Kit, on Feb 18 2008, 03:20 PM, said:
As some of you may know F, my friend had a stroke last year. How common is stroke in people with SCI?
The so called health care professionals she has dealt with seem unsure of treatment (other than wauferin(sp?) to keep her blood thin), rehabilitation and possibilities of recovery. We've tried various internet searches but haven't been very successful in finding others who have been in the same situation as my friend or a specialist that is able to offer her advice. Any help and/or advice any of you can give me to pass onto her would be much appreciated.
It seems so unfair as F was finally making some progress towards becoming more independant and now she is more dependant than ever
you know, it always ticks me off when warfarin is dished out to people who are at increased risk of falling (our of chairs etc). There are better treatments available for people at risk. I take it from the Warfarin that he had a 'clot' (thrombosis) as opposed to a 'bleed'. These types of CVA ( cerebral vascular Accident) are actually more common in SCI/D, other people with disabilities who use a wheelchair/ others who are not active. As with CHD ( heart disease), there is a Genetic component( if you have a familial history), cholesterol and BP ( blood pressure, not bowel program - this time!)
Then there is of course the factor of AD ( Autonomic Dysfunction), which if is not treated appropriately or in a timely fashion, can lead to CVA ( Stroke) ( usually due to a bleed, but can be a clot being forced to the brain under immense pressure).
So it is pertinent to carry medication such as GTN to help with AD so called attacks and also a Warning card so that those who have no idea about AD ( yes I do mean medics and RNs and hospital drs too) can follow the correct path. If your friend is prone to frequent AD, it may be worth looking into a Medic alert band which can be worn under clothes.
So, basically there are the two risks - the one from lifestyle ( seated life) genetics and smoking and drinking and eating high 'bad cholesterol' foods - and the the increased risk that the actual changes in the body after SCI/D bring.
See HERE for info into the research front and what is happening with regards to SCI/D and CVA/stroke/CHD ( coronary Heart Disease)
The below fit into the second category, the 'caused by physical changes' as opposed to lifestyle (so called):
DAMAGE TO VERTEBRAL ARTERY WITH CERVICAL SPINE INJURY
Vertebral artery injury after acute cervical spine trauma: rate of
occurrence as detected by MR angiography and assessment of clinical
consequences." Friedman D, Flanders A, Thomas C, Millar W. AJR Am J
Roentgenol. 1995 Feb;164(2):443-7; discussion 448-9.
http://www.ncbi.nlm.nih.gov/entrez/query.f...amp;query_hl=13
OBJECTIVE. "The purposes of this study were to assess prospectively
the frequency of vertebral artery injuries after major acute cervical
spine trauma as determined by MR angiography and to assess the
clinical consequences of these injuries."
CONCLUSION. "In our experience, vertebral artery injuries due to major
cervical spine trauma as determined by MR angiography are common.
Although these vascular abnormalities usually remain clinically
occult, a small percentage of patients may suffer devastating
neurologic complications of posterior fossa infarction. Noninvasive
assessment of the vertebral arteries by means of MR imaging should be
an integral part of the evaluation of the acutely injured cervical
spine."
HIGH BLOOD PRESSURE AND INCREASED RISK OF STROKE IN SPINAL CORD PATIENTS
From Spinal injuries Research Centre Projects. Prince of Wales Medical
Research Institute.
http://www.powmri.edu.au/research/injury/s...ircresearch.htm
Dr James Brock - Recipient of a grant from the Christopher Reeve
Paralysis Foundation.
* "Spinally injured patients often have periods of excessively high
blood pressure that may cause stroke or death."
"We have discovered that changes in the way blood vessels are
activated by nerves contribute to this condition. Bladder distension
or minor unheeded injuries below the lesion in spinally injured people
often lead to episodes of high blood pressure that may cause stroke or
death. These events require emergency hospitalization and are
expensive as well as dangerous. After spinal injury, the control of
sympathetic nerves that supply arteries and regulate blood pressure is
lost. However, the nerves below the injury remain in place and the
spinal cord below the lesion contains connections that can activate
them. Signals from the bladder or skin enter the lower part of the
spinal cord and activate the sympathetic supply generating a rise in
blood pressure. We have shown that increased sensitivity of arteries
below the lesion to the chemicals released from the sympathetic nerves
leads to excessive vessel constriction (nearly 10 times normal),
contributing to the exaggerated increase in pressure. We are now
investigating how the muscle of the arteries changes to produce this
increased sensitivity."
There is clearly a lot which can not be done, which is down to 'bad' luck, genetics and your friend's injury etc. However, there are a lot of things which can be done ( under the direction of a medically trained individual following stroke or MI (heart attack), to ensure safety). These include stopping or reducing smoking, cutting the units of alcohol drunk per week, eating healthier, well balanced diets, moving as much as possible - getting into adaptive sport such as wheelchair rugby, boules, adaptive archery, swimming, basketball (lower injuries) etc...as far as situation allows. Even passive exercises and therapy and 'standing' in a frame and or with braces (according to injury level) are all good forms of exercise to ward off stroke and MI's. Just remember slowly and build up and under direction of health care team...
I hope this helps,
Best wishes to your friend..
Take care,
K
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