Dr Jose Biller

Giving blood pressure medications right after stroke not beneficial

A major study has found that giving patients medications to lower their blood pressure during the first 48 hours after a stroke does not reduce the likelihood of death or major disability.

The study is published in the Journal of the American Medical Association.

At least 25 per cent of the population has high blood pressure, which greatly increases the risk of stroke. Lowering blood pressure has been shown to reduce the risk of stroke. The study investigated whether there also would be a benefit to lowering blood pressure immediately after a stroke.

The study included more than 4,000 stroke patients in 26 hospitals across China who were randomly assigned to receive or discontinue blood pressure medications. At 14 days or upon hospital discharge, there were no statistically significant differences between the groups in mortality or disability.

Blood pressure often is elevated following a stroke.

“But in most cases, treatment is unnecessary because the blood pressure declines naturally over time, and lowering blood pressure may be contraindicated,” said stroke specialist Dr Jose Biller, chair of the department of neurology of Loyola University Medical Centre. “It is important not to over treat and cause low blood pressure because the most important objective is to maintain adequate blood flow to the brain.”

Dr Biller was a member of the study’s Data and Safety Monitoring Board. Dr Paul K Whelton, former president and CEO of Loyola University Health System, was chair of the monitoring board.

First author of the study is Dr Jiang He of Tulane University School of Public Health and Tropical Medicine.

The study is called the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). It involved patients who had suffered ischemic strokes, which account for about 85 per cent of all strokes. Such strokes are caused by blood clots that block blood flow to a part of the brain.

Source: India Medical Times

New technique enables patient with ‘Word Blindness’ to read again

In the journal Neurology, researchers report a novel technique that enables a patient with “word blindness” to read again.

Word blindness is a rare neurological condition. (The medical term is “alexia without agraphia.”) Although a patient can write and understand the spoken word, the patient is unable to read.

The article is written by Jason Cuomo, Dr Murray Flaster and Dr Jose Biller of Loyola University Medical Centre.

Here’s how the technique works: When shown a word, the patient looks at the first letter. Although she clearly sees it, she cannot recognize it. So beginning with the letter A, she traces each letter of the alphabet over the unknown letter until she gets a match. For example, when shown the word Mother, she will trace the letters of the alphabet, one at a time, until she comes to M and finds a match. Three letters later, she guesses correctly that the word is Mother.

“To see this curious adaption in practice is to witness the very unique and focal nature” of the deficit, the authors write.

The authors describe how word blindness came on suddenly to a 40-year-old kindergarten teacher and reading specialist. She couldn’t make sense of her lesson plan, and her attendance sheet was as incomprehensible as hieroglyphs. She also couldn’t tell time.

The condition was due to a stroke that probably was caused by an unusual type of blood vessel inflammation within the brain called primary central nervous system angiitis.

Once a passionate reader, she was determined to learn how to read again. But none of the techniques that she had taught her students — phonics, sight words, flash cards, writing exercises, etc — worked. So she taught herself a remarkable new technique that employed tactile skills that she still possessed.

The woman can have an emotional reaction to a word, even if she can’t read it. Shown the word “dessert,” she says, “Oooh, I like that.” But when shown “asparagus,” she says, “Something’s upsetting me about this word.”

Shown two personal letters that came in the mail, she correctly determined which was sent by a friend of her mother’s and which was sent by one of her own friends. “When asked who these friends were, she could not say, but their names nevertheless provoked an emotional response that served as a powerful contextual clue,” the authors write.

What she most misses is reading books to children. She teared up as she told the authors: “One day my mom was with the kids in the family, and they were all curled up next to each other, and they were reading. And I started to cry, because that was something I couldn’t do.”

Source: India medical times