CVA Aftershocks

F. Frank LeFever flefever at
Thu Jan 16 23:59:33 EST 1997

In <5bl9tg$s05 at> <stump002 at> writes: 
>I would appreciate any and all responses.
>I am a 47 yo male who suffered a stroke last June. Physically, I have 
>completely recovered, but my memory continues to worsen. Mentally, I 
>feel more damaged now than in July. I was told that in time the brain 
>would tend towards the better, not the worse.
I am a neuropsychologist with a special interest in chronic sequelae of
mild head injury, but the line of investigation I'm pursuing is
probably relevant to stroke as well.

Some more info is needed:
       first, where was the stroke?  What were the acute cognitive,    
       sensory, and motoric results?
       second, what can you tell me about the exact nature of your     
       memory problems?
       third, did you have any neuropsych testing in early recovery 
       (e.g., July?) which could be repeated now for an objective
       assessment of any changes?

Some things to consider:
 in many cases, recovery includes recovery of self-awareness--greater
awareness of deficits often makes patients feel they are getting worse
when (objectively) they are getting better.

"Memory" means many things to many people, and a good neuropsych
assessment should include measures of more than one kind of verbal
memory and more than one kind of nonverbal (visual) memory.

A common phenomenon in mild head injury is memory complaint not
substantiated by objective memory tests; my impression is that the
complaint is based on memory LAPSES, i.e. sporadic failure to remember
(rather than pervasive memory impairment).  Theoretically, this may be 
due to (1) attentional lapses, or (2) sporadic failure of consolidation
(e.g. failure to initiate LTP).

My paper at the Society for Neuroscience meeting (Nov. 96) suggested a
possible basis for such sporadic lapses (which may be worse some days
than others), involving neuroimmune mechanisms; conceivably treatable
when better understood.

It was based primarily on mild head injury phenomena, but mmay be
applicable to stroke; I have already suggested it may explain
similarities to complaints in fibromyalgia, Lyme disease, chronic
fatigue syndrome.

Whether it makes sense in your particular case depends on answers to
the questions I posed at the beginning--makes sense, as in "plausible",
but far from proven!!

Frank LeFever
New York Neuropsychology Group

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