This morning I awakened to the news that a US Senator from New Mexico, Ben Ray Lujan, had sustained a stroke in his cerebellum last week, diagnosed after he presented to the University of New Mexico Hospital with dizziness. Of course, the media was making it into a political Senate 50/50 split issue (and in a divided nation, this certainly seems to get the ratings these days), but I was thinking – I wonder if he is relatively young, as so many of my cerebellar stroke patients have been. And he is – 49 years old.

Which had me wondering if he could have had a vertebral artery dissection. Or was prone to forming blood clots because of an underlying condition. Or has a patent foramen ovale (a PFO – a tunnel between the right and left atria of the heart that is thought to permit blood clots to more easily reach the brain, rather than being filtered out by the lungs). I really don’t know what caused his stroke at this point, as I only know as much as is being released to the media, but I am concerned for him.

Reports are stating that he underwent “decompressive surgery” as part of his treatment. This means he developed enough severe swelling in the cerebellum that his doctors were concerned that the swelling could compress his brain stem and create a life-threatening situation. A decompressive suboccipital craniectomy involves surgically removing part of the skull on the back of the head to allow the cerebellum to swell outward, rather than pushing on the brain stem in such a tight, confined space. I won’t post an image here in case it causes anyone discomfort, but if you click here you can watch a video at the Neurosurgical Atlas website to see a demonstration.

Typically, patients who are diagnosed and treated early with cerebellar strokes do “well.” But what does “well” mean? In the world of stroke survivors, doing well usually means living independently, walking, talking, and eating. Many of my patients have told me that while they are back to independent living, they have not made a “full recovery.” They feel off-balance, particularly if they turn too quickly. Or they struggle with fatigue. Or headaches. Or double vision. Or some combination of the above. Sometimes cerebellar stroke patients can even have difficulty speaking because of language impairment, a condition known as aphasia. When I saw the statement from Senator Lujan’s office about him being expected to make a “full recovery,” I had my doubts, but I sincerely do hope that he has a very robust recovery and can celebrate the milestones along the way.

With a cerebellar stroke that is large enough to require a decompressive suboccipital craniectomy, the situation can become rapidly fatal without recognition and treatment. I am glad that he sought treatment and was appropriately diagnosed and treated. May his stroke also serve as an example to others about the importance of good, early stroke care.