Cerebral small artery disease with remote left and newer right deep hemispheric infarctions
went to Dartmouth yesterday for my appointment with neurologist after my aug 5th stroke. (they are very! busy people). we did a cat scan ~4 days after the stroke(mild, affected left hand - some parts of fingers numb, arm-- weaker than before and lost control when lifting a 10lb weight, and leg --think gait affected. my neurologist, showed me the scan taken and the infract which was on the right side and near the center of brain and was in a symmetric location to the stroke a year and a half ago(mild right side stroke). the first stroke was also a stroke deep in the brain.
as I have mentioned in a previous blog, in the days before my strokes and particularly on the day of the stroke, I with my walking/jogging, had got myself into a state of excessive exhaustion. on the day of the aug 5 stroke I did wonder after the walk if I had got myself into a little trouble. and sure enough I did. all strokes happened many hours later while asleep during the nite. and all were small arteries that clogged. the diagnosis is that my small arteries are damaged and their flowing diameter is restricted and can close. I note that there is no direct evidence for this conclusion. they are too small to be imaged.
the below are my thoughts : the fact remains that I had strokes and I assume that my small arteries are damaged. however there are lots and lots of small arteries in the brain and in all parts of the brain. however my strokes happen deep within the brain - near the center. there are two possibilities, 1 a small piece of plaque dislodges from somewhere and finds a deep small artery and plugs it. hence stroke. this doesn't really make sense since there are so many other small arteries that it could plug, why would it plug these deep ones. the second possibility is there is no piece of plaque but the artery simply closes since the blood pressure is too low to keep it open. but now my problem with this why don't the other small arteries in other regions of the brain also close. the only thing I can come up with is that being deep within the brain the pressure at the artery is less than the pressure at small arteries in other places in the brain. -- water flowing in a tube looses pressure as it traverses the length of the tube. and the location deep within the brain is on a different chain of tubes(arteries) than say small vessels near the surface of the brain and may experience a more significant pressure drop. this is the only scenario that does make some sense. coupled with the fact that it is generally thought that blood pressure falls when sleeping at nite.
my conclusion is that my state of excessive exhaustion produces a lower than usual night time blood pressure which is not sufficient to keep the deep small artery open. it then closes and a clot forms.
and now the catch 22. my blood pressure is a little high and am taking bp meds. however in lowering the blood pressure with the meds I may be putting myself into a more dangerous territory wrt the closure of these small vessels.
these are my thoughts on a January nite that also promises to be kind of cold. in a few hours I will go to bed and when waking up I will see what faculties may have been left behind in my dreams(lol). I must say that I am not left with a warm and fuzzy feeling concerning my visit to Dartmouth, not their fault and I do want to know what is what. and in about 2 min I want to focus on what I can do and ignore thoughts of what might be. and I am happy about what I can still do.
if you got to this point, thank you for reading these thoughts.
david
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