Cause of Stroke

[PATE298]

My husband suffered a stroke about 1 1/2 years ago. It was a stroke that at the time was identified by syptoms only.  6 months later, an additional MRI confirmed that it was indeed a brain stem stroke.  The day he had the stroke, he had first slipped on something and fallen, got up walked a ways to a restroom and after sitting down, he couldn't get back up again as his right side had gone numb.  Once someone helped him to get up, he again felt ok and got up walked around, then once the ambulance laid him down to go to the hospital, his right side was paralized again, not to return without extensive therapy.  Our question is this, could the fall possibly have caused a blood clot to break free or release, causing the stroke?  In all of the tests since then, everything was fine or within acceptable range, except that they discover a small hole in heart, that was prob there since birth.  At the time of stroke, he was 51 yrs old, maintaining slightly high blood pressure with Norvasc, and cholesterol was slightly elevated.  He now additionally takes Coumadin, and can walk short distances with a cane, but has balance and ear problems. He has been labeled permanently disabled. We are just curious and would like to read any literature that is out there about this possibility.  We had two different dr. say that it might be a slight possibility. One said he had seen articles before on it.  Can you please let us know if you ever heard of it, or suggest where we might read more about such a thing?

[mesmer]

im 24 and diagnosed with a stroke.  age 19 diagnosed with high blood pressure, just recently found a hole in my heart this week and the neurologist claims the cause of my profound hearing loss and balance problems.  My question is this-if anyone comes across this:  mri of head negative, mra of head, chest, neck, and kidneys negative, eng abnormal, tee-hole in heart.  Yet otherwise i am normal.  completeley still i am fine, when i walk or move the worl seems to jump around, kinda like looking through a video camera as you walk thats not absorbing the bumps.  doctors say they have never seen anyhting like it.  vertigo for 6 weeks now and an initial episode in 95 that lasted 2 weeks with some minor hearing loss in my right ear.  as of 4/1/03 this episode began with some slight hearing loss in my left ear a week prior.  now i am completely deaf in my right ear.  PLEASE HELP IF SOMEONE IS OUT THERE READING THIS!!! specialists dont know what to tell me.  How likely is it that the hole in my heart led to two blodd clots each affecting both sides of my hearing at two different times?? JUST LOOKING FOR SOEM HELP OR DIRECTION!

[dizz]

have they done anything about your husband's PFO (hole in heart)?  We all have that hole in our heart from birth, but it usually closes up after we reach the age of 6-months or so. But for some, this hole never completely closes.

If you are asking what the cause of his stroke was, I'd have to say the chances are pretty good that the PFO was the cause, having this hole allows dirty returning blood and/or clot to by-pass the filtering effects of the lungs and travel directly to the brain causing a stroke.

Your husband should have a non-evasive TEE test done to determine how large the hole is and should consider some new PFO repair procedures, these new procedures resemble a parachute that is inserted via a catheter in the leg and seals the hole after a few months tissue grows over and completely seals the PFO.  I know a couple people who had this done at UCSF with successful results.

[CCF-Neuro-M.D.-JT]

I suppose it is possible, but it may be more likely that in your husband's particular case the stroke caused the fall as there appears to be a stuttering aspect to the initial presentation of the stroke. It is well known that strokes occuring after a fall may be due to fat embolism after a traumatic bone fracture.  A little piece of fat gets into the circulation and clogs up an artery in the brain leading to stroke.  ANd recently, a pediatric study showed that minor head injury can very RARELY lead to a stroke.

Now please keep in mind that I have never seen your husband nor have I reviewed his history and diagnostic workup in detail. It's also important to know where exactly in the brainstem the stroke was, how large it was, was there any involvement of the arteries in his neck or brain like a tear in the vertebral artery and how well his stroke risk factors such as the high blood pressure and elevated cholesterol were really being controlled. FOr one thing, a tear in the vertebral artery can occur as a result of trauma and lead to a brainstem stroke. Both hypertension and cholesterol problems can lead to clogging of the small arteries in the brain (including the ones supplying the brainstem) which may result in a stroke. Small vessel disease due to these factors constitue one of the major causes of
brainstem strokes.

Typically, blood clots from the heart that travel up to the brain do not make it all the way to the little tiny blood vessels supplying the brainstem.  Rather, they clog up the larger arteries that supply the larger parts or lobes of the brain like the cortex (outer part of the brain) or deeper parts, but not the brainstem (typically).  

With balance and fall risks, you may want to reconsider the treatment with coumadin as a fall with head injury could result in serious consequences such as bleeding in the brain.  I'm assuming that the coumadin is for the "hole in the heart."  Consider seeing a stroke specialist at a major academic center to evaluate your husband's stroke and what the best treatment plan for him may be. For more info, contact the American Heart Association or try www.stroke.org for the National Stroke Association. Best of luck.