Shahar Madjar, MD
At 79, Joe turned from a healthy man into an interesting medical case. The change seemed sudden. It came about as a series of twitches or involuntary movements. The twitching initially lasted for a minute or two and then reappeared, every month or so, lasting longer, for up to 10 minutes at a time.
“It’s getting worse,” he told the doctor in the Emergency Department, “and lately, on top of the twitching, I can feel tingling and numbness in my left leg…it’s as if an uncontrollable, invisible force is moving my left leg, taking control of my left arm, moving my left cheek.”
After he was hospitalized, another episode of involuntary movements took place. This time, in addition to his twitches, Joe also became, for a minute of two, unresponsive.
What caused Joe’s symptoms? In my last article, I described some of the medical conditions that could have caused Joe’s symptoms: epilepsy, brain tumor, brain infection, trauma, exposure to certain drugs or toxic agents, even a severe case of diabetes. But Joe’s history, lab results, imaging studies and his electroencephalogram didn’t completely agree with any of these diagnoses.
Here is what happened to Joe: During childhood and early adulthood, Joe was in perfect physical shape. His heart was strong and could pump his blood without difficulties. His arteries were wide open and flexible and allowed the blood to flow freely from his heart to every cell in his body, carrying oxygen and essential nutrients.
As he reached middle age, Joe’s arteries became clogged and narrow. It didn’t happen at one, but rather gradually, over months and years. Doctors call the process atherosclerosis. In essene, atherosclerosis is the gradual deposition of fat, called plaques, in the walls of the arteries. As plaques continue to form in arteries, the walls of the arteries became thick and hard. The arteries became narrow, impeding the blood flow through them. As time goes by, a narrow artery can get completely blocked. The blood flow can gradually stop. Cells and tissues may not survive.
Or, in more dramatic circumstances, a plaque can break apart forming a defect along the inner surface of the artery. When that happens, a blood clot (thrombus) can form at the breaking point, over the damaged surface. The blood clot can then grow larger and block the artery, or suddenly dislodge from the plaque and move along the blood stream to farther, smaller blood vessels where it gets suck.
Atherosclerosis typically takes place in multiple locations at once: in the heart, leading to chest pain and heart attacks; in the legs, causing intermittent pain during walking and potentially to a loss of a limb; and in the neck, leading to mini-strokes (called TIAs, or transient ischemic attacks), even fulminant strokes.
Oh, Joe! Poor Joe! What seemed to sudden was actually so gradual: Atherosclerosis took place as is usually does, over years. And then, over several months, miniature blood clots have formed over the plaque, dislodged and carried away through the blood flow in the areas in his brain controlling his left shoulder and his left side of his face. The blood flow to these areas momentarily stopped. Deprived of oxygen, these brain cells, Joe’s neurons, turned dysfunctional–their membranes ran amok, polarized, and started to shoot a series of aberrant electrical messages down their long axons and into the muscle cells in their control: twitch, twitch, TWITCH!
Oh, Joe! Lucky Joe! Realizing what had happened, Joe’s doctors ordered a Doppler ultrasound of his carotid arteries–the blood vessels that supply blood to the brain–which proved that severe atherosclerotic process had taken place and resulted in an almost complete obstruction of blood flow to the brain. A team of vascular surgeons removed the plaque and reestablished a normal blood flow. Joe was advised to change his diet, be physically active, quit smoking, and take cholesterol-lowering medications, and Aspirin. These are all measures proved to slow down atherosclerosis and to lower the risk of further complications. Months later, Joe was thankful because he had no more involuntary movements, and no mini-strokes or fulminant stokes.
Events that seem sudden are often gradual in nature. By recognizing the gradual nature of these events, we can often interfere in time, and prevent further, often devastating consequences.
EDITOR’S NOTE: Shahar Madjar, MD, MBA, is a urologist and an author. He practices in Michigan, at Schoolcraft Memorial Hospital in Manistique, and in Baraga County Memorial Hospital in L’Anse. Find his books on Amazon or contact him at smadjar@yahoo.com.
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