AUGUSTA, Ga. (WJBF) – A brain-stem stroke like Gwen Snead suffered is not that common. And what is Locked-In Syndrome? Who of us might be at risk? Dr. Manan Shah is a Neurointensivist at the Medical College of Georgia at AU. He joins us to explain these rare medical events and the long-term prognosis.

Brad Means: Dr. Shah, thanks for what you do for patients and thanks for being with me.

Dr. Manan Shah: Thanks for having me.

Brad Means: Kind of walk us through the basics, if you will, Dr. Shah.

Dr. Manan Shah: Mm-hm.

Brad Means: First of all, what causes somebody to have a stroke? And if my understanding is correct, it can just happen out of the blue, right?

Dr. Manan Shah: It is. So stroke is basically caused by when there is an interruption to the blood flow to the brain. There are four main vessels, two in the front which we call carotid, and two in the back, the vertebral. They supply blood flow to the brain. And when there is an interruption to the blood flow the neurons get permanent damage from not having enough blood supply. And depending on the location of the occlusion, you can have different type of symptoms related to that stroke.

Brad Means: Is there a typical age for a stroke victim? Our patient who we talked about, Mrs. Snead, in our first segment, is 41. Is that about the average? What do you see?

Dr. Manan Shah: It is not. It is somewhat uncommon to have a stroke in such a young age.

Brad Means: Yeah.

Dr. Manan Shah: Age is actually a big risk factor for the stroke. With the age you have your other comorbidities built up, high blood pressure, diabetes, high cholesterol, all those risk factors increases the chances of having a stroke in an older age. So this is certainly somewhat uncommon.

Brad Means: You know, we mentioned that it can happen out of the blue. And so with that in mind, are there any signs or symptoms that we should be aware of to think, hey, this might be the beginning of a stroke, or this might indicate a stroke is coming later.

Dr. Manan Shah: So for some strokes, you do get some warning signs. What we call the TIA or a mini-stroke where people get this transient focal deficit where they may lose their ability to speak, they may lose their ability to move the arm or leg, they may get little facial droop. and then they get a reversal of their symptoms within few minutes to an hour. And that can be a big warning sign for something bad to come.

Brad Means: How do you tell the difference between something that just might happen and something that’s a true warning sign of a stroke? For instance, if somebody is giving a speech and they get their words tangled up for one or two sentences, should they think, “Uh-oh, something’s happening because I’m not getting my words out properly,” and other symptoms. How do we know where to draw the line?

Dr. Manan Shah: It is somewhat difficult.

Brad Means: Yeah.

Dr. Manan Shah: But I think you, yourself and as a person, should know yourself best. So you should know if you’re having trouble speaking. Also, the family members can sometimes notice that they’re having some type of facial droop, that someone who is not acting normal, two kind of warning signs should always be checked upon. So it is always better to go in and get medical help.

Brad Means: You know, Dr. Shah, we always hear that time is of the essence when somebody has a stroke and that the real damage is done the longer somebody is left unattended. Can you reverse the effects of a stroke if somebody is brought to you quickly enough? Can you make it as if they never had a stroke?

Dr. Manan Shah: It is to some extent. So we have few therapies for the acute strokes. They are very time sensitive. So the sooner the patient can be brought to us, we have higher chances of, we cannot maybe completely prevent the damage, but we can mitigate the damage. One of the therapy is an intravenous therapy where we can give an IV tPA, which is a clot-busting medicine. If someone is presenting with the stroke symptoms within first four and a half hours, we might be able to offer that medication. The other much more promising therapy we are able to offer at AU is the endovascular therapy. So depending on the patient’s symptoms and their imaging, our specialists might be able to offer a thrombectomy where they actually go through the vessel in the groin and advance the catheter all the way to the brain vessel and able to suck the clot out.

Brad Means: You know, if I’m thinking about ways to get my blood flowing better and to make my blood not clot in my blood vessels, I’m thinking I’m gonna take an aspirin, because that’ll thin my blood out and get it racing through those vessels. Is that a good idea if you notice somebody with symptoms of a stroke, make ’em take an aspirin?

Dr. Manan Shah: It is. The only caveat is that even if you develop stroke-like symptoms, in 20% of cases it can be a hemorrhagic type of stroke. In which case, you probably do not know if aspirin is a good idea, because in that case it can actually increase the risk of bleeding further. But the most important take home point will be to get medical help. Call 911. Or if you are with someone and you can drive to the hospital with someone, just get medical help.

Brad Means: Have you ever seen Locked-In Syndrome in your practice?

Dr. Manan Shah: Unfortunately, yes.

Brad Means: Yeah.

Dr. Manan Shah: This is something we often come across in Neuro ICU practice.

Brad Means: What’s the prognosis for the typical patient? We are seeing patients, we have heard of patients regaining function slowly but surely over time. What are these folks looking at in the coming months and years after a Locked-In Syndrome event?

Dr. Manan Shah: So I would say the overall prognosis is not good for the Locked-In Syndrome, just because the disability burden it comes with. These patients, when they have the Locked-In Syndrome, they are not able to move any of their limbs. They are not able to talk. They need a mechanical ventilation and a feeding tube for the nutrition. They do get some recovery months to years down the road.

Brad Means: Yeah.

Dr. Manan Shah: They might start moving their extremities a little bit. They might be able to communicate, that the tracheostomy tube that was providing the ventilatory support, it might come out. But the recovery is going to be very slow and they will still be significantly dependent for their activities of the daily living with dressing, cleaning, bathing.

Brad Means: Sure.

Dr. Manan Shah: They will need a lot of social support.

Brad Means: What can people do to try to make sure they don’t have a stroke or to increase their chances of not having one? Are there lifestyle decisions that will help?

Dr. Manan Shah: Yes. That is a major factor to prevent stroke. For primary prevention, the lifestyle modifications are the key. Having a healthy diet, avoiding high sodium, high salt containing diets, avoiding fatty food, doing an exercise. Those are the major lifestyle modifications you can do to prevent stroke. And another important aspect is that no matter even if you do those things, you can still develop hypertension, diabetes, high cholesterol. And in those cases, then, it is very important that you remain compliant with your medication. Because that is something we often see that one or other reason, maybe it’s for economical reasons, or just not able to, they don’t want to take those medications and that can lead to this poorly controlled risk factor causing stroke.

Brad Means: You know, you mentioned the importance of getting help quickly, dialing 911 if you’re noticing the onset of a stroke. Isn’t it better to take an ambulance to the hospital so that you’ll get triaged faster? We don’t wanna get stuck in the crowded waiting room.

Dr. Manan Shah: It certainly is. Because the ambulance paramedic personnel can also identify your stroke signs very accurately. And they can make a decision, where they should take you because not all the hospitals can provide the same level of care for the stroke treatment. So it is always a good idea to call just 911 and get an ambulance.

Brad Means: And y’all have got a great stroke treatment center at MCG at AU.

Dr. Manan Shah: We do. We are one of the only comprehensive stroke centers in the CSRA region and only one of the two or three comprehensive stroke centers in Georgia.

Brad Means: That’s good to know. No, it’s good to know. And it’s good that you’re here. Dr. Manan Shah, thank you for the work that you do and thanks for helping us understand it.

Dr. Manan Shah: Thanks for having me.

Brad Means: Absolutely. Welcome back anytime, Dr. Shah.