Sharon’s Grave Condition Raises Questions About Strokes
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JIM LEHRER: The grave illness of Israeli Prime Minister Sharon, who underwent five more hours of brain surgery today. His situation has focused much attention on strokes, their causes and treatments.
We talk now with Dr. Mark Alberts, professor of neurology at Northwestern University Medical School. He’s also director of the stroke program at Northwestern Memorial Hospital in Chicago.
Dr. Alberts, welcome.
DR. MARK ALBERTS: Thank you, Jim.
JIM LEHRER: They operated on Ariel Sharon again today to stop bleeding. Tell us about the nature of that kind of operation.
DR. MARK ALBERTS: Well, what I anticipate the surgeons tried to do is go in there, remove any blood that had collected since the prior operation, prevent any further bleeding, and take steps to reduce the pressure on the brain that the initial bleed and the swelling around it might have caused.
JIM LEHRER: And that pressure on the brain is certainly a life-threatening situation, right? They had no choice but to do that sort of thing?
DR. MARK ALBERTS: Correct. You basically have two ways of dealing with the pressure on the brain that a big stroke like this can produce: Surgery, and medical therapy. And it sounds to me like they are basically doing both in an attempt to save the prime minister’s life.
JIM LEHRER: Now, they have induced a coma, and he’s still in that coma. Is this also a common practice, Doctor?
DR. MARK ALBERTS: Yes, it is. What we try to do is give patients medicine to put their brain, particularly the nerve cells in the brain, to sleep or sort of put them into a state of hibernation so that the nerve cells do not sustain further damage from the swelling and pressure on the brain and any further bleeding that may occur. So this is to protect the brain from further damage and injury.
JIM LEHRER: And are there any guidelines for how long this kind of coma should be — should stay in effect or is it just a kind of individual situation?
DR. MARK ALBERTS: Well, certainly I’m sure the doctors are making an individual situation based on the prime minister’s condition.
JIM LEHRER: Sure.
DR. MARK ALBERTS: But typically we do this for a few days. You cannot keep people in a coma forever, because then they have medical complications from being in an ICU in terms of infections and heart problems and other conditions.
But a few days would certainly seem like a reasonable thing to do.
JIM LEHRER: Now, let’s go back, now, to the original situation. When he was brought to the hospital, he had what was described as a cerebral hemorrhage. Explain in layman’s terms what that is.
DR. MARK ALBERTS: Well, there are two different types of stroke. The first most common type is cerebral ischemia. That’s when a blood vessel in or around the brain gets plugged up. The second type of stroke is –
JIM LEHRER: Excuse me, what would cause that plugging up?
DR. MARK ALBERTS: Atherosclerosis or a blood clot within a blood vessel or hardening of the arteries. And, again, an ischemic stroke is the most common type, responsible for about 80 percent of all strokes. And that’s the type of stroke he had initially, a couple weeks ago.
Now, a cerebral hemorrhage is in when a blood vessel in or around the brain ruptures or bursts. And that puts abnormal amounts of blood around the brain or within the brain. Cerebral hemorrhages only account for 20 percent of the strokes but they’re by far the most deadly with a mortality or death rate of at least 50 percent and in some cases even higher.
JIM LEHRER: Well, there is a standard treatment for this, for a cerebral hemorrhage?
DR. MARK ALBERTS: No, there are no good treatments for cerebral hemorrhage. Various studies in the past have compared medical therapy versus surgery and have found that one is no better than the other.
However, there is a new medicine on the horizon called Novo-7. This is a medicine that you give patients this with hemorrhage that makes the blood sticky or thick in the hopes of preventing further bleeding. And an initial study of this medicine showed that it did seem to be safe and effective. But another study is currently under way. But this is a very promising medical therapy for cerebral hemorrhage.
JIM LEHRER: And, Dr. Alberts, as I’m sure you know, there were some initial reports after Prime Minister Sharon’s serious condition arose about blood thinning drugs he was given as a result of the first stroke; as you described, that was, more minor stroke than a cerebral hemorrhage. Explain that to us, what is there to be concerned about, if anything?
DR. MARK ALBERTS: Well, after an ischemic stroke, again, a stroke caused by clogging up of arteries in the brain or formation of a blood clot, we give patients blood thinners. Medicines that we would give include aspirin, or Plavix, or Abernots, things like that. And those are taken orally, and they do a good job thinning the blood. But typically those medications are not associated with a significant risk of bleeding.
But if you have to give patients more powerful blood thinners, things like warfarin and the like, that increases the risk of bleeding complications. So we want to make sure we give patients the proper medications for the proper type of stroke, weighing the risk versus the benefit of each medication for an individual patient.
JIM LEHRER: And so, in here, again, I’m not — obviously we don’t know what the details are, specific details are, in Mr. Sharon’s situation. But to give him blood thinning drugs would have been a logical thing to have done after the first stroke, correct?
DR. MARK ALBERTS: Obviously his physicians felt that he needed a more powerful blood thinner than aspirin. I saw some reports that he was on lobonox which is used in some cases, that’s true.
JIM LEHRER: But then the complications comes when the larger stroke happened, right, the second stroke, and then you want to stop the bleeding, that’s when you say you want to thicken the blood, not thin it?
DR. MARK ALBERTS: Correct. I mean, certainly giving these powerful blood thinners cause the blood to be thin and it may not cause a bleed but it may make the bleeding go from a minor amount of hemorrhage to a massive hemorrhage. And it sounds like that, unfortunately, is what occurred in the case of the prime minister.
JIM LEHRER: Dr. Alberts, finally let me ask you this. As somebody who has devoted his professional life to strokes, and here there’s this attention in the United States, and all over the world, on strokes as a result of what has happened to Prime Minister Sharon, what is the message you would give to people about strokes? You got their attention, what do they need to know?
DR. MARK ALBERTS: Well, people need to know the best way to treat a stroke is to prevent a stroke. And the major things to do to prevent a stroke are to have a healthy lifestyle, to make sure that your high blood pressure gets treated, that your diabetes gets treated, that you stop smoking, that you don’t drink alcohol to excess. And certainly for the young people, stay away from illegal drugs.
And I would remind your audience that some famous people have had strokes and have died of a stroke. Franklin Roosevelt died of a cerebral hemorrhage. Richard Nixon died of an ischemic stroke. So you can see our treatments are somewhat limited. But the best thing to do is try to prevent a stroke, healthy lifestyle, and taking proper medications as prescribed by your physician.
JIM LEHRER: Dr. Alberts, thank you very much.
DR. MARK ALBERTS: Thank you.