whatever she has yet to regain, will come much more gradually. If I recall correctly, it takes about 3 to 4 months to reach the point where there is likely to be no significant further improvement. However, the sooner her physicians feel she is able to receive some form of rehabilitation, the better, and it's always an advantage to start as soon as possible. It sounds as though things are progressing at about the right pace, and if the difficulties are limited to the extremeties, I would feel that the prognosis should be good, but please do be aware that it is also possible for things to 'go into reverse' before finally settling down. If she has recovered most of her sight, can speak in an understandable fashion and importantly, can understand what you're saying to her, has movement in all four limbs and can control her head movements, then she could well make an excellent recovery. The next few days and weeks should see the best improvements. It is tempting to say more but it would be unwise, I feel, to raise your hopes too high, too soon, and would rather take the cautious route. I'm sure that your aunt's physicians are on top of the job and doing their very best.
Answered: Sun, 20 Dec 2009
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