Chris DeWald: Strokes, vision and cerebral vascular disease

My world is turning out information for you as if you are going upstream with no motor.  I figured not saying paddle as most have only one good working hand.  First, what is cerebral vascular disease?

According to

Cerebral vascular disease refers to the brain abnormalities caused by diseases of the blood vessels that supply the brain. The most important cause of a cerebral vascular disease is hypertension. Due to hypertension, blood vessels deform, they become narrow and uneven which makes them vulnerable when the blood pressure fluctuates. Other risk factors are obesity, diabetes and smoking. A cerebral vascular disease increases the risk of suffering a stroke, especially in older people even though it can occur with younger patients as well, especially if they have a history of diabetes, heart disease and they smoke. However, strokes are not common in patients younger than 40 years old but the risks increase exponentially with the age.

The stroke is the result of a cerebrovascular condition and it occurs when a blood vessel within the brain is completely blocked or when these blood vessels rupture. Usually the blockage is caused by a blood clot in the cerebral arteries (also known as thrombosis). It may also be due to a an embolism, which means that the blood clot was caused by a piece of tissue, cholesterol or other several substances in the blood. When a thrombosis or an embolism occurs, the blood supply to the brain may be completely blocked or it can lead to blood vessels ruptures that will bleed into the brain. Both of these situations may result in a stroke. An embolism can cause a transient ischemic attack (or a TIA) because it blocks the small arteries in the brain which will cause losing the brain function in the specific area. After the blockage moves on and the blood flows again, the affected area of the brain will regain its functions. Dementia may be a result of a cerebrovascular disease due to the progressive destruction of brain tissue caused by repeated blockages of the arteries.

All right friends, those are the basics.  The blood vessels get plugged with various junk and become smaller.  In my case, genetics played a significant role in having smaller arteries in my head.  I have been told since 2006, I am lucky to have survived at all and that this is a progressive disease.  I do not have just one area they can stent but so many small paths that any operation will do not good.  Yes it shall, I am here to tell you what happens.

At approximately 3 months ago, I started to notice my vision becoming unclear.  I could see objects as usual, but I could not read the shows on my TV.  Hey, a man and his remote control?  Now we are in the danger zone.  My usual visit, to the Neurologist, set a landslide of more doctors.   But I am here to talk about vision today, so let’s focus on that.  Did I type focus?

According to

The eye is the one structure in the body in which the blood vessels are easily visible to the examiner. Changes observed in the retinal vessels mirror changes that are taking place in other parts of the body, particularly those in the brain. In arteriosclerosis, degenerative changes occur in the walls of arteries that lead to thickening of arterial walls and narrowing of blood vessels and may give rise to complete occlusion (blockage) of a vessel. If the central retinal artery that supplies blood to the inner retina is affected, loss of vision is profound and sudden and, unless the obstruction can be relieved right away, permanent. Occlusion of the retinal veins is more common than arterial occlusion and also has dramatic effects caused by the damming up of blood in the eye. Blockage of retinal veins results in the bursting of small vessels, retinal swelling, and multiple hemorrhages scattered over the retina. Some degree of recovery of vision is usual but depends on whether a branch of the central vein or the central vein itself is occluded.

Profound and sudden I can see with my bifocals and with the screen at a higher degree of enlargement.  It was sudden to me and profound.  My vision is uncorrectable at 20/200 and my arteriosclerosis is visible to the “Medical Physician”.  This is not a lens technician, but one who deals with diseases of the eyes.  No matter what lens corrections, I cannot read with regular lenses.  What does 20/200 vision mean?

Levels of Vision

20/20 – Normal vision. Fighter pilot minimum. Required to read the stock quotes in the newspaper, or numbers in the telephone book.
20/40 – Able to pass Driver’s License Test in all 50 States. Most printed material is at this level.
20/80 – Able to read alarm clock at 10 feet. News Headlines are this size.
20/200 – Legal blindness. Able to see STOP sign letters.

The point to remember is that the progression of this disease may reach your vision center and it is “quick” and profound.  I can tell you, yes it is.  One day, all clear.  Next day “what’s on TV”?

You can follow me and this progressive disease as I was also sent to a neuropsychiatrist. Neuropsychiatry is the medical specialty committed to better understanding brain-behavior relationships, and to the care of individuals with neurologically based cognitive, emotional, and behavioral disturbances.

What is a neuropsychiatrist? A neuropsychiatrist is a physician (M.D. or D.O.) qualified to practice neuropsychiatry by virtue of either 1) primary training in psychiatry or neurology followed by a period of at least one year of fellowship training in neuropsychiatry/behavioral neurology, or 2) formal residency training in both psychiatry and neurology.  Psychiatrists or neurologists with many years of extensive clinical, educational, and scientific experience in the field of neuropsychiatry may also merit this specialty designation.

Which patients are best served by neuropsychiatric consultation or treatment? The Neuropsychiatrist treats people with neurologic illness and cognitive, emotional, or behavioral problems; individuals with combined psychiatric illnesses and neurologic conditions; and individuals with atypical or refractory primary psychiatric disorders in which there is concern that an underlying neurological condition may be causing the “psychiatric” symptoms.

So, I am now at this level.  Tune in next time, same Bat Channel…

Column by Chris DeWald

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