THE brain is the most delicate organ of the body,” states neurologist Dr. Vladimir Hachinski, of the University of Western Ontario in London, Canada. At only 2 percent of the body’s total weight, the brain contains more than ten billion nerve cells, which are in constant communication to produce our every thought, movement, and sensation. Dependent on oxygen and glucose for energy, the brain receives a steady supply via an intricate system of arteries.
However, when any limited part of the brain is deprived of oxygen for even a few seconds, delicate neuron functions are impaired. If this persists for longer than a few minutes, brain damage results, as brain cells begin to die along with the functions they control. This condition is called ischemia, a lack of oxygen mainly caused by artery blockage. Further damage is inflicted on brain tissue as oxygen starvation triggers a deadly cascade of chemical reactions. The result is a stroke. A stroke also occurs when blood vessels rupture, flooding the brain with blood, which cuts off connecting pathways. This disrupts chemical and electrical flows to the muscles and causes injury to brain tissue.
Its Effects
Every stroke is different, and strokes can affect individuals in ways that are almost limitless. Although no one suffers from every possible consequence of a stroke, the effects may range from mild and barely observable to severe and painfully obvious. The area of the brain in which a stroke occurs determines which bodily functions are impaired.
A common affliction is weakness or paralysis of the upper and lower limbs. Generally, this is limited to one side of the body, the side that is opposite the side of the brain where the stroke occurs. Thus, right-brain damage results in left-sided paralysis, and left-brain damage, in right-sided paralysis. Some individuals may retain the use of their arms and legs, only to find that their muscles shake to such an extent that their limbs seem to go off each in its own direction. The victim looks like a novice skater trying to keep his balance. Dr. David Levine, of New York University Medical Center, says: “They have lost the kind of sensation that tells them whether or not their limb is moving and where it is in space.”
Upwards of 15 percent of survivors experience seizures, resulting in episodes of uncontrolled movements and, commonly, in periods of unconsciousness. Also, feeling pain as well as changes in sensations is common. A stroke survivor who experiences constant numbness in his hands and feet says: “There are nights when something touches my legs and I wake up because it seems as if I am receiving electric shocks.”
Stroke outcome may include double vision and problems with swallowing. If the sensory centers of the mouth and the throat are damaged, further indignities can be suffered by stroke victims, such as drooling. Any of the five senses can be affected, causing disturbances in sight, hearing, smell, taste, and touch.
Communication Problems
Picture yourself being followed down a dimly lit street by two huge strangers. Glancing back, you see them rushing toward you. You try to scream for help, but nothing will come out! Can you imagine the utter frustration you would feel in such a situation? That is what many stroke victims experience when they suddenly lose their ability to speak.
Being unable to communicate thoughts, feelings, hopes, and fears-figuratively being isolated from friends and family-is one of the most devastating consequences of stroke. One stroke survivor described it this way: “Every time I tried to express myself nothing came out. I was forced to remain silent and could not follow either verbal or written commands. Words sounded . . . as though the people around me spoke a foreign tongue. I could neither comprehend nor use language.”
Charles, though, understood everything being spoken to him. But about making a reply, he writes: “I would frame the words I wanted to say, but they came out scrambled and garbled. At that point I felt I was trapped inside myself.” In his book Stroke: An Owner’s Manual, Arthur Josephs explains: “Over one hundred different muscles are controlled and coordinated during speech and each of those muscles is controlled by an average of over one hundred motor units. . . . An astounding 140,000 neuromuscular events [are] required for each second of speech. Is it any wonder an injury to a portion of the brain controlling these muscles may result in garbled speech?”
Many baffling phenomena in the speech area are produced by a stroke. For example, an individual who cannot speak may be able to sing. Another may say words on impulse but not on command or may, on the other hand, talk incessantly. Others repeat words or phrases over and over or use words inappropriately, saying yes when they mean to say no and vice versa. Some know the words they want to use, but the brain cannot prompt the mouth, lips, and tongue to say them. Or they may experience slurred speech because of muscle weakness. Some may punctuate their words with explosive outbursts.
Other stroke damage may be impairment of the portion of the brain that controls emotional tone. The result can be speech that sounds flat. Or there may be difficulty in comprehending the emotional tone of others. Communication barriers like these and those described above can drive a wedge between family members, such as husband and wife. Georg explains: “Because stroke affects facial expressions and gestures, indeed the whole personality, we suddenly did not get on with each other as before. It seemed to me as if I had a totally different wife, someone I had to get to know all over again.”
