Arrival of
the Bees

About that first MRI

Two weeks earlier I began work on the story this was supposed to be. I paid a visit to Jim Lah, an Emory neurologist and principal investigator for the Emory Healthy Aging Study. The plan was to undergo an MRI procedure so I could write about the study while going through what a typical participant would. My ears were plugged to muffle the intense racket caused by vibrating metal coils carrying rapid pulses of electricity. As I lay on my back in the snug tube, I stared up at a computer screen with a slide show of calming, bucolic images, glad this was just research.

After that, we went over the images of my brain to understand what researchers can learn from high-tech imaging. It was Lah, me, and another journalist, Jaye Watson, who was working on a GPB television segment that was going to dovetail with my story. Lah pulled the images up on a monitor and said, “Your brain looks brand new, like it’s never been used, right out of the package.”

That joke was all I remembered from the interview. I had forgotten everything else from that day until I found the gumption to listen to the recording five months later, in January 2019, and heard something that gave me chills: Lah is going over images of my brain and says, “I just want to make sure there’s nothing scary here, or unexpected.” Jaye responds lightheartedly, “The story might not happen at all if that were the case,” and then adds an imaginary explanation to an imaginary boss, “We were going to do the story, until he became a patient.” 

Lah concludes with, “Until he had to go to the emergency room.” On the recording, I was laughing.

But it’s not so funny anymore. Turns out, neither Jaye nor I did the stories we were supposed to do.

Cerebellar strokes account for about 10 percent of all strokes and they’re not easy to diagnose. Indeed, they are often misdiagnosed as migraines, gastritis, meningitis, even inner ear infections. But if not recognized and quickly treated as the stroke they actually are, they can ruin your life—or end it. 

I was lucky. Lucky because, even as my brain raged, I had the presence of mind to take an aspirin. Lucky because, like 88 percent of strokes, mine was an ischemic stroke, in which a blockage or clot in an artery to the brain causes reduced blood flow. Aspirin thins the blood and can break up a clot. 

On the other hand, if this had been a hemorrhagic stroke, the kind where a blood vessel bursts in the brain, the aspirin makes the bleeding worse. 

Location, location, location

“All things considered and in the grand scheme of things, if you had to choose a stroke, the kind you had would be near the top of the list,” Lah told me in January 2019, the second time we met. “When it comes to damage in the brain, the same three rules apply as the first three rules of real estate. Do you know those? Location, location, location.”

The same rule also applies to neurologists, which is why I wound up at the Emory Clinic in the care of Fadi Nahab, medical director for the stroke program at Emory University Hospital and Emory University Hospital Midtown. After looking over my MRI from the night of the stroke, Nahab told me that I’d actually had two strokes. He saw evidence of not only the cerebellar stroke, but an earlier episode closer to the front of my brain. 

At some point, it seems, I’d had some type of minor stroke, probably while sleeping. I have no memory of it, but learned of something called a silent stroke, which often has no symptoms but still causes damage to brain tissue.  

We still don’t know exactly when that first, mysterious stroke happened, but we finally know why the cerebellar stroke happened. We’ll get to that in a moment.

The risk factors for stroke are high blood pressure, high cholesterol, heavy smoking, alcohol and drug abuse, and a sedentary lifestyle.

 I had high blood pressure that I wasn’t treating, but the cholesterol was under control with medicine. Everything else was off the table. I’m not a smoker, not a heavy drinker, and I was in great physical shape—I thought.

Brain-heart connection

While I was in the hospital following the episode, doctors found a patent foramen ovale (PFO), a hole between the left and right atria of my heart, that I’d lived with, blissfully unaware, for 57 years. We all have PFOs in utero, but they usually close shortly after birth. For about 25 percent of us, they stay open and, in some circumstances, a PFO will allow a clot to pass through the heart and travel up to the brain.

In some cases, the PFO together with another condition, like atrial fibrillation (an irregular heartbeat), can increase the risk of stroke.  So, three months post-stroke, in November, an Emory physician implanted a loop recorder in my chest to record my heart rhythms for the next three years, monitoring for atrial fibrillation, or some other sign that the PFO was responsible. A few months after the device (which is smaller than a thumb drive) was installed, we found it was working just fine. It recorded atrial fibrillation, probably while I was playing basketball. I never felt a thing, but that’s not uncommon with AFib, I was told.

Even if the PFO wasn’t responsible, “having a stroke is a warning sign that your brain already sustained some kind of injury from a decrease in blood supply,” according to Ihab Hajjar, associate professor of medicine at Emory. 

An internist and geriatrician, Hajjar leads Emory’s Brain, Stress, Hypertension, and Aging Research Program (BSHARP), a team of researchers exploring the links between brain health and the cardiovascular system.

Hajjar is researching the connection between high blood pressure (hypertension) and cognitive impairment later in life. He’s found that drugs for high blood pressure (such as lisinopril, the drug that I’ve been on since the stroke) have an added benefit. 

“Evidence has shown that when you treat hypertension, especially in the early stages, you potentially prevent cognitive decline later in life,” Hajjar says. This is positive news for me, since I’ll probably be treating my high blood pressure from now on.

With Nahab and Hajjar, I’ve found two biomedical heroes whose work I’m personally interested in. Nahab sees 2,000 patients a year and estimates that 200 of them have had cerebellar strokes. His research focus is on cryptogenic stroke of an undetermined cause. 

Thankfully, data collected from the monitor in my chest helped clear up my mystery.

 I’m back on the basketball court (though at a more cautious pace). 

But sometimes my imagination takes me down some dark roads. For instance, every time I drive, I make a mental plan of what to do if the bees come back. I try to stay close to the shoulder or the median, due to this irrational fear of crashing while having a stroke and taking out some other poor motorist.

 I wonder about dying suddenly, or becoming incapacitated. My responsibilities require a fully functioning (and breathing) Jerry. Chief among these are my son, Joe, who is profoundly affected by cerebral palsy. He needs his old Pop, at least for a few more years. The bottom line is, I must be physically and cognitively capable of lifting and caring for my son. Dropping dead or out are not options. I come by my high blood pressure honestly.

Fortunately, my physician is excellent. He’s also glad I’m his patient and was thrilled by the challenge of a mystery like the one my stroke presented. (Of course, I never really shared his enthusiasm.) 

“Frankly, I get excited when I see patients who are told, ‘We don’t know what caused your stroke,’ ” Nahab says. “I know that they are going to the forefront of evaluation and treatment, and that I will most likely be able to give them peace of mind.”