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Your Good Health: Delayed treatment of stroke results in lost brain function

With any of the cardinal symptoms of a stroke it is time to call 911.
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Dr. Keith Roach

Dear Dr. Roach: I am a 60-year-old man. In April 2020, while watching TV, I developed dizziness, changes to my vision, difficulty standing and walking, and sudden deafness. I did not want to go to the hospital right away. I finally went to the hospital the third day after symptoms appeared.

I was informed by my doctor at the hospital after extensive testing that I had come down with vertebral artery dissection (on my right side), and that it is extremely rare, affecting roughly 3,000 people a year in the U.S.

Communication is now extremely difficult and challenging. Mostly everything that people say to me needs to be written down. I have also noticed that I seem to forget so many things.

So, I have three questions: How long before my dementia turns into complete dementia and I will need to go into assisted living? Do you think that because I didn’t go to the hospital right away, I sustained permanent damage in my brain?

I was put on 10 mg of atorvastatin, but I don’t have high cholesterol. My third question is, do you think 10 mg is a sufficient dosage?

G.M.

Let me answer your second question first. Yes, you had a stroke, which is permanent damage to the brain. In your case, it was caused by lack of blood flow from the damaged vertebral artery. Immediately going to the hospital might have been able to prevent much of the damage. With any of the cardinal symptoms of a stroke (balance or coordination loss; eye or vision symptoms, such as blurry vision or vision loss; face drooping or weakness; arm weakness; speech difficulty or loss), it is definitely time to call 911. BE FAST is an acronym that can be used as a memory aid for these symptoms. After so long, it is unlikely that you will recover much of your lost brain function.

However, if the memory changes are due to the stroke, they are not usually progressive unless you continue to have strokes. Medication to prevent stroke recurrence is important. Aspirin or anticoagulant medication is usually recommended. Statin drugs like atorvastatin may have some benefit, but with this particular type of stroke, statins are not as critical as they are in the more common type of stroke caused by a blood clot in the brain. So, I don’t think the dosage is critical.

There is no reason to think that your memory changes will progress unless you have another reason for memory loss, such as Alzheimer’s. Hearing loss itself, rare even in a vertebral artery dissection, may predispose patients to dementia, so getting your hearing treated as much as possible may also help.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu