good evening and welcome to doctors on call I'm Dr Ray Christensen a faculty member from the Department of Family Medicine and biobehavioral health at the University of Minnesota medical school here on the duth campus and a family physician at the Gateway Family Health Clinic in Moose Lake I am your host for our program tonight on neurolog IC problems headaches stroke Ms and Alzheimer's disease the success of this program is very dependent on you the viewer so please call in your questions tonight or send them to our email address ask pbsn north.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr vickram jov a neurologist with Essentia Health Dr Chris Tess a family physician with Gateway Family Health in Moose Lake and Dr John Wood a family medicine physician with the duth Family Medicine Residency program our medical students answering the phones tonight are Jenna Carlson of Royalton Minnesota Lindsay monag of sck Rapids Minnesota and McKenzie Peterson of lever Minnesota and now on to tonight's program on neurologic problems headaches stroke Ms and Alzheimer's disease just like to take a moment let you gentlemen introduce yourself Dr Wood can you tell us a little bit about yourself or your practice what you're doing thanks a lot Dr Christenson yeah John Wood here I'm the one of the faculty at the DU Family Medicine Residency program which is for those of you who don't know after medical school every medical student has to do a residency which is anywhere from say three to nine years in length depending on your specialty and for us for Family Medicine where we learn many different skills primarily to our mission is mainly to work in rural areas underserved areas and so I was I'm one of the faculty that helps train those beautiful young Physicians to do that work so been privileged to do it for about 10 years Dr T I'm Christopher T I work at Gateway Family Health Clinic in Moose Lake and I do all sorts of medicine in a rural area just like Dr Wood trained us to do Dr J hi thanks for having me on the program so my name is Dr Vick jadav and I'm one of the stroke and Interventional neurologists at at Essentia St Mary's Hospital here in duud so primarily our specialty deals with problems of the head of of the blood vessels of the head the neck and the spine so essentially uh you can call us like cerebral plumbers because we make sure that we keep the pipes that are going into the head and the neck and the spine open thank you very much gentlemen and welcome again Dr Wood can you tell us what a stroke is or a CVA and give us some language thanks a lot for asking Dr Christensen so stroke or CVA meaning cerebral vascular accident probably been around as long as people have been on the earth and you can think of it as simply as the plumbing as we just alluded to the blood vessels are very um tenuous they work when they work they work great but when they don't work sometimes the outcomes can be catastrophic and you can think of a stroke as hemorrhagic where suddenly a blood vessel will burst and you'll get a lot of bleeding and that might present differently than the probably the more common kind of stroke is es schic stroke which is seen from a variety of conditions say atrial fibrillation hypertension high blood pressure diabetes smoking um uh all these kind of diseases can lead to those uh states that can make one predisposed to stroke whether hemorrhagic or ES schic um one thing I just want to say about stroke is it's really important to recognize the signs and symptoms of a stroke and there's an acronym called B fast which I think maybe many people in this audience are aware of but B would stand for balance e would stand for eyes F would stand for face a would stand for arms if your arms are not working properly s would stand for speech and T would stand for time and I think the important thing about a stroke is to recognize if your partner or yourself are acting a little funny it can be anything it can be subtle or it can be again hard to miss but time is a very important factor and we'll be talking about things that you can do in a stroke but it's really important to get to a medical facility as quickly as possible I hope that was helpful oh very good thank you and thanks for bringing in the B fast piece in fact that has been expanded to B faster oh so when you when you have signs that are representing the acronym B fast then you go to the nearest ER so that's faster call 911 or go to the nearest ER because as you alluded to time is of the ense and you have to get certain treatments within time and if you if the patients who are having stroke symptoms stroke signs if they get those sympt get that treatment within a certain time window then they are likely to have a very good outcome so time is brain time is brain totally as long as you're on the verge of this then what happens when they come into your your shop and what do you do that's a so uh patients who have symptoms of stroke so one thing I also like to point out uh there is a lot of awareness of uh in the Cardiology world when somebody has a heart attack or the feel that they're having a heart attack they have a chest pain or some tingling in the arm and patients would immediately go in but with stroke sometimes patients tend to delay going into the nearest ear because they just feel that oh it might just be a little bit of a tingling or a slept on the wrong side so the acronym that Dr W alluded to if patients recognize that come into the ER if they get within the to the ER within the first 4 and a half hours from the symptom onset you are eligible to get a clot busting medication and this medication can go and break up the clot which is blocking the blood vessel that is preventing the blood from flowing to that part of the brain and preventing oxygenation of the brain so the medication can lies the clot or break open the clot sometimes the medication may not work to open up the clot and that's where our specialty comes in wherein we put in the catheter either through the arm or through the leg blood vessel and go all the way up to the neck and then into the brain and we put in the device