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difference betwen EDAS and BYPASS (Read 32162 times)
cherylb
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difference betwen EDAS and BYPASS
Oct 28th, 2005 at 5:36pm
 
Hello all, i have just been diagnosed with moya moya.  The doctor suggested EDAS procedure; is it the same as the bypass surgery that is mentioned here on the message board?  I am going next week to see the doctor where he will educate me on this EDAS procedure. 
    Very informative message board.  Thank you all

Cheryl
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LisaH
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Re: difference betwen EDAS and BYPASS
Reply #1 - Oct 28th, 2005 at 7:16pm
 
Hi Cheryl,

The EDAS is a bypass surgery but an indirect bypass as opposed to a direct bypass (STA-MCA) that is often mentioned here.  People here on this board have probably experienced equal amounts of each surgery (I'm guessing as there has never been an official poll of that number). Take a look at this recent discussion titled "Choosing the right type of surgery".  This should help you quite a bit.  

http://www.moyamoya.com/cgi-bin/yabb/YaBB.cgi?board=news;action=display;num=1129...

Also, if you haven't already, take a look at this link which can be found under Medical Info (MoyaMoya surgery) up at the top of the page.  It's a small synopsis of the different surgeries.

http://www.moyamoya.com/journals/moyamoya.html

Please ask away with any further questions as I know that it can all be a little overwhelming at times.  Good luck at your doctor visit next week and keep us posted.

Lisa
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« Last Edit: Oct 28th, 2005 at 7:17pm by LisaH »  

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Shan
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Re: difference betwen EDAS and BYPASS
Reply #2 - Oct 28th, 2005 at 9:11pm
 
Hi Cheryl,

Here's some additional information to what Lisa has already shared with you.  The last paragraph mentions "children" but I believe this holds true for adults too.  Hope this helps...

(1) EDAS procedure, in which a blood vessel that supplies the scalp is gently tacked to the surface of the brain. Small vessels spontaneously grow from this and connect to surface blood vessels on the brain. These newly grown vessels will then help to supply both the superficial and deep portions of the brain. Xray studies have shown this procedure to be beneficial in restoring blood flow to the brain.

http://www.bcm.edu/pednsurg/disorder/moyamoya.htm **article also mentions that "A modification of the EDAS procedure has been developed at Texas Children's Hospital."  It's the first I've heard....very interesting.


(2) The EDAS (encephaloduroarteriosynangiosis) procedure requires dissecting a scalp artery over a course of several inches and then making a small temporary opening in the skull directly beneath the artery. The artery is then sutured to the surface of the brain and the bone replaced.

Other operations include: the STA-MCA (superficial temporal artery-middle cerebral artery) in which a scalp artery is directly sutured to a brain surface artery; and a procedure in which multiple small holes (burr holes) are placed in the skull to allow for growth of new vessels into the brain from the scalp.

All of these operations have in common the concept of a blood and oxygen “starved” brain reaching out to grasp and develop new and more efficient means of bringing blood to the brain and bypassing the areas of blockage. The risks of the surgery seem to be more due to the risk of being under general anesthesia for an extended period of time then to the actual surgical manipulations. The Moya-moya vessels and the involved brain are very sensitive to changes in blood pressure, blood volume and the relative amount of carbon dioxide in the blood. When awake, the child’s brain is able to regulate these factors fairly well. However, under general anesthesia these parameters are much harder to artificially control and this can lead to bleeding or strokes. It is crucial for surgery that the anesthesiologist have experience in managing these children as the type of anesthesia they require is very different from the standard anesthetic children get for almost any other type of neurosurgical procedure.



Where are you going to have your surgery done?  Any firm date set?

Take care,
Shan
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« Last Edit: Oct 28th, 2005 at 9:13pm by Shan »  

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Re: difference betwen EDAS and BYPASS
Reply #3 - Oct 28th, 2005 at 9:48pm
 
I am not sure when the surgery will actually happen.  I will meet with the Dr. next wednesday.  Thanks for the info. I will keep you all posted.
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Re: difference betwen EDAS and BYPASS
Reply #4 - Oct 29th, 2005 at 1:16am
 
Shan wrote on Oct 28th, 2005 at 9:11pm:
(1) EDAS procedure, in which a blood vessel that supplies the scalp is gently tacked to the surface of the brain. Small vessels spontaneously grow from this and connect to surface blood vessels on the brain. These newly grown vessels will then help to supply both the superficial and deep portions of the brain. Xray studies have shown this procedure to be beneficial in restoring blood flow to the brain.

