(9/19/04 11:12 pm)
VASOSPASM: A PRIMER FOR PATIENTS - Full article|
VASOSPASM: A PRIMER FOR PATIENTS
William M. Hammesfahr, M.D.
Copyright © 1996 MedForum. All rights reserved.
This article is intended for the non-professional. It is essentially an overview of vasospasm, or narrowing of the blood vessels, and the symptoms and treatment with respect to this condition in the brain and, by implication, elsewhere in the body. It is a primer, and not intended for diagnosis or treatment by itself.
This article is intended for the non-professional audience.
WHAT IS VASOSPASM:
Vasospasm is a narrowing of the artery which bring blood to your brain, heart, and other organs. Vasospasm may occur in all of the parts of the body at the same time or in only certain parts of your body at specific times.
WHO SHOULD BE INTERESTED:
Any individual who has been diagnosed as having a problem that deals with the heart, brain, or blood vessels should be interested. Vasospasm, by narrowing the tube that brings blood to the body's tissue, may cause that portion of the body to stop working properly. Vasospasm, or narrowing of the artery, may mimic many other conditions of the body. It has been identified in HEADACHE, STROKE, BRAIN INJURY, POST-CONCUSSION SYNDROME, WHIPLASH, BALANCE DISORDERS, VERTIGO, TINNITIS, ATTENTION DEFICIT DISORDER, SEIZURES, PSUEDO-SEIZURES, POSSIBLE MULTIPLE SCLEROSIS SYNDROME and MULTIPLE-SCLEROSIS LIKE SYNDROME, DYSLEXIA, VISUAL BLURRING, DEPRESSION, PSYCHOSIS, MOVEMENT DISORDERS, TREMOR, MEMORY LOSS, MOOD SWINGS, ANGINA, PRINZ-METAL ANGINA, FIBROMYALGIA, FIBROMYOSITIS, IRRITABLE BOWEL SYNDROME, TOXEMIA and PRE-ECLAMPSIA, COGNITIVE DISORDERS FROM ALL CAUSES INCLUDING CHEMICAL ALLERGIES AND MEDICATIONS and multiple other problems as identified in accompanying articles.
Vasospasm has been identified in all of these conditions and the patients have improved with treatment oriented to causing the blood vessels to dilate.
HOW IS IT DETERMINED IF I HAVE A NARROWING OF THE BLOOD VESSELS:
A careful history and physical is carried out by your Doctor. Unfortunately, a narrowing of the blood vessels that is enough to cause symptoms or problems, is not generally bad enough to be identified from physical exam. Suspicion for this condition is based upon history, the presence of one of the diseases mentioned above or elsewhere in the literature, and characteristic abnormalities that can only be seen on blood vessel tests like transcranial doppler or tests that evaluate the effectiveness of blood flow to an organ, such as Computerized EEG testing, certain types of EKG or Stress tests of the body, etc. IT IS THE OPINION OF THE AUTHOR THAT ALL PATIENTS WITH THE ABOVE MENTIONED SYMPTOMS OR DISEASES, OR ANY OTHER DISORDERS OF THE BRAIN OR VASCULATURE OF THE BODY, SHOULD BE TESTED.
WHAT CAN BE EXPECTED FROM TREATMENT:
Essentially, if vasospasm is identified by your Doctor, you will be started out on low doses of medications that dilate blood vessels and increase blood flow to your blody. As your body becomes acclimated to these medicines, your doctor will increase the medicines. The goal is to continually increase the medications to the point that your body rejects them by feeling tired soon after taking them. The physician will then slightly reduce the dose of medication to the point that you can take them without side effect. You will need to give feedback to your Doctor concerning your body's response to medication, when symptoms recur ( which suggests the time course that the medication is wearing off in your body and allows the doctor to know how and when to change doses) and when the medication begins to give side effects. Generally, YOU MUST DISCUSS SIDE EFFECTS WITH YOUR DOCTOR IMMEDIATELY, AS WELL AS WHEN THE MEDICATION IS NOT WORKING. APPARENT SIDE-EFFECTS MAY MEAN THAT THE MEDICINE IS TOO STRONG, OR TOO WEAK. A diary in which you chronicle the times you take the medication, and their effect on your body, is very helpful.