to capture the clot and pull it out thereby restoring blood flow to that part of the brain and providing oxygen and blood flowing back to the brain and then that way you are able to stop the stroke from progressing Salvage important viable parts of the brain and improve recovery function in the patient so Dr T you're the ER doc today I've been away from that for a while tell me about the presentation emergency room and what kind of uh uh presentations you see let's let's just stay with stroke for a bit sure in my mind I always remember the ones that happened at night it seems like that they were the hardest ones but what do you think so I've certainly seen a lot and uh that can range from um someone who just feels like their faces suddenly drooping um to someone who can't move their right side and can't speak and I think um for many of those uh people often notice that because the patient themselves may have less of an idea what is happening that something is different and it depends on the stroke but uh sometimes it takes a loved one to look at somebody and say you know this is really different because the the patient may not really know that something is gone there's a there's a phenomenon called neglect where that part of the brain that's missing is just not the patient isn't aware of it I changed our sequence a little bit we were going to talk about headaches too I'm going bring you back to that sure because stroke can be a headache also and yes why don't you give us just a bit of a perer on the headaches there are many different types of headaches and we see a few of them in particular in Primary Care um one is a migraine headache and I think many people think of migraines as just the very severe headaches but a migraine will tend to have some things like uh being maybe on one side of the head feeling throbbing um maybe giving you nausea uh and then also um sensitivity to light or sound or social interaction so a lot of people with migraine May uh just sort of withdraw from being with other people and go t take a nap and sleep um a lot of times migraines can be treated with uh things like ibuprofen or acetaminophen but sometimes they need specialized medic ation and we're happy to help out with that um tension headaches we see a lot of to and those tend to be maybe in the front or the back of the head and maybe not as throbbing um and more persistent and I think a lot of people can tell when they're under stress or they may be having a reason for attention headache and one more I'd like to mention that we see fairly often is just a medication overuse headache um I've had people who have a shoulder injury and then after a week or two of using ibuprofen or something for that pain they might develop a headache that's almost a withdrawal headache every day and that's from taking that pain medication just for a couple weeks uh bringing on the next headache and having to take the medication to take it again uh to get rid of the headache and that's something where we can also help with weaning off the medication and getting rid of those thank you very good John the worst headache that you could have well that bleed that bad it over this way when yeah be kind of what kind of a Thunderclap headache the worst that's always something when I used to work in the er2 that would be a question we'd ask and if we got the answer that someone said yes that would immediately make us think about certain kinds of bleed subid Hemorrhage or whatever and then we'd be referring ourselves to our colleagues to my left to send people down to Essentia Health or St Luke's or one of our regional hospitals in order to get the interventions they need for those kinds of headaches so not all headaches some headaches can present as a stroke some headaches can some Strokes can present as a headache it's very complicated and often hard to figure out I think the common theme Here is we're talking about trying to get people into Medical Care as quickly as possible and certainly if anybody's listening and they're having the worst headache of their life and that's subjective that's there's no there's no answers to that my headache might be different than your headache but it's the worst headache of your life you need to seek medical attention immediately Vic do you want to carry on on that one sure as Dr would alluded to the the thunder clap headache is pretty much like the worst headache of your life presentation and uh accompanied with the headache there'll be nausea vomiting and many of times depending on how large the bleed is then the patients might even be upended like they can actually lose Consciousness or they might just have uh symptoms or signs that are mimicking like basically it's a bleeding stroke so you can be either paralyzed or not being able to breathe and then the paramedics would have to come in and intubate so that you are able to breathe and uh put you on a mechanical ventilation so these kind of headaches they occur because of an aneurysm that has ruptured so what what essentially an aneurysm is it's an outpouching or a weakness in the blood vessel wall and it has reached an extent that the weakness is so much that the blood vessel has ruptured through that aneurysm and the blood has gone between the layers of the brain so there is blood inside the brain and that's why the pressure inside the brain has spiked up and this leads to further problems down the road and unless it is treated like the pressure inside the skull is treated and also the aneurysm is secured by either coiling or putting Sten with coils to block the flow of blood into that part of the brain where there is leakage or the blood has or the vessel is bleeding it could further lead to more problems so so anorm treatment is an important part and parcel of Interventional neurology specialty thank you John how do you diagnosis how do you diagnose a TIA and what are the treatment options for that well I think what we're talking about is Tia would be a temporary or esic attack you know attack that the es keemia is what we talked about earlier was the stroke like symptoms which as Dr T or Chris