Our Take: Beacon neurologist explains cerebral stroke after death of Pope Francis

Dr. Jose Luis Lopez

In the wake of Pope Francis’ passing, many have questions about cerebral strokes — his cause of death as reported by the Vatican. To help understand this medical condition, we spoke with Dr. Jose Luis Lopez, Medical Director of Beacon Health System’s Stroke Program. Dr. Lopez explains what cerebral strokes are, their causes, risk factors, warning signs and the critical importance of rapid treatment.

Q: Can you explain what is meant by a cerebral stroke?

A: “Ictus Cerebri” as delineated in Pope Francis’ cause of death is Latin for “stroke of the brain.” In English, we broadly use the term “stroke” noting that “cerebri” does not need to be translated; we additionally often use the term “cerebral infarction.”

A stroke is an interruption of blood supply to any part of the brain that results in injury. It occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When brain cells do not get the blood and oxygen they need, the brains cells in that part of the brain die.

Q: What are causes of cerebral stroke?

A: There are two types of strokes: an ischemic stroke can be caused by a clot obstructing the flow of blood to the brain, and a hemorrhagic stroke can be due to a blood vessel rupturing and preventing adequate blood flow to the brain. These are different than a transient ischemic attack (TIA), or “mini stroke,” that is caused by a temporary clot that usually resolves on its own without any resultant permanent brain injury.

Q: What underlying health conditions might increase the risk of a fatal stroke?

A: There are several risk factors that contribute to the risk of stroke, with 80% of strokes being preventable. Controllable risk factors include high blood pressure, high cholesterol, uncontrolled diabetes, obesity, smoking tobacco, physical inactivity, and poor sleep.

Traditionally, there is a described Stroke-Heart Syndrome (SHS) that refers to cardiac complications that occur after stroke, including cardiac dysfunction, arrhythmias, and myocardial damage. Evidence has shown that the frequency and severity of SHS reaches its peak within the first 3 days after stroke. Although most stroke-related cardiac disorders are transient, some patients demonstrate poor prognosis. Cardiac complications that lead to morbidity and even death in the days immediately after an acute stroke include heart attack, congestive heart failure, cardiac arrest, and abnormal heart rhythms. Underlying vascular or stroke risk factors, such as high blood pressure, diabetes, high cholesterol can increase the likelihood of the cardiac syndrome and worsen the cardiac injury after a stroke.

Pope Francis suffered of diabetes mellitus type II and hypertension. During a preceding 5-week hospitalization, he struggled with bilateral pneumonia and multiple episodes of acute respiratory failure. His cause of death was reported to have been a stroke that resulted in coma, followed by heart failure.

Q: What are the most common symptoms or warning signs of stroke people should watch for?

A: When it comes to recognizing the common symptoms of stroke, learn the stroke warning signs F.A.S.T.:

• F. Face Drooping
• A. Arm Weakness
• S. Speech Difficulty
• T. Time to Call 911

Q: What should you do if you suspect you or another person is having a stroke?

A: If you suspect someone is showing the stroke warning signs, call 911. A patient presenting to the emergency department by ambulance could impact the outcome immensely, making a greater difference between a full recovery and long-term disability and even saving a life.

Q: How important is rapid treatment for improving outcomes?

A: “Time is brain,” with every 15-minute delay in restoring blood flow to the brain increasing the risk of resulting disability by 4%. Patients who are treated with a clot-busting drug within 90 minutes of their first symptoms are almost three times more likely to recover with little or no disability. When a clot causing the stroke is identified and a procedure is recommended to remove the clot, 91% of patients treated within 150 minutes of their first symptoms may recover with little or no disability.