It is surprising to know how frequently inflammation is going on in brain tissue. The aging process itself is associated with dying off of cells, inflammation and mopping up of debris. However there are critical times when inflammation progresses rapidly, inducing both damage and repair (sometimes referred to as a ‘double-edged sword’) especially in stroke and multiple sclerosis. I have been thinking about ‘the inflamed brain’ and if there are strategies that someone could employ to reduce inflammation and enhance repair. I am reading a paper by Wolf-Dieter Heiss at Max Planck Institute for Neurological Research, Cologne, Germany in Annals of NY Academy of Science 2013 about inflammation after stroke. He explains that there are several phases of inflammation after stroke which I will summarize:
STAGE 1: Immediate effects (first few minutes)-when blood flow is reduced to an area, the brain cells, which are high users of oxygen and energy, are no longer able to carry-out their routine activities. The pumps within the cell that keep things in balance, fail. This results in an immediate loss of function of these cells-they do not ‘talk’ to other cells- so the person experiences a sudden loss of normal function (for example, sight, sensation, balance).
STAGE 2: Spreading of damage (first 6 hours or so) – The damaged cells in the core of the damage spill out their contents, including neurotransmitters, which produce waves of chemical/electrical activity in neighbouring cells. The tissue surrounding the core is called the penumbra and now becomes very vulnerable to injury since it is also has reduced blood flow at a time when activity is increasing. So the cells are being driven hard with very little gas in the tank. These cells reach a point when they can no longer function, the pumps fail and they also start to die off.
STAGE 3: Delayed injury (days and weeks)- There are three things happening during this phase, 1. Swelling, 2. More inflammation and 3. An automatic dying off of cells that are connected to the damaged region called ‘apoptosis’. Swelling happens because the chemicals released from dying cells attract inflammatory cells from the body triggering leakage from the small capillaries in the area. This swelling causes pressure because, of course, the brain (and spinal cord) is encased in bone. The inflammatory cells continue to leak in and cause other problems. Finally the cells that were previously connected to the damaged area are no longer receiving information so the body begins to shut them down.
What can be done to tilt the odds in favour of recovery during these phases? Here is what I think..
STAGE 1: This is really about prevention. What can you do so that if you do have a stroke, you have the best possible chance of recovery? Number 1 is to live a healthy lifestyle, reduce your intake of fat and salt, eat colourful foods that contain anti-oxidants which can help to reduce the effects of free radicals that are released when cells are under stress…and finally EXERCISE! Get in 30 minutes of moderate intensity exercise at least 3 times per week and everyday if you can. Walk, climb the stairs at work, cross-country ski, swim, do yoga, cut firewood.. do something that you feel a bit out of breath. Exercise increases blood supply to the brain (see my previous post about angiogenesis).
STAGE 2: if you suspect a stroke get help as soon as you can. There are two main ways to remove a blood clot (if you have one): one using drugs to dissolve the clot and another using a special surgery to insert a device into the blood vessel to grab the clot and either dissolve it or pull it out. Check out the warning signs of stroke here
STAGE 3: Key to enhancing recovery at this stage is excellent early hospital care by controlling body temperature, blood pressure, glucose and providing good nutrition (sometimes just saline in IV or using a feeding tube). The person with the brain injury should also be encouraged to move their limbs and get moving around if at all possible (for example rolling side to side and sitting at the bedside). Family members should be speaking to the person from their most affected side to encourage attention to that side. If the person with the stroke can’t move yet, gently move their limbs. Ask advice from the therapist, doctor or nurse. Be careful not to tug on the person’s affected arm as this can hurt the shoulder very easily. Make sure the affected arm does not droop over the side of the bed. Be aware that swallowing can be slowed so the person should be assessed before allowing them to drink liquids.
I encourage you to review the Canadian Best Practices for Stroke Care-an excellent resource for health professionals, patients and families based on research evidence.