IE 11 is not supported. For an optimal experience visit our site on another browser.

Sen. Johnson's stroke: 'Like a leak in the dike'

/ Source:

NBC chief medical editor Dr. Nancy Snyderman spoke with MSNBC about what happened to Johnson and his chances of recovery.

Q. It’s reported that Sen. Johnson underwent surgery for a congenital arteriovenous malformation, or AVM. What is that? Did it cause a stroke?

A: He did have a stroke. He had a hemorrhage into his brain and it was caused by this abnormal collection of blood vessels which is known as an arteriovenous malformation. It’s just what the name says — the arteries come into the brain and go from biggest to smallest and abruptly dump blood into this mishmash of veins that really looks like a bunch of tangled rubber bands. The problem is, the pressure in an artery is so much greater than the pressure in a vein, so over time that pressure pounds on the wall of these weird veins and causes them to leak. It’s like having a leak in the dike.

The symptoms the senator showed yesterday were not a result of the AM sitting there all these years. It was a result of the blood leaking into his brain.

Q. It seems like they caught it quickly. Is that a good thing or has the damage already been done?

A: It’s phenomenal. Hats off to the Capitol Hill doctor for recognizing that this was a big deal and getting him to the right center [George Washington University Hospital]. There is a three-hour magic window [for treatment] because the brain can only be cut off from oxygen for so long. If you can diagnose and treat within three hours the brain has a phenomenal chance of rebounding. If you wait longer, the brain tissue can literally die.

It’s always easier and better to treat those things in the first three hours.

Q. Are there warning signs?

A. If you have a congenital malformation, which he probably did, 60 percent of those will at some point bleed.

He may never have had a warning sign until yesterday. However, after he gets through this, he may look back at it and go, ‘I have been having headaches’ or ‘I did slur my speech last week.’

It’ll be interesting to see if there were little warning signs that he ignored. For some people, the presenting stroke is the first warning sign.

One thing people will say, is ‘If I knew I had this from birth, I’d get it fixed.’ It’s easier said than done. If you have an abnormality in the speech part of your brain [like Johnson] and you’re perfectly functioning, you’d be hard-pressed to say, ‘Sure, doc, go on in and fix my brain,’ but know that you might come out of it with a deficit afterwards.

He was probably playing the odds. These things, if they cause trouble, usually peak between the second and fourth decades of life. So, a 59-year-old who is otherwise healthy and not fat and having a robust life, I don’t think he can be criticized for playing the odds.

Q. He’s reportedly spoken to his wife after. How important is that so soon after the operation?

A. It's quite important because it shows that he is alert. The question is, how well did he speak to his wife? Was it slur, kind of like a drunk? Or was he, in fact, quite articulate and defining his words? That is something his doctors and his family and his office will hold very close to the vest right now, because it might be a window to long-term impairment.

It does mean he’s not in a coma, that the part of his brain that controls speech is functioning. It’s just a little too early to put a prognosis on it.

Q. What is the range of recovery for this type of thing?

A. It’s hard to know for a couple of reasons. We don’t know how big the clot was, if there had been preexisting symptoms and exactly what part of the brain this was in. Doctors and hospitals will always say neuro-surgery patients are critical for the first 24 hours.

What they’ll do now is keep him very, very quiet. I’m sure he’ll go in for a daily MRI scan and CT scans. They will start speech rehabilitation immediately, if they think he’s up for it. They’ll keep monitoring him.

He’s fortunate in that he made the three-hour window and he’s at one of the premiere stroke centers in the country. Assuming that his speech this morning was good, it all bodes well for him. That’s all we can say right now.

The increments of improvement in this situation can be quite rapid. So tomorrow, they could say, he’s really good. It could be really quite fast.