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Prognosis: Driving after a Stroke

Dr. Alan Wheatley rawheatley at canadalane.demon.co.uk
Tue Mar 23 14:01:12 EST 1999

flefever at ix.netcom.com(F. Frank LeFever) wrote (7227) on 20 Mar 1999:

>One month is VERY early in the recovery process.
>To some extent, it appears "nonspecific" complaints of fatigue and
>impaired concentration, very much like in some cases of mild traumatic
>brian injury (post-concussion syndrome) may be common after stroke,
>although traditionally not given so much attention as specific deficits
>(aphasia, apraxia, unilateral neglect, etc.), and may persist beyond
>acute recovery.  <--snip-->

I'm afraid I have no wisdom to offer on the rehabilitation of the stroke
patient except to say that Frank's comments sound very reasonable. 
However, I have come across the concept of secondary brain damage mediated
by arachidonic acid (AA) following head injury.  AA is released by damaged
brain tissue and its peroxidation by specific forms of lipoxygenase and
cyclo-oxygenase leads to the formation of leukotrienes, prostaglandins and
oxygen-derived free radicals. These active species have been shown to be
capable of neurotoxicity and of damage to the blood-brain barrier. 
(Unterberg A, Maier-Hauff K, Dautermann C, Hack U, Schürer L & Baethmann
A, in      Baethmann A, Go K G & Unterberg A, eds., Mechanisms of
Secondary Brain Damage.  Plenum, 1984, p139).  Could the "nonspecific"
complaints of fatigue and impaired concentration be associated with this
phenomenon, I wonder?  I should be very interested to learn of evidence
and/or opinions about this.

Dr. Alan Wheatley at http://www.canadalane.demon.co.uk

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