(2) The EDAS (encephaloduroarteriosynangiosis) procedure requires dissecting a scalp artery over a course of several inches and then making a small temporary opening in the skull directly beneath the artery. The artery is then sutured to the surface of the brain and the bone replaced.

Other operations include: the STA-MCA (superficial temporal artery-middle cerebral artery) in which a scalp artery is directly sutured to a brain surface artery; and a procedure in which multiple small holes (burr holes) are placed in the skull to allow for growth of new vessels into the brain from the scalp.


If I may expand a little on Shan's post (it was a little confusing to me when I first read it).  Shan's second link actually explains the different surgeries pretty well.  There are four surgeries mentioned...

"There are many operations that have been developed for the condition, but currently the most favored are: EDAS, EMS, STA-MCA and multiple burr holes.

1) The EDAS (encephaloduroarteriosynangiosis) procedure requires dissecting a scalp artery over a course of several inches and then making a small temporary opening in the skull directly beneath the artery. The artery is then sutured to the surface of the brain and the bone replaced.

2) In the EMS (encephalomyosynangiosis) operation, the temporalis muscle, which is in the temple region of the forehead, is dissected and through an opening in the skull placed onto the surface of the brain.

3) STA-MCA (superficial temporal artery-middle cerebral artery) in which a scalp artery is directly sutured to a brain surface artery

4) and a procedure in which multiple small holes (burr holes) are placed in the skull to allow for growth of new vessels into the brain from the scalp."


From the research I've read in the last four years, the multiple burr holes surgery hasn't proven to be too effective by itself and has been discontinued by most surgeons.

Shan's second link also mentions some very important information which I've
changed
and
added
to with my own, personal, edit...

"The long-term outlook for
patients
with treated moya-moya seems to be good. While symptoms may seem to improve almost immediately after
the EDAS, EMS, and multiple burr holes
surgeries
, it will take probably 6-12 months before new vessels
(blood supply)
can develop sufficiently.
With the STA-MCA surgery, increased blood supply is immediate
.

Once major strokes or bleeding take place, even with treatment, the
patient
may be left with permanent loss of function so it is very important to treat this condition promptly
."


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Re: difference betwen EDAS and BYPASS
Reply #5 - Oct 29th, 2005 at 1:30am
 
By the way...

Drawings and pictures of the STA-MCA procedure can be found at:

http://www.moyamoya.com/journals/sta-mca.html#FIG8
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Re: difference betwen EDAS and BYPASS
Reply #6 - Oct 30th, 2005 at 5:24am
 
Thank you DJ for explaining it a little better...and especially for the pictures.  I shared the link with some close family/friends that have supported me through this whole ordeal to give them a "visual"...and I got some very interesting comments.  Wink  Nonethess, it's always great to share/raise awareness of this "rare" disease.

Cherylb--Whatever procedure your dr recommends, we'll be here for you! Smiley Wink  Cheesy  Smiley

Take care,
shan
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« Last Edit: Oct 30th, 2005 at 5:30am by Shan »  

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Re: difference betwen EDAS and BYPASS
Reply #7 - Oct 30th, 2005 at 6:48pm
 
Thank you DJ and to all of you.  Very informative I now know the difference between the EDAS and the STAC Mac.  thanks once again, i will keep you all informed.
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Re: difference betwen EDAS and BYPASS
Reply #8 - Nov 17th, 2005 at 10:34am
 
My son was just told yesterday that he is not ready for surgery yet as his symptoms are not bad enough.  The surgery they want to do is the EMS.  How do they determine that?  And how bad do the symptoms have to get before they will do the surgery?  What if they get too bad?  He is 28 years old and just started with symptoms back in July with his first stroke on July 23.  Would appreciate any help you can give.
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Re: difference betwen EDAS and BYPASS
Reply #9 - Nov 17th, 2005 at 11:03am
 
Hello Moyamom

Welcome to the site!Hope can answer your questions.
Most common for children is EDAS and EMS.
Most common for adults is STA-MCA direct bypass.

If look at the top of the page,you see the links page!
Their are two very experienced MoyaMoya Doctors that you can contact and also (ie) send films to for second opinoin!
It is better to get this treated as soon as possible.!

Wecome to MM.com
More people will respond quickly
Kevin
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« Last Edit: Nov 17th, 2005 at 11:20am by cubbie »  

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Re: difference betwen EDAS and BYPASS
Reply #10 - Nov 17th, 2005 at 12:37pm
 
Moyamom,

I'm glad you have found our website as you will find it's full of very important information and many people that are willing to help answer questions and provide support where we can.  Please read my post in the forum titled: Newly Diagnosed Family Member.

I think you will find that information very helpful! 

Please know that we are all here to help when we can and that I will keep your son and your family in my thoughts and prayers.

