Neurology 103: Basilar Artery Thrombosis

I have been studying a series of medical journal articles about basilar artery thrombosis, which is what caused my brain stem strokes.

According to one online journal, Basilar artery occlusion is associated with a poor prognosis. Some patients with partial occlusion have limited ischemic injury and, therefore, a better prognosis, although outcomes continue to be poor.

Those factors associated with poor outcome include decreased level of consciousness, dysarthria, pupillary abnormalities, bulbar symptoms, diplopia, bilateral cerebellar lesions, tetraplegia, and a cardiac cause of embolism. Up to 90% of patients with no such factors have a good functional outcome, while all patients with such factors either died or had severe disability.

The mortality rate is consistently reported at greater than 70%. Recanalization may decrease the mortality rate by 50%. However, the outcome in a recent series of patients with basilar artery thrombosis treated with antithrombotics was similar to the reported outcome in the available series of patients treated with thrombolytic therapy.

tPA treatment was not applied in a timely manner in my case, but I started using Plavix, a antithrombotic drug that may serve to moderate future thrombosis. I hope so, anyway.

Stroke II: brain stem damage

This little bit of brain tissue is the focus of the problem. Apparently, small pieces of plaque material are being carried through my blood circulation through my heart and deep into the tissues of my brain, where they become lodged and block the vessels of the brain from receiving vital oxygen through the bloodstream. The oxygen-starved cells in that region of the brain quickly die, and the functions they once governed in my body suddenly lapse into uncontrolled chaos.

The brain stem controls operations such as motor locomotion and sensory awareness. In particular, my most recent stroke caused damage to brain centers that control muscles, sleeping, tactile awareness, and other senses to some degree. I find my body somewhat desensitized now as far as sensing what is touching me, and I might hurt myself without any sensation of pain. This also has some intriguing benefits, I have found. For example, the hospital has found it expedient to turn me into a human pincushion during my short stay, but I find most of my body to be insensate to the needle pricks. I can feel some pressure, but sense no pain. How convenient, that they can sink needles deep into my body, and I feel so little discomfort. (I suspect it spoils the desired effect somewhat for some of them, but I don't really mind spoiling their fun.)

Some other brain stem functions include regulation of things like heartbeat and breathing. Thank heaven, these things seem to be functioning without any compromise, else I suspect I would be suddenly and most decidedly dead.

Sooner or later, this seems to be the reality that faces me. In the mean time, I will do my best to put my time to good use.

Next instalment:  Mr. Toad's Wild Ride