Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
A 73 year old woman is vacuuming when her left leg becomes weak and she has
difficulty standing. Her face and left arm become numb. She calls for her
husband, who helps her to a chair, and even though the symptoms resolve within
five minutes, they decide to go to the hospital. In the hospital parking lot,
they debate whether they should go into the Emergency Department or just turn
around and go home.
This woman has suffered a TIA, or transient ischemic attack, which is
basically a stroke that
resolves on its own. Since the right side of the brain controls
the left side of the body (and vice versa), she suffered reversible damage to
her right brain and that caused her left leg to get weak and also developed
numbness on the left side.
After some discussion, the woman decides she wants to seek medical care, and
she and her husband walk through the Emergency Department doors. The doctor and
nurse take a medical history to find out what happened. All of the symptoms have
resolved, so the next step is follow-up care. The healthcare team asks the
patient if she has any of the known risk factors for stroke (which are the same
for heart disease):
The artery blockage may occur because of a ruptured plaque due to
atherosclerosis or hardening of the arteries, debris that floats downstream
from narrowed carotid arteries or blood clots (emboli) that form (often in
the heart) and travel to block an artery in the brain.
Since TIAs resolve on their own, the goal for treatment is to minimize
the risk of future TIAs and stroke. Treatment involves looking for the
reason why the TIA occurred.
Treatment may include aspirin or other anti-platelet medications like
Aggrenox or clopidogrel (Plavix).
It is important to educate the patient and family that should another
stroke-like event occur, 911 must be called and emergency medical services
activated, since there is no guarantee that symptoms will resolve.
What is a transient ischemic attack (TIA)?
The primary role of the brain is to send signals to the body for motor function and to receive signals through the five senses (sight, hearing, touch, smell, and taste), and to respond to them. The brain processes information through conscious thought, and unconsciously through nerve systems that control basic bodily functions, like heart rate, breathing, and temperature control.
In simple terms:
The brain is arranged so that the right side of the brain controls the left side of the body, and the left side of the brain controls the right of the body.
Vision is located in the back of the brain (occiput), and balance and coordination are located at the bottom of the brain (cerebellum).
Blood supply to the brain comes from the carotid arteries that are located in the front of the neck, and the vertebral arteries that run in the back of
the neck through small canals in the bony spine (vertebrae) of the neck.
All of these connect at a junction of blood vessels located in the base of the brain (called the Circle of Willis), and from there smaller arteries supply the brain with oxygen and nutrients.
When a portion of the brain loses its blood supply, it can become damaged and stop functioning. When a portion of the brain does not function, the part of the body that it controls also stops working. This is called a stroke or a cerebrovascular accident (CVA). If the brain is able to regain its blood supply quickly, then the CVA symptoms may resolve; this is known as a transient ischemic attack (TIA). A TIA is
similar to a stroke that resolves by itself because of a temporary lack of oxygen to a portion of the brain.
What are the causes of transient ischemic
attack (TIA)?
Loss of blood supply to portions of the brain can occur for a variety of reasons. A blood vessel can
become blocked, and blood supply to a part of the brain is lost, or a blood vessel can leak blood into the brain (brain hemorrhage). Most commonly however, the blood vessel is blocked. The blockage can be caused by a blood clot that forms in the blood vessel (thrombosis) or it can be caused by a clot or debris that floats downstream (embolus).
Blocked blood vessels
Fatty plaque formation in the blood vessel wall is called atherosclerosis or "hardening of the arteries." Plaque can rupture and cause a small blood clot to form and occlude the blood vessel. Blockage can also occur when debris from narrowing of a carotid artery breaks off, and floats downstream to cause the occlusion. Sometimes, in people with an irregular heart beat called atrial fibrillation, small blood clots can be formed within the heart and travel to the brain to cause the obstruction.
Picture of
Carotid Artery Disease and Plaque Buildup
Brain hemorrhage or bleeding in the brain can be due to an
aneurysm, a weak
spot in a blood vessel that ruptures and spills blood into the brain tissue, or
it may be due to spontaneous bleeding caused by poorly controlled hypertension
(high blood pressure). Such bleeding more commonly results in
the irreversible damage of a stroke, as
opposed to a TIA.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
A hematoma is a collection of blood that is outside a blood vessel. There are different areas where hematomas occur including the inside the skull, scalp, ear, septum, bones, finger and toenails, and intra-abdominal. Treatment for hematomas depend on the type and location of the hematoma.
Brain aneurysm (cerebral aneurysm) is caused by microscopic damage to artery walls, infections of the artery walls, tumors, trauma, drug abuse. Symptoms include headache, numbness of the face, dilated pupils, changes in vision, the "worst headache of your life," or a painful stiff neck. Immediate treatment for a brain aneurysm is crucial for patient survival.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Aphasia is a condition that is the result of damage to portions of the brain. It can be caused by stroke, head injury, brain tumor, or infection. There are two types of aphasia, fluent and non-fluent. Some patients may fully recover from aphasia over time, while others may not.
Cholesterol is the most common type of steroid in the body. The treatment of elevated cholesterol involves not only diet but also weight loss, regular exercise, and medications. By understanding your cholesterol profile you can better manage your cholesterol levels.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
Heart failure is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include congested lungs, fluid and water retention, dizziness, fatigue and weakness, and rapid or irregular heartbeats.
Heart disease, particularly coronary artery disease is the leading cause of heart attacks. Women are more likely to die from a heart attack than men. High cholesterol, high blood pressure, obesity, and high triglycerides are contributors to heart disease. Some of the common symptoms of a heart attack in women include chest pain, shortness of breath, nausea, feeling faint or woozy, and more. Heart disease can be prevented by lifestyle changes and controlling high blood pressure, cholesterol, weight, and diseases such as diabetes.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble seeing with one or both eyes, dizziness, loss of balance, and more. Stroke prevention and reatable risk factors for stroke include lowering high blood pressure, quit smoking, heart disease, diabetes control and prevention.
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
If you're like most Americans, you plan for your future. When you take a job,
you examine its benefit plan. When you buy a home, you consider its location and
condition so that your investment is safe. Today, more and more Americans are
protecting their most important asset--their health. Are you?
Stroke ranks as the third leading killer in the United
States. A stroke can be devastating to individuals and their families, robbing
them of their independence. It is the most common cause of adult disability.
Each year more than 700,000 Americans have a stroke, with about 160,000 dying
from stroke-related causes. Officials at the National Institute of Neurological
Disorders and Stroke (NINDS) are committed to reducing that burden through
biomedical research.
What is a Stroke?
A stroke, or "brain attack," occurs when blood circulation
to the brain fails. Brain cells can die from decreased blood flow and th...
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