Michelle
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Re: difference betwen EDAS and BYPASS
Reply #11 - Nov 17th, 2005 at 4:15pm
 
Dear moyamom,

Welcome to our family!  I am sorry about your son's diagnosis, but very glad you've found your way here!  This is a great place to learn about MM, and there are some wonderful people here, all who have traveled this road in one way or another.

I am the mom of an 18 year old girl who was diagnosed and had two bypass surgeries in May 2004.  We consider ourselves very fortunate that our daughter had "only" had two small strokes prior to surgical treatment.

The best thing you can do for your son is to read up and educate yourself about this disease.  As you become more familiar, you will understand that this is not a "wait and see" disease.  It is progressive, and ideally surgical treatment is obtained PRIOR to a devastating stroke or hemorrhage.

I don't know your son's history, and I am not a medical professional.  However, to hear a physician say that symptoms don't warrant surgery is something I don't understand at all.  Is the blood flow to your son's brain less than it should be?  Symptoms or not, if that is the case, he should be proceeding with treatment, BEFORE something terrible happens. 

Unfortunately, the majority of the medical profession is just not well educated about MM.  The wait and see stance seems to be fairly common.  The question you have to ask is, what are they waiting for?  This is a progressive disease that won't get better or improve with medicinal treatment.  The true experts, doctors who see it on a DAILY basis, are few and far between.  The leading specialists are located at Stanford (Dr. Gary Steinberg) and Boston Children's (Dr. Michael Scott).  Dr. Steinberg operates on both children and adults, and Dr. Scott primarily sees pediatric patients.  Both are happy to offer an opinion free of charge.  You might want to seriously consider sending your son's test results to one of them for a recommendation.

In the meantime, some key questions to ask your son's current doctor:  How many MM patients has he/she seen?  How many MM surgeries  has he/she performed?  How did he/she conclude that the EMS surgery was the best for your son? 

I don't want to frighten you, but as a mom, I'm sure you don't want someone who just dabbles with this disease to treat your son.  With the lack of MM knowledge amongst the medical profession, it is not unusual for people to have to travel away from home to seek good medical care.  I've met many people from out-of-state and out of the country who have come here (California) for treatment by Dr. Steinberg at Stanford.  It is commonplace there - they've performed several hundred surgeries (amazing when you consider that MM occurs in 1 in every 2,000,000 people!).

Good luck to you as you start the education process.  You and your son will be added to my prayers.  Please don't hesitate to continue asking questions, and I hope you can decide on a plan of action that seems to best suit your son.

Warmly,
Jill
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Re: difference betwen EDAS and BYPASS
Reply #12 - Nov 17th, 2005 at 8:33pm
 
WinkHi Cheryl,  My name is Tom (Tom G)
I'm in New Jersey and had my EDAS surgery done by Dr. Sander Connolly at NY Presbyterian.
     Who is your doctor?  if you want to stay close to home Dr. Connolly is great and the best MM expert in the NY area.

     I just want to clarify something in how the surgery is done.
     Yes the temporal scalp artery is freed up.  Then 2 burr holes about the size of a quarter each are drilled through.
     Then a large piece of the skull, (about the size of an extra large egg is removed,  The Dura is cut open and the working artery is stitched to the surface of the brain.
The hope is that the artery will grow roots throughout that hemesphere of the brain increasing blood flow.  This takes 3-6 months or longer.
     The large piece of skull is replaced and attached with titanium cleats and screws.. Now to allow the artery to go under the skull and come back out, the burr holes must remain open.There will never be bone there just dura, muscle, skin and hair.

I have to say that it unnerves me to feel the dents in my head (yes you all have them regardless of which type of bypass.

Dr. Connolly said not to worry but to avoid really mad people
     Roll Eyes   I have also developed an unnatural fear or freshly sharpened pencils Shocked
I guess that we should all avoid mad people with sharp pencils Smiley

You gotta laugh.

Hope I was some help,  If you want to talk feel free to call me at 732-256-4090

Take care  Tom G
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Re: difference betwen EDAS and BYPASS
Reply #13 - Nov 18th, 2005 at 5:27pm
 