This approach to treating your body is very difficult. As re-occurrence of the symptoms you presented to your doctor with may represent both medication overdose or underdose, your doctor may request multiple tests and evaluations with ultrasound or other tests or visits with him in order for him to be able to determine the proper dose and schedule of medications. Most people can undergo major medication changes on a monthly basis. Medication changes may occur even more frequently in selected cases.
HOW LONG DOES IT TAKE BEFORE ONE SEES IMPROVEMENT: Improvement can occure rapidly and dramatically. In trained hands, and depending on the problem and specific patient, one may see dramatic improvement in the space of 5-10 minutes. In one stroke patient, a profound hemiparesis and aphasia, or difficulty with choosing the right word such that the patient could not carry on normal conversation for even one sentence at a time, we saw virtually complete resolution of these problems within 45 minutes. Within 48 hours, she was able to step from boat to dock without assistance, where two days before she had difficulty walking a straight line on the floor or walking across a room. However, such dramatic results requires special expertise. More commonly , one should expect marked improvement over the course of 1-2 months, with then entering into a more chronic phase with slow improvement over the course of the next 6 months.
HOW LONG DOES THE CHRONIC PHASE LAST: Generally one is on medication initially in low doses for 1-2 months. During this time, much of the symptoms that the patient first reported to the Doctor will resolve or become rarer. Then, over the next 4 months, increasing doses of the medications will be used to resolve the less severe but still significant symptoms. As time goes on, you may feel that the medication is not doing anything. Continue on it until you develop side effects to the medication, or the Doctor tapers you from these medications after having first obtained objective tests like Computerized EEG tests, ultrasound doppler tests, neuropsychological tests, etc. YOU CANNOT BECOME ADDICTE TO THESE MEDICATIONS. YOU MUST REMAIN ON THEM UNTIL YOUR BODY REJECTS THE MEDICATIONS. YOUR DOCTOR WILL PROBABLY THEN TAPER YOU TO WEAKER VASODILATING MEDICATIONS. Again, remember to stay on them, until your body develops side effects or your Doctor tapers you from them.
The chronic phase, during which you will need to take medication every day, generally lasts about 6 months. Some patients will be able to leave this stage, and end up only needing medication intermittently or for several days of each month. It is important to understand, that vasospasm is the body's response to something else wrong. It is usually an overreaction of the body to some form of a chronic irritation to the body. Thus , as long as that irritation is present, the condition will probably recur at some time.
WHAT ARE THE SYMPTOMS THAT I SHOULD WATCH FOR THAT SUGGEST VASOSPASM IS CONTNUING OR HAS RETURNED:
Although everybody is different, there is a typical progession of symptoms that occurs with vasospasm. In the early stages, there is usually seen concentration problems, attention deficit type disorders, and mild memory disturbances. Spouses and co-workers will frequently notice the attention deficit problems before you. As the problem progresses, patients will notice irritability, grouchiness, mood swings, depression, a sensation of stress, aggravation of the concentration problems, and depression. They also may notice excessive sleepiness, menstrual cycle irregularities, development of hypertension. As the problem deepens, people start to notice sensory and motor control problems. Vision problems such as visual blurring, sensitivity to light including to computer screens, driving, flourescent lights in stores and malls and T.V. screens may be seen. Sound sensitivity frequently also occurs at this stage. Balance disorders, vertigo, and light-headedness all occur during this stage, as balance control essentially represents a from of motor disability. Word finding difficulties, mathematic calculation problems, dyslexia, also usually occurs at this time. As the problem progresses, patients may develop headaches, then blac-out spells, seizures, psuedo-seizures, strokes, transient ischemic attacks, and psychosis. The symptoms frquently wax and wane, or vary in level of severity or presence.
As your body heals up, you will generally see a loss of the more severe symptoms, and finally the less severe symptoms. The last of the symptoms to resolve are the concentration and emotional issues. Most patients are not able to accurately recognize when these symptoms are due to stress in their environment or are from the early stages of the vasospasm. It is important to continue under care until your Doctor tapers your from your medication, and to return for periodic re-evaluations with ultrasounds or other objective tests, as these conditions return in many people. Also, complete resolution of the problem is vital for your long term health.
WARNING: Although the diagnosis and care of this condition is conceptually simple, it is actually very difficult and potentially very dangerous. Rapid improvement can be the norm for most patients, but great care and attention by the physician and the patient must be taken. This can be dangerous without a physician committed to meticulous attention to detail and care of the condition.