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Monday, January 23rd 2012

Senator Suffers Large Stroke

Senator Mark Kirk is the junior Senator from Illinois. He currently holds President Obama’s old seat which he won in a special election in 2010 to replace Roland Burris.

He has apparently suffered a large right sided, non-dominant hemisphere middle cerebral artery stroke, potentially after a carotid artery dissection on that side. And he’s now undergone a decompressive craniectomy on the right from the late edema suffered with such a large stroke.

Dr. Fessler said the stroke “will affect his ability to move his left arm, possibly his left leg and possibly will involve some facial paralysis. Fortunately, the stroke was not on the left side of his brain, in which case it would affect his ability to speak, understand and think.”

Chances for a full mental recovery were “good” but chances for a full physical recovery were “not great,” Fessler said.

The doctor said he was hopeful that, after rehabilitation at an acute care facility, Kirk would regain the use of his left leg, but said prospects for regaining the full use of his left arm were “very difficult.”

He said recovery is a matter of weeks or months — “it’s not going to be days.” Kirk’s relative youth and good physical shape are positives, Fessler said, and he expects Kirk could return to “a very vibrant life.”

I’m sure they’ve been aggressive considering his age and functional status, not to mention his stature. But to feel the need to go ahead with a craniectomy following a stroke implies a large area of ischemia. Decompressive craniectomy for large middle cerebral artery strokes is not terribly uncommon and the popularity for it has probably grown over the decades. As one, admittedly international paper, describes it.

Decompressive craniotomy in the setting of acute brain swelling from massive MCA infarct is a life saving procedure. It should be considered in patients with initial good GCS, who are deteriorating in neurological status. With the team effort of neurologist and neurosurgeons these cases have good outcome contrary to the natural history of disease…Thus an ideal candidate for decompressive craniotomy is the victim who is young, with no risk factors, who presents early and has nondominant, middle cerebral artery territory infarct, with a reasonable Glasgow Coma Scale with no (or) early signs of herniation. The key for success of these cases of large MCA infarcts is early detection. Clinicians should concentrate on formulating newer clinical, radiological and technical protocols to detect the suitable patients at an early stage.

Certainly from what we know Senator Kirk appears to be an ideal candidate. From the description of his possible long term deficits he appears to have had a large non-dominant hemisphere middle cerebral artery stroke. He is relatively young and fit. And, as The Chicago Tribune describes it, he presented with a relatively good exam and deteriorated quickly.

My thoughts and prayers are with him and his family. He has a long road ahead of him.