Jill, Michelle and Kevin,
My son is 28 and had a stroke on July 23rd of this year.  He did not have any lasting symptoms.  That started a barrage of tests which led to a neuro in Ft. Walton, FL.   The surgeon, suspected MM, because he was stationed in Japan and saw it alot, but is not qualified, by his own admittance, to treat it.  He sent us to UA Birmingham Medical Center where he saw a Neurosurgeon who did an angiogram and diagnosed MM.  My son just went back this week for a special MRI that measures blood flow.  His bloodflow is normal, and the veins his body has made to make up for the 100% blocked ones are very strong in the NS's opinion.  So he is saying wait until symptoms get worse, even though he has never done an MM surgery.  Needless to say we are seeking 2nd and 3rd opinions and fast!!  We have DVD's of angiogram, CTA, and recent MRI.  I read that Dr. Steinberg in LA will look at them at no charge and give a determination.  Dr. Lewis at UFL Gainesville, FL will look at written reports of the tests at no charge.  That is where we are at this point.  Any tips, info or suggestions are greatly appreciated!! Sorry, Jill for the repeat, I sent this to you privately.
Marguerite
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Re: difference betwen EDAS and BYPASS
Reply #14 - Nov 19th, 2005 at 11:02am
 
Hello TomG,
                   Thank you for all the information.  I really do appreciate it.  I  am in California waiting to have my surgery with Dr.  Steinberg.  I feel comfortable with making the decision to come out here to California.  I am just so anxious about the surgery.  I just want to get it over with.  Once again thanks for the info.
Cheryl
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Re: difference betwen EDAS and BYPASS
Reply #15 - Nov 22nd, 2005 at 2:07pm
 
MoyaMom wrote on Nov 18th, 2005 at 5:27pm:
 His bloodflow is normal, and the veins his body has made to make up for the 100% blocked ones are very strong in the NS's opinion.  


Hi Marguerite -

I have to tell you that this statement made me very uneasy.  The veins that are produced - collaterals - are anything but strong and they do not provide enough blood flow to supplement the narrowing arteries.  The problem is that they are thin and weak.  This means that there is risk for those vessels to break and cause hemorage.

I don't mean to freighten you - and I think you are doing the right thing by getting multiple opinions!  Dr. Scott, who I went to, is easily accesable as well.  He is a pediatric neurosurgeon in Boston - but he sees adults up to age 35.  He did my surgeries 2 years ago.

Keep up the good work in seeking a better opinion!

-Shari
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Re: difference betwen EDAS and BYPASS
Reply #16 - Nov 29th, 2005 at 12:45pm
 
MoyaMom wrote on Nov 18th, 2005 at 5:27pm:
His bloodflow is normal, and the veins his body has made to make up for the 100% blocked ones are very strong in the NS's opinion. 


STrantas wrote on Nov 22nd, 2005 at 2:07pm:
Hi Marguerite -

I have to tell you that this statement made me very uneasy.  The veins that are produced - collaterals - are anything but strong and they do not provide enough blood flow to supplement the narrowing arteries.  The problem is that they are thin and weak.
-Shari

Marguerite,

I would have to agree with Shari.  Collateral arteries are like temporary side streets built around a "bridge out" sign on a major four lane highway.  They are enough to keep the traffic flowing in the short term, but in the long run, they can't handle the amount of traffic the major highway does.

I hope you and your son continue to explore more proactive options than waiting for further strokes, and quite possibly permanent damage, before seeking surgical treatments.

"Wait and see" attitudes towards moyamoya are like playing "Russian Roulette", with more than one bullet in the cylinder.

Just my  Smiley

DJ
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Re: difference betwen EDAS and BYPASS
Reply #17 - Jan 4th, 2006 at 9:21pm
 
Hi all,

Seeing that Dr Marshall is recommending that I have EDAS surgery on my left side, I thought that I would re-read this wonderful post. From what I have read on hear (TomG correct me if I am wrong), at least those treated at Columbia Pres, will have two burr holes remaining after surgery. So my question, how safe is it to walk around in life with two quarter sizes holes in the skull? Call me a klutz, but I know that I have banged my head pretty hard a bunch of times in life.....and seeing that I do ride a motorcycle, I guess I should never take off my helmet....

For those who have had the EDAs, have you had any issues with having burr holes.

Thanks,
Greg
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I was misdiagnosed with MM in March of 2005. In January 2006, I was told it is not MM, but rather a massive restriction in the MC1 segment of my left carotid artery.
 
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Re: difference betwen EDAS and BYPASS
Reply #18 - Jan 6th, 2006 at 9:31am
 
Greg -

I had the EDAS surgery, but I honestly don't recall if I had burr holes (I guess I should find out!)....there was a post about bumps and indentations on the head after surgery (in fact, when we all first met up in Vegas we all sat there feeling our own heads  ;Grin )....

I definitly have "dimples" in my head that I don't recall having before...but my doc didn't say any thing about being cautious in that respect.  I'm assuming your surgeon will advise you....if not, you definitly know the questions to ask!  Since my surgeries (2 years ago yesterday - YAY!) I am definitly more cautious, in general, about my head - like when I go to the salon and get my hair washed - I ask them to be gentle around my scars....or, at work, we get 15-minute mini-massages once in a while - I tell him to steer clear of my head....just common sense stuff!

