Ka Wai Ola - Office of Hawaiian Affairs, Volume 1, Number 5, 1 June 1984 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D

This I0th eolumn deals with stroke. the third leading cause of death in Hawai'i and Amelika. Since we po'e Hawaii ( Hawaiian people) have the highest death rate from stroke, compared to the other lahui (races) in Hawai'i, we need to give special effort to understanding and preventing this eommon tragedy. As pre\iously, mahalo a nui to you po'e heluhelu (readers) who ha\e contributed ninau on this imnortant topic.

Q. Papa recently had a stroke on his 62nd birthday. His left side is lolo (paralyzed) and he can't talk. but he seems to know us. The kauka (doctor) says we have to wait and see if Papa will recover. Mama says he needs lomilomi. My brother says he should get a blood thinner. But I saw on TV surgery for stroke. What is the best treatment for Papa? Do you think he ean be cured? He wants to be at his mo'opuna's graduation in June. Pehea la? A. The outcome and treatment of stroke depend on casual factors, mechanisms of the stroke, and the extent of lolo (brain) injury, so it is difficult to give a direct and complete answer to your ninau about "cure" for stroke without more precise information. In modern times, stroke refers to a sudden a'a koko (blood vessel) injury in the lolo with altered brain function. Stroke is sometimes called "CVA" or cerebrovascular (brain vessel) accident. In 'olelo Hawai'i (Hawaiian language), the terms ma'i lolo (paralysis). ulupo ("black-out"), kauhola (loss of consciousness), hahau ( strike), and huki (fit) are used, depending on the external manifestations. But these are non-specific signs that may or may not result from sudden ma'i a'a lolo.

The most eommon mechanisms or forms of stroke are thrombosis with infarction, embolism, and hemorrhage (Figure 1). These technical terms and their special meanings with respect to the brain did not evolve in Europe until the end of the 19th century. Accordingly, they have no exact equivalents in 'olelo Hawai'i. Thrombosis means attachment and hardening ("clotting") of koko ( blood) to the a'a koko wall in the form of a thrombus ("clot"). If the thrombus completely occludes the a'a koko so that the affected brain tissue does not receive adequate blood flow with sufficient oxygen and other nutrients, the brain cells die. This death of tissue from impaired blood flow is called infarction. Occlusive thrombosis is usually a sudden ' complication of long-standing damage and thickening of the a'a wall by athero-

sclerosis ("hardening of the arteries"). Embolism is closure of a'a by a loosened "clot" (an embolus), from a thrombus, whieh 11ows downstream until it blocks a smaller a'a koko. Such loosened clots (emboli) usually arise from the pu'uwai (heart) or large a'a'ai (neek carotid arteries). Embolism ean also cause infarction.

Hemorrhage is kahekoko (bleeding). When kahekoko is from a small a'a koko within the brain substance, it is often associated with koko-pi'i (high blood pressure). When kahekoko is from a larger a'a koko on the undersurface of the brain, it usually results from rupture through a weakened small poho (poueh) in the a'a wall, called an aneurysm. Blood leaking through the ruptured aneurysm fills the space between the lolo (brain) and the 'iwi po'o (skull) and compresses the lolo. This kind of kahekoko is called subarachnoid hemorrhage. The outward effects of a stroke depend on whieh a'a koko is involved (Figure 2), what part of the lolo is injured (Figure 3), how mueh of the lolo is destroyed, and on the ability of the noninjured lolo to take over and compensate for the damaged tissue. Thus, nawaliwali (weakness) of the left lima (arm) and wawae (leg), and faulty speech, such as in the case of your makua, usually mean injury of the right (opposite) middle portion of the lolo (Figure 31.

If lolo injury is massive, the patient may lose consciousness and die quickly, as perhaps occurred in the cases of Kamehameha III in 1854, at the age of 42, and Queen Emma in 1 885, when she was 49. If the injury is small and brief, the patient may recover fully within hours or a day. Such a pokole (short), mild episode is sometimes called a "transient ischemic attack" (TIA). lschemia means reduced blood supply. T1 A may be due to an embolus from the heart or a'a'a'i, heart rhythm abnormality, blood pressure fluctuations. or spasm of a'a koko. With this backgorund on the varieties of stroke, I will discuss in my next eolumn the diagnostic approach, the several available new as well as old therapies, and especially the prevention of this major killer of po'e Hawai'i. Meanwhile, you other po'e heluhelu may be interested in learning that as this eolumn went to press, our ninau reader's Papa was not able to attend his mo'opuna's, 'uniki (graduation), but he was stronger and uttering a few words. More follow-up concerning Papa in my next eolumn.

COMMON MECHANISMS OF STROKE (FIGURE 1) Fig. I. On ihe left, a newly-formed thrombus completely blocks an artery previously narrowed by atherosclerosis. In thc middle, an cmbolus breaks offfrom a thrombus and is carried downstream until ii completely closes off a smallcr artery. Both thrombosis and cmbolism frequently Iead lo infaretion (death of the affected tissue). On ihe right. hemmorrhage occurs through a ruptured artcrial wall. This is a eommon eomplication of high blood pressure.

ARTERIES FROM THE BRAIN TO THE HEART (FIGURE 2) Fig. 2 BloodJlows lo the brain from the heart through iwo main arteries on eaeh side: the carotid artcry in ihe front of the neek, and the vertebral artery whieh runs through the bony spine. lnterferencc of blood supply to particular parts of the brain through these major vessels or their man v branches accounts for stroke.

LOCALIZATION OF BRAIN CONTROL OF BODY FUNCTIONS (FIGURE 3) Fig. 3. The left sidc of the brain showing specific areas whieh control particular parts and function of the body.