Dr. Rimma Ruvinskaya, MD

Ischemic strokes are severe because it restricts blood flow and an inadequate blood supply damages the brain, which cannot function without a steady supply of oxygen and nutrients. Ischemic strokes may alter appearance by leaving one side of the face paralyzed, also affecting speech and communication. Additionally, ischemic strokes can result in impaired movement, cognitive ability, and can impede important physical functions like walking.

The main cause of ischemic stroke is from plaque (deposits of fat and cholesterol) accumulating in blood vessels. Plaque causes atherosclerosis, a condition where the blood vessels narrow and harden with cholesterol, fat, and calcium, causing damage to the endothelium (inner layer of cells in the arteries), which in turn restricts blood flow. At some point, a large blockage of plaque or bits of broken up plaque may result in an ischemic stroke.

People who are older are more likely to have ischemic strokes due to accumulated plaque. Additionally, certain repeated behaviors are associated with an increased risk of ischemic stroke. These behaviors include:

• Smoking
• High fat diet
• Lack of exercise
• High salt diet
• Alcohol abuse

Conditions such as heart disease, diabetes, high blood pressure, and high levels of cholesterol and lipids are also known to be correlated with ischemic strokes. If possible, people are advised to avoid modifiable risk factors (factors one can change themselves) such as smoking and lack of exercise by keeping an active lifestyle and a healthy diet.

Signs of stroke include:

• Disorientation or confusion
• Difficulty speaking
• Difficulty walking
• Impaired vision
• Weakness in the face, legs, or arms
• Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Hospital treatment generally begins immediately if a stroke is detected.

Medical treatment for ischemic strokes includes a thrombolytic medicine which breaks up and disperses blood clots. This medicine can greatly improve stroke recovery and long-term health. However, the thrombolytic medicine must be administered as soon as possible to achieve these results. Other treatments for ischemic strokes are blood thinners and thrombectomy, a surgical procedure to remove a blood clot in the brain. Thrombectomy is performed using a catheter (thin needle) to the artery to reach the blood clot and mechanically remove it. With the clot removed, normal blood flow to the brain resumes. Thrombectomy is typically performed at most six hours after a patient shows signs of a stroke.

Ischemic stroke patients who have lost some essential functions while the blood flow to their brain was obstructed may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from neurologists, who can assist patients in recovering certain brain functions and cognitive abilities, and rehabilitation psychologists, who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, ischemic stroke rehabilitation can last for years.

If someone begins to show signs of ischemic stroke, contact emergency services and call 9-1-1 immediately since blood flow must be restored as soon as possible to avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate ischemic stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.

Spinal cord injury medicine seeks to stabilize the spine and to alleviate the symptoms of spine damage. Practitioners of spinal cord injury medicine are called spinal cord injury specialists. Spinal cord injury medicine is an interdisciplinary field, meaning physicians of various specialties may be trained to treat spinal cord injuries.

Damage to the spinal cord may initially be diagnosed through X-ray, MRI, or CT scans. Patients can also undergo spinal exams to evaluate their sensory ability and strength. Injuries to the spinal cord can be complete (no feeling or sensation) or incomplete (some feeling or sensation remains). Conditions spinal cord injury medicine specialists may treat include:

• Paralysis, such as paraplegia (loss of function in the legs), or quadriplegia (loss of function from the neck down)
• Spine fracture or trauma, which can lead to impairment and/or significant pain
• Spinal infections
• Myelopathies, such as herniated disks, spinal tumors, and rheumatoid arthritis
• Inflammatory diseases such as ankylosing spondylosis, and degenerative conditions like Lou Gehrig's disease (ALS)

Treatment for spinal cord injuries often involves surgery, either directly after an injury occurs or at a later date. Surgery for spine injuries is intended to ease spinal compression and stabilize the spine. Surgical procedures can involve shifting vertebrae, removing bone, or altering spinal placement with implantable devices. Patients with significant spinal trauma may require urgent surgical intervention.

Surgical treatments can be complemented by rehabilitative physical therapy to improve mobility. Spinal cord injury specialists also treat complications arising from a spinal injury, such as respiratory or bladder conditions. Some patients with spinal cord injuries may require lifelong treatment. Spinal cord injury specialists aim to help these patients successfully adjust and lead an improved quality of life. An emerging treatment for spinal cord injuries is neural prosthetics, which replicate patients' lost nerve function. Neural prostheses may be used as artificial body parts or assistive devices that patients may cognitively control. Other assistive devices include wheelchairs and scooters.

Spinal cord injury specialists may collaborate with physical therapists, radiologists, neurologists, urologists, and orthopedists.