-Shari

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Re: difference betwen EDAS and BYPASS
Reply #19 - Jan 6th, 2006 at 8:26pm
 
Shari....

Congratulations on the two year aniversary.

Thank you for the feed back as well. Now that I've been officially diagnoised and now waiting for my appointment with the Dr. C. at Columbia, I'm trying to learn as much as possible about the EDAS surgery, and the events shortly after surgery in attempt to ask better questions at my appointment. I'm hoping to spend a bit of time with you and Tom next weekend to gain some better insight, seeing that you both are among the few people that have had the EDAS on the site.

Looking forward to next weekend,
Greg
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I was misdiagnosed with MM in March of 2005. In January 2006, I was told it is not MM, but rather a massive restriction in the MC1 segment of my left carotid artery.
 
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Re: difference betwen EDAS and BYPASS
Reply #20 - Jan 12th, 2006 at 11:12am
 
[color=Purple][/color]My name is Laura Stevens and I am scheduled for EDAS Procedure on Jan 18th with Dr. Ogilvy at Massachusettes General Hospital. I'm a little nervous too think I will be under "the knife" for that long of a period of time.  The EDAS procedure is the only surgery that I would be a good candiate for.I would not be a good candiate for the STA-MCA procedure.  This will be the 1st of 2 surgeries that i will indure one on the 18th of Jan and the other about 3 months later. I would like too know just how big of a scar i will have?
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Re: difference betwen EDAS and BYPASS
Reply #21 - Jan 15th, 2006 at 7:15pm
 
Hi Laura -

Well, I had about 20 stiches on each side...but not to worry, your hair will completely cover it!  They only shave what they need - about the width of 2 fingers (I have small fingers!)  and you will be able to hide it well.

The picture over here <---- was taken about a month after my second surgery.

-Shari
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Re: difference betwen EDAS and BYPASS
Reply #22 - Jan 28th, 2009 at 5:18pm
 
What is the difference between "pial synangiosis" and "EDAS"?  Thanks for such a great resource with this blog!! 
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Re: difference betwen EDAS and BYPASS
Reply #23 - Oct 23rd, 2010 at 11:29am
 
Hi My name is Leigh Ann. I am 32 years old and was just diagnosed with Moya Moya in August of 2010. I am not Japenese. No one in my family has this. I just had the EDAMS surgery September 27,2010. My vessels were too constricted for the other surgery. I had 5 mini strokes and was having seizures or "Spells" like seizures prior to. But the way I was diagnosed was because I had a headache that would not go away. I am re-cooperating from my surgery still. It is a hard thing to go through, but I was up and moving after one week. I wanted to go n still want to go. I have a hard time accepting what I have, but thats why I am looking for support. Ask the doctor lots of questions. My surgeon said they do this operation 30 times per year only because its a rare disease. So far, I've had no spells or strokes since the surgery. Im awaiting my first follow up appointment in another week to get my stitches removed. If I can be of any help let me know.
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I forgot where I left
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UN-NOTICED Strokes for 20 YEARS??
Reply #24 - May 24th, 2011 at 2:35am
 
Hi,  I have been diagnosed with Moya Moya  and am 58 y/o female.  The Drs tell me that I have had many strokes all over both sides of my brain. The stroke that caused me to go to the Hosp. happened in the morning   I was going to take my dog out to do his morning business  when I suddenly couldn't remember his name    and then my speech started coming out all "flat and wrong".  I thought it was just a weird thing because I don't have high blood pressure, high cholesterol or weakness in my arms or legs, and waited until the next day...when it was continuing my husband noticed and called my Dr.
    My question is this...The Drs said I have had many frequent strokes  over the past 20 years .  During that time I was caring for my older children and working as an RN IN a hospital  in pediatric critical care.  NOW...How the heck did I go to work everyday and no one noticed I was ill. How did I keep driving  and not notice I was confused or anything.  When the Drs sent me home they told me to call or come back if I notice any new sympthoms  of Stroke.  I never noticed any for the first 20 yrs  and they built their collateral circulations up so fast I didn't exhibit any deficits.
   Is any body interested and studying the way our brains go into 'overdrive' and form all this circulation. Maybe  people don't need to suffer for months or years in Rehab and paralzed like they do.  Maybe  we have a strange enzyme  or something  that kicks in to cause this fast growth of the collateral irculation.Anyway...Back to my initial question...How am I supposed to know what a new stroke  will feel like??  Has anyone else had this..???  SandyR
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