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Heath Ledger talks about the Joker

Heath Ledger talks about the Joke

http://batman-dark-knight.moviechronicles.com/ Heath talks about his experiences as the Joker




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Stroke and Depression: Frequently Asked Questions

Stroke and Depression: Frequently Asked Questions
Robert Robinson, MD
Division of Psychiatry
University of Iowa Hospitals and Clinics

Creation Date: June 2000
Last Revision Date: December 2004
Peer Review Status: Internally Peer Reviewed

Some facts: there are approximately 500,000 strokes that occur in the United States. Of those strokes, about 70 to 80 percent of patients survive the stroke. Of those patients who survive the stroke, depression occurs in approximately 40 to 50 percent of patients. Major depression occurs in about 20 percent of patients. Major depression is the most severe form of clinical depression that we recognize in neuropsychiatry. Another, about 20 percent of patients, will develop minor depression. There are some, approximately 10 to 20 percent of patients, who develop either major or minor depression some months or even a year after the onset of the stroke. Most depressions occur within the acute period after the stroke, but there are some depressions, that are delayed in onset and occur during the first year of poststroke recovery. The issue of poststroke depression has gained worldwide interest in the past 10 years. There has been a general agreement about the prevalence of both major and minor depression after stroke. Depression is one of the major impediments to full physical and mental recovery from stroke.

Do most stroke sufferers end up suffering depression?

Approximately 50 percent will become depressed at some time during the first two years after the stroke. The majority of patients, approximately 40 percent, will develop depression within the first one to two months after the stroke. There is another number of 10 to 20 percent of patients who will develop depression at some later time during the first two years.

What type of rehab can help with stroke depression?

By rehab, I assume what is meant is the usual types of rehabilitation therapy such as physical therapy, speech therapy, and occupational therapy. These do not specifically treat depression after a stroke. The treatment for poststroke depression that has received the most scientific study has been the use of antidepressant medications. Both Nortriptyline and Citalopram have been demonstrated in controlled studies to be effective in treating poststroke depression.

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AVM...

AVMs can cause a wide range of specific neurological symptoms that vary from person to person, depending upon the location of the malformation. These symptoms may include muscle weakness or paralysis, loss of coordination, difficulty carrying out tasks that require planning, dizziness, visual disturbances, problems using or understanding language, abnormal sensations (such as numbness, tingling, or spontaneous pain), memory deficits, mental confusion, hallucinations, or dementia.

It was noted that during his phone call with reporters the Senator began having difficulty with his speech, including having problems finding the words he wanted to say and slurring his speech. Senator Johnson was displaying the signs that he was in the early stages of a stroke, in his case caused by hemorrhage from his AVM.

There are two types of stroke: ischemic and hemorrhagic. Ischemic strokes occur when the blood flow to the brain is stopped by a blood clot or by low blood pressure throughout the body. If you are talking to a medical professional, they may refer to the formation these blood clots in one of two ways, either thrombosis or embolism. A thrombosis is a clot that forms in an artery or vein and stays in the place where it forms. An embolism is a clot that forms in one place in the body (often in the heart) and then travels somewhere else (usually the brain), and becomes trapped in an artery.

There are other sources of emboli besides blood clots, such as broken off bits of arterial plaque, fatty emboli which can occur after surgery or broken bones, amniotic emboli after childbirth, and bacterial emboli from an infection in the heart called endocarditis. The most common emboli is a clot that forms in the heart of a person in atrial fibrillation and travels to the brain.

The result for all forms of emboli is the same: lack of blood flow beyond the embolus causes a loss of oxygen and nutrients to the body's tissues. This is called ischemia (pronounced iss-scheme-ee-uh), or in the brain, ischemic (iss-scheme-ick) stroke. The other way an ischemic stroke can occur is if there is reduced blood flow to the brain, such as when a person is in cardiac arrest or has great blood loss from a major trauma. In these cases there is too little blood getting to the brain, which causes a loss of oxygen and nutrients to the cells and they die. It is known that about 85-90% of strokes annually are due to ischemic events.

A hemorrhagic stroke is a form of stroke that occurs when a blood vessel in the brain ruptures or bleeds. Like ischemic strokes, hemorrhagic strokes interrupt the brain's blood supply of oxygen and nutrients because the bleeding vessel can no longer carry the blood to the brain tissue. As the bleeding continues, it causes increased pressure in the brain, which physically impinges on the tissue and further restricts blood flow into the brain. For this reason, hemorrhagic strokes are more dangerous than the more common ischemic strokes.

There are two types of hemorrhagic stroke: intracerebral hemorrhage, and subarachnoid hemorrhage; Senator Johnson suffered from an intracerebral hemorrhage from a ruptured AVM. Intracerebral hemorrhage (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging pool of blood. A Subarachnoid hemorrhage is bleeding into the cerebral spinal fluid in the space between the brain lining and the brain itself.

Unfortunately most AVMs are not found until they cause a problem, or they are discovered accidently because the brain is scanned for another reason. Senator Johnson was very lucky; his AVM was discovered early on and surgery was performed right away, giving him the best chance of a full recovery.

Despite the commentary from the newsies and political pundits, it is much too early to speculate on Senator Johnson's ability to make a full recovery or whether or not he will resume his duties in Washington. In an interesting side note, in 1969 another South Dakota senator, republican Karl Mundt, suffered a stroke while in office. Mundt continued to serve until the end of his term in January 1973, although he was unable to attend Senate sessions and was stripped of his committee assignments by the Senate Republican Conference in 1972. Senator Johnson, who was elected in 1996, holds the same seat previously held by Mundt.

Personal stroke prevention is similar to heart disease prevention: controlling high blood pressure, blood sugar and blood cholesterol levels, not smoking, and getting regular exercise all help to prevent stroke.

It is also important for you to recognize the signs and symptoms of stroke in others, so that you can assist them to seek early treatment. In the same way that early intervention in heart attack saves muscle, early intervention in "brain attack" can save brain cells.

Researchers at the University of North Carolina-Chapel Hill School of Medicine developed this one-minute, three-step stroke assessment test to enable bystanders to quickly screen for a possible stroke diagnosis. Learn this 3-step stroke assessment and pass it on to all your friends:

You may remember the steps to this test by thinking of the first three letters of the word stroke, S-T-R

S: Ask person to "Smile broadly, showing your teeth." This "smile test" is to look for one-sided facial weakness or paralysis, shown as a drooping on one side of the lips.

T: Ask the person to "Talk" to you by repeating a simple phrase, such as "don't cry over spilled milk, " or "it is a rainy day." This is a check for difficulty speaking or understanding speech or following basic instructions.

R: Ask person to close their eyes, Raise their arms in front of them and hold them out for a count of ten. This is to test for arm weakness or paralysis (if standing it can also test for leg weakness, paralysis, dizziness, or loss of balance.)

If any or all of the above are noted to be true, the person should be taken by ambulance to the nearest emergency department for evaluation for a stroke. Doing this quickly could prevent a person from living with a lifetime of neurological deficits or from death.
For more information, please see the Web MD Stroke Health Center