alluded to it can be variable speech loss paralyzed loss of function on one side the difference with a TIA is that those symptoms will resolve usually within 24 hours the problem with it making a diagnosis of a TIA it's it's retrospective because often at the time you don't know that you're dealing with a TIA until the symptoms have passed and you can get complete resolution I think of a TIA as we were talking about um heart attacks as sort of an anginal symptoms your your body is telling you something that there's something wrong excuse me I'm not looking at the camera I apologize for that I'm looking at my colleagues so um your body is telling you there's something wrong and so this is a sign that you need to one get to the emergency room and get evaluated you're going to have the same amount of testing that you would have for a stroke but the issue is that these symptoms are going to resolve thing about a TIA is that once the Tia is passed it's about managing risk factors it's about managing the things that cause that your high blood pressure your smoking your diabetes your these factors that have led to the to the es schic part of the lack of oxygen and blood flow that's caused those symptoms in the first place Chris I know that you've kind of covered this already but just to brush it up a little bit one should see one should you go see the doctor for headaches and then some options for headaches and you've kind of covered some of this already there are a few um specific things that might make it worse I I guess a lot of times headaches will have patterns and so if you've had tension headaches and you know what they are and they're stable that's not something that we worry about but something that comes on rather quickly like a Thunderclap headache is of course bat um headaches that come on uh for the first time after age 50 um headaches with uh a fever or some other illness if you have cancer and there are new headaches we might think that uh there's some other problem that's causing the headache um headaches with other nerve symptoms so if your hand isn't working like in the concern of a stroke um that that would also tell you to go in and get that checked out um those are the ones that I can think of right now John let's go on to postconcussion sure so sometimes after a concussion you can have debilitating headaches you know that and the the problem or the challenges with postconcussive headaches and concussions in general is that treatment is is we're lacking a common consensus and I think definitive treatment for that at this point in time I think we've gotten a lot better at recognizing that the brain is a very fragile vessel like injuries that maybe the four of us would have thought as a child would have been relatively minor are now treated probably a little bit differently meaning that um the kind of injuries that we might have had in sports would be treated much differently now but postconcussive headaches can be very challenging because your brain is trying to sort of normalize its function and there's the only real treatment for that is obviously medications to help with the headaches but time and then recognition that this is an issue so if anyone has had a concussion or a head injury which can be really frankly relatively minor it's important to speak with your family physician or your physician who will often be able to get referred to a neurologist for some postconcussive care so Vic I'm circling back to you now we've had somebody that's had a significant concussion and then let's let's go into subdural epidural those kind of areas and does that fit into your specialty a bit also yes it does and I'm glad you brought that topic up because uh this is a new and exciting developing field wherein we can use the same catheter based technology to take care of patients who have suffered because of a bleed from the concussion so there are a couple of different kinds of bleeds which are probably not as common as say intracerebral Hemorrhage like there is bleed bleeding inside the brain but there is bleeding between the layers of the brain between the brain and the skull so one of the common ones that we do see is uh subdural Hemorrhage and this unfortunately is seen in patients at an advanced age so for these kind of bleeds the blood keeps on gradually accumulating and expanding and that can cause some Mass Effect so the brain can get kind of squished over time and this can lead to gradual development of uh say deficits on the other side of the body whereas there could be weakness or patients can start losing their language function or they can start becoming imbalance and gate could be a problem so for these patients if they are able to tolerate surgery then the neurosurgeons can go in and just put in like a small hole in the skull and drain that blood out or sometimes they can take a part of the skull out and then drain the blood out but many of times the patients are older and they're not able to tolerate surgeries so for these patients since we put in again a catheter through the groin or the arm go all the way up to the neck and then outside the brain this time these are very small blood vessels that feed all the way over the scalp and then they dip inside into the membranes that Supply the where the where the blood has accumulated and by embolizing or blocking these small distal blood vessels we can treat and prevent future accumulation of blood and so that way the patients will have a much improved chances of recovery faster recovery and they can even go back sometimes on the medications that caused this bleeding in the first time sometimes they are on aspirin Plavix or some blood thinners which contribute to bleeding of these types that is a change to what I grew up with definitely it's a change yeah it is it's very good and yes this type of care is available here in duth is is there an increased risk of future Strokes if a patient has visualized visual loss and difficulty speaking just prior to getting a migraine headache so we'll walk into the swamp a little on that what do you think Chris um so migraines seem to have a lot