Stroke/cerebrovascular accident (CVA) refers to the loss of normal function of the brain tissue caused by impairments of circulation within the brain. When normal circulation is obstructed due to a clot or hemorrhage, the supply of oxygen is rapidly depleted. Without oxygen, the neurons within the brain die (this why hyperbaric oxygen therapy is so effective, it can increase oxygen concentration with in body tissue and fluids, thereby offsetting the lack of circulation, while promoting regeneration). The disabilities that occur depend upon the area of the brain that has been deprived of oxygen-enriched blood. The common symptoms of a stroke may be that of numbness or weakness of the face, arm, or leg, spasticity or rigidity of the limbs, double vision and imbalance. In addition, a stroke may cause a loss of the ability to speak, comprehend and swallow. There may even be associated mental difficulties, including memory loss and distinct personality changes.

There are several reasons for the cessation of blood circulation to part of the brain. The first is ischemia, or lack of blood flow, which is caused by narrowing or blockage of an artery. Ischemic thrombotic strokes may result from arteriosclerosis or cholesterol plaques. A second cause for a stroke is the development of emboli. These are blood clots that sometimes arise from the carotid artery or heart and travel from these distant places to deep vessels within the brain, thus causing disruption of normal blood flow.

A third and final cause of stroke is a cerebral hemorrhage. This entails the rupture of a vessel, thus causing massive bleeding into the brain tissue, destroying the tissue in and around the site of the hemorrhage. In addition, there is damage to the brain by the pressure exerted by this blood clot on the preserved brain tissue as well.

Infrequently, a patient may be given a warning of an impending stroke. This is classified as a transient ischemic attack (TIA). A TIA is a "mini-stroke" which presents itself as a transient episode of numbness or weakness of the face, arm or leg, which may be associated with inability to speak, or slurring of speech. Once again, the symptoms that present are directly related to the area of the brain in which the circulation has been compromised. It is estimated that approximately one-third of patients who experience a TIA will suffer an incapacitating stroke within 5 years with a 15% chance of a stroke occurring within 2 years after the TIA.

When a patient develops a stroke, there is a central region of brain tissue, which dies. It is not possible to rejuvenate this localized area of brain tissue with hyperbaric oxygen therapy or any other treatment currently known. However, there is an area between this damaged tissue and the unaffected brain which is referred to as the pnumbra. This pnumbra is a very important area as it contains "dormant", "idling" or resting brain cells that are alive but unable to function due to the lack of blood and oxygen needed for normal cell metabolism. Hyperbaric oxygen therapy greatly increases oxygen concentration in the body, effectively bathing the dormant region with oxygen rich blood. If these cells were to be "awakened", with the restoration of adequate blood flow, improvement in function would occur.

There is a belief that the brain has plasticity in that there is some ability of the brain to reorganize itself after a trauma. At times one part of the brain can assume the function of another part of the brain by switching functions.

An acute stroke occurs in several phases. The first phase is called the ischemic cascade. This phase, which lasts several minutes up to 6 hours, requires immediate medical attention. It has been termed a "brain attack." After the ischemic cascade, the brain goes through a period of reorganization, which can last approximately 1 week. Following reorganization, the brain enters a more stable phase, which can last, from approximately 1 week up to 3 months. It is felt by some clinicians that this period of time is not amenable to HBOT therapy or hyperbaric medicine procedures.

It is generally considered among neurologists that patients can achieve 95% of their ultimate magnitude of improvement by 6 months with an additional 5% occurring between 6 months to 1 year. There are many treatments that have been found helpful in the recovery from devastating strokes. These include medications to reduce limb spasms, injections with preparations such as Eotox to reduce spasticity as well as various medications to reduce the chances of recurrent ischemic events such as aspirin, Plavix, Aggrenox, Ticlid or even Coumadin.

How does HBOT therapy help the brain recover?

As stated earlier, the most important factor in determining the patient's ability to recover from a stroke, utilizing Hyperbaric oxygen therapy or any other treatment, is the size of the infarct, the location of the infarct as well as the size of the pnumbra (the region that surrounds the area of infarct). Following an acute brain infarction, there is a moderate amount of swelling which causes additional pressure upon the viable brain structures. HBOT has been found to reduce this swelling and enable oxygen- enriched blood to enter the dormant/idling brain cells.

Hyperbaric oxygen therapy increases the concentration of oxygen within the body to 1,500 to 2,000 times the ~concentration one has on room air. This allows the oxygen to diffuse into all the body fluids, including blood, plasma, lymph and cerebrospinal fluid (the fluid that bathes the brain and spinal cord). There is also increased oxygen perfusion from HBOT to the brain tissue itself as well as muscle and bone.

Just as a non-healing diabetic wound slowly and gradually heals with hyperbaric oxygen therapy by stimulating capillary growth, the brain too is healed by the growth of new capillaries into the area of the pnumbra. These new capillaries bring nutrients, including oxygen, and carry away the bi-products of cell metabolism.

Physical therapy has been found to complement the effects of hyperbaric oxygen therapy. When an orthopedist removes a cast from a fractured arm he frequently finds it necessary to refer the patient for physical therapy to restore the strength and movement of the joint that has been immobile for an extended period of time. Similarly, a patient who has had a stroke requires physical therapy after a certain number of treatments of hyperbaric oxygen therapy to restore strength and mobility as well as stability in limbs that have not been used for a period of time.

There was a study with 122 patients having ischemic strokes who were treated with hyperbaric oxygen therapy. Of the 122 patients, 79 were treated from 5 months to 10 years after the initial stroke (this is well beyond the time in which normal spontaneous improvement would be expected). Prior to entry into the HBOT study, many of these patients had received physical therapy; occupational therapy and various other modalities yet still had significant impairments. These patients underwent HBOT treatments at 1.5 to 2.0 atmospheres absolute, for a period of 60 to 90 minutes. Seventy-nine patients (65%) reported improvement in their quality of life. It should be noted that the HBOT patients spend less time in the hospital (an average of 177 days compared with 287 days for conventionally treated patients) .It should be noted that all the HBOT patients were able to go home while a large number of the other patients had to enter a rehabilitation facility.

One should never lose sight of potential improvement that HBOT can render. If you can take a patient who lives a bed-to-wheelchair existence and enable them to walk with a walker or take a patient who ambulates with a walker and allow them to walk with either a cane or unassisted, their life has changed greatly. If you have a patient who cannot communicate and with hyperbaric oxygen therapy restore the ability to speak or take a man who has slurred speech and allow him to return to gainful employment you have given him back dignity, self-worth and at times financial stability. I have seen these frequently with the use of hyperbaric oxygen therapy.

To help you discover what Hyperbaric Oxygen Therapy can do for you, for a limited time, Dr. Spiegel will provide a free assessment to determine if you would benefit from this treatment. To schedule a hyperbaric oxygen therapy consultation to discuss how this treatment can help you, give our office a call.