A blow to the brain

Stroke: A scientist tells what it's like to be a victim and how it has changed her life for worse - and for better.

February 21, 1999|By Jill Bolte Taylor | Jill Bolte Taylor,Special to the Sun

On the morning of Dec. 10, 1996, I awoke with a pulsing pain behind my left eye. I got up to begin my morning routine and jumped onto my cardio-glider. The exercise, I thought, would get my blood flowing and banish the throbbing inside my head.

While I exercised, however, the pain became more intense. Within a few moments I started to feel very peculiar -- confused, yet clearheaded and alert.

When I got off the machine, I noticed that I was slightly off balance and feeling strangely detached from my body. I climbed into the shower, my movements slowed and deliberate.

When I held my hands up in front of my face, I felt as though my consciousness was suspended somewhere between normal reality and some esoteric space. The running water of the shower felt like little bullets spattering into my flesh.

I knew something was very wrong with my brain. I dimmed the lights, because they made the throbbing behind my left eye worse.

Time seemed to stand still. I was disturbingly aware that the intricate networks that operate the different functions of my mind were shutting down.

I tried to visualize myself driving to work, and in the next instant my right arm went totally dead.

In that moment I knew I was having a stroke.

I was 37 years old and, testifying to the impact of my scientific training, my next thought was "Wow, this is so cool!" I am a trained neuroanatomist, and this was an opportunity for me to study my brain -- from the inside out.

I witnessed the breakdown of my higher cognitive skills. I could no longer integrate and associate my thoughts with the incoming sensory information.

Although I felt no sense of urgency, I understood that the prognosis of stroke is often determined by how quickly a patient gets to the hospital. To save my life, I had to make a plan, then consciously hold it in my memory long enough to execute it. But I kept forgetting what it was I was trying to do.

After minutes of effort, I dialed the phone number of the Harvard Brain Bank at McLean Hospital, where I worked. I tried to ask for help, but my throat wouldn't form the words. I simply grunted.

Eventually I blurted something out, but it was unintelligible. I heard my colleague speaking, and I knew that I knew what was being said, but I couldn't grasp the meaning. Fortunately, he sensed the danger of my condition and assured me that he would send help.

It wasn't long before I found myself at the hospital and in a CT scanner. The resulting images revealed that I was indeed having a stroke, with severe bleeding in my left temporal lobe.

Later I learned that 10 percent of people who experience this kind of stroke die immediately. Another 50 percent remain in a vegetative state.

Most strokes are caused when a blood clot lodges in an artery that is supplying life-giving oxygen-rich blood to the brain. The artery that is blocked determines which cells will be starved and die. For some people there is extensive neurological destruction, while for others there is minimal effect.

My stroke, however, was not caused by a clot but by an arteriovenous malformation (AVM). Normally, capillary networks -- fine-mesh structures of tiny blood vessels -- function as a buffer zone between sturdy arteries, in which blood flows forcefully, and thin-walled veins, which return blood to the heart and lungs. With an AVM, there is a shortcut between arteries and veins, and a low-pressure vein is directly hooked up to a high-pressure artery.

Some people have the condition and never have symptoms. But in others the direct connection between the artery and the vein becomes so weak that the connection bursts.

In my case, the hemorrhage occurred over a fold in the left hemisphere of my brain: the superior temporal gyrus.

The bleeding in my brain placed pressure on certain nerve fibers, blocking my ability to speak or understand spoken language. The most lasting injury occurred in a nearby region that allows for the performance of both simple and complex mathematical calculations.

Later in the afternoon, I regained full consciousness and discovered I was completely mentally disabled.

Seventeen days after the stroke, I underwent brain surgery at Massachusetts General Hospital. The brain swelling from the hemorrhage had receded, but my doctors needed to open my skull and remove the affected tissue and residual debris.

When I awoke from surgery, I faced the challenge of rebuilding my brain. A small amount of tissue had been permanently destroyed. Neuronal connections that had been broken by the injury would have to be reconnected, and in some cases I would have to build entirely new pathways.

It is one of the marvels of the brain that neurons can be recruited to take on new functions. The recovery would not be swift: It would be two years before we would know how well I would recover from both the stroke and the surgery.

Some tasks came back more easily than others. Although I could remember what it felt like to do simple things like walking smoothly, my body wouldn't cooperate.

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