to do with the blood vessels in the brain and that may be part of the feeling of throbbing in the head and uh sometimes the signaling that brings on a migraine can also squeeze down the blood vessels so much that you can have a stroke from a MIG and fortunately I haven't seen many people with that but it is enough of a problem to make it I think sometimes very difficult to understand whether we're dealing with headache or stroke or uh something else like Ms and it's very difficult to figure it out it can be in the end yes you have anything to add on that one thankfully uh uh there are a lot of Investigations that can be done even before the patient can be seen by a neurologist and this would be doing an MRI of the brain or a CT scan of the brain initially so sometimes these pathologies or the diseases that are contributing to the headaches or the vision problems they can be teased out before a specialist even can see the patient very good John how does trigeminal neurologia fit in with Strokes boy um and personally I'm not aware that it does I not I frankly am searching my brain and I'm not aware that it is there's any causal causality between trial neuralgia and stroke I would say trial neuralgia is a challenging diagnosis and neurologically that's a tough thing to treat but I don't think that it's related to Str different problem wasn't there also an uptick in trigeminal neuralgia during Co yes okay I I I thought there was a connection where there had been a few more of those we don't know a whole lot about Co I I don't think even yet but yes yeah and that's trigeminal neuralgia is a horrible thing and sometimes misdiagnosed as dental problems for a few people so if you have some sort of problem with horrible pain that's worse with tapping uh see a doctor and try and get it taken care of it's awful yeah as long as you're in that area can TMJ problems cause headaches oh yes so the the the joint right where your jaw works is something that uh can get arthritis just like any other uh joint and cause pain and um that's another spot that can be really awful especially when people have to talk or of course you have to chew to eat um uh those things can make it worse and those are everyday things that we have to do John can baby aspirin U are the daily benefits for does baby aspirin have daily benefits for preventing stroke or is it hogwash uh the daily it depends on when you answer that question answering it in 2024 is a little different than 2014 or 2010 or whatever so folks that have had identified risk factors for heart disease stroke who have had a stroke who have had H who have had an MI or candidates for a daily aspa we don't universally Rec recommend say the average person walking down the street to take a daily aspirin like we used to you know what I mean but conceptually though the baby aspirin can help thin your blood out makes the platelets a little less sticky helps the blood flow a little better so yes Chris can diet and exercise help prevents Alzheimer's disease absolutely uh regular exercise is one of the better uh ways to keep yourself from getting Alzheimer's and diet uh certainly avoiding alcohol and uh trying to eat healthy with reduced fats to lower the risk of damage to your blood vessels I'll also add uh avoiding smoking you guys haven't talked much about alcohol as we deal with stroke and other problems is alcohol a significant factor in stroke and neurologic disease and any one of you can jump in on that I've seen a lot of alcohol related neurologic disease um a lot of it due to withdrawal from alcohol or overuse causing dementia and with stroke I don't know about the connection this definitely there is like I would just tell the patients uh if there somebody's asking me question about that a little moderation alcohol is okay because sometimes red wine it does have antioxidant properties and that might be beneficial but I always tell it is has to be in moderation and when I tell them it's one glass you do you define the size of the glass to the patient first and make sure it's not a big one so tell them uh alcohol such as in red mine would definitely be helpful uh sometimes but all other forms of alcohol if not done in moderation is not good for stroke and it is likely to be delerious and harmful for stroke patients John are blue light blue light glasses really effective in preventing headaches I'll have to say I have absolutely no idea I'm just going to take the fifth on that one maybe my colleagues to my left have heard I I honestly don't know I haven't heard anything about that no the same straight on C is there something as a pin prick headache above the right eyebrow um this person apparently has a like a pin prick headache above the right eyebrow what would cause that we have about a minute there's a nerve right in the middle of the eyebrow that can be irritated and perhaps it's that maybe the super orbital yeah where it comes out of foran maybe that's it or migraine I've had a couple people with that and you've got stroke throm bomy available here in duth yes we have that we established the program way back in 2018 so this would be the sixth year and it has been very successful because now the treatment is available in the backyard in so to say in Northland because patients do not have to be transferred to the cities uh for stroke thrombectomy treatment that is the Sten retriever the catheter treatment that I mentioned about because with every passing minute patients are losing brain cells so for 1 minute of prevention of blood flow patients are losing about 2 million brain cells so you can calculate and keep on adding the amount of time so if by getting this treatment in duth itself you're able to salvage the brain for the stroke patients great discussion tonight gentlemen really really good we learned a lot of new things I want to thank thank our panelists Dr vickram JV Dr Chris ton and Dr John Wood and our medical student volunteers Jenna Carlson Lindsay Montag and McKenzie Peterson please join Mary Morehouse next week for a mental health program on Stress and Anxiety thank you for watching and have a great night w