Few weeks ago I was called to admit a patient with “a likely stroke” He was having intermittent right-sided weakness, vision problems and impaired coordination. The Neurologist saw him in ER. The diagnosis of the posterior circulation stroke was made. The patient was started on tPA (thrombolytic, clot dissolving medicine). I saw him in ICU. He was awake and joking around – “Oh, this is nothing, Doc”. Few hours later he became less responsive and I had to intubate him. Repeat CT head showed no bleed; Extensive posterior-circulation ischemic changes were noted (see image above). Now the patient is unresponsive and prognosis for his recovery is quite poor. The family decided to withdraw care.
Stroke could be a devastating disease. Most patients survive, but left with motor deficits, weakness in their arms, legs or inability to speak or even understand human speech. What strikes me is how little we can do to treat this disease. Aspirin is commonly used to prevent further strokes. Clot dissolving medications (tPA in the case above) could improve your chances for survival and recovery. The problem is, a lot of the patients come to us too late for this medicine to be administered. And even when it’s given, it doesn’t work all the time and the complications could be even more disabling or lethal (bleed into brain). This could be very frustrating. In the case above the patient “was lucky” to be with a window of opportunity for the medication to be administered. Yet it did not work. The patient decompensated right in front of your eyes and there is not much you can do. Modern medicine can do wonders for our patients. Testing the limits of it is what makes this job difficult.