October 5th

Background:

Ken has an arterial disease known as MoyaMoya. The internal carotid artery (ICA) on the left side of his brain is completely collapsed. The ICA on the right side is about 90% collapsed.

The treatment we have been using for this in the past (mostly blood thinners) have become ineffective. He started experiencing something called a transient ischemic attack (TIA) which are mini-strokes (a stroke with no damage, just a period of loss of oxygen to a region of the brain)

Ken's TIAs were about two to three times per week, and were always the same: numbness in his right side (leg, foot, arm, hand and head) and blury vision, and an inability to form words.

Ken's neurologist had been trying to treat this with pills for a while. Then this summer, the TIAs began happening daily, and then several times per day.

Ken was no longer able to drive a car or go to work. His neurologist gave us test after test, and we were getting nowhere.

We finally had a procedure called a cerebral angiogram. They would inject a dye into the artery of the brain, and photograph is with MRI images as the dye moved through the brain. The radiologist said surgery was not only the only option, but that it needed to be done months ago.

There were two options for surgery:

• 1. Direct Bypass - They take an artery from the scalp, pass it through the skull and sew it into the middle cerebral artery of the brain. Results and benefits should be immediate (i.e. all symptoms will go away)
• 2. Indirect Bypass - If they can't do the direct bypass, then they will do this procedure where they take the artery from the scalp, pass it through the skull and graft it onto the surface of the brain. There will be no improvement of his symptoms for at least 3 weeks, and will take 4 months for the symptoms to go away completely.

We selected the direct bypass, for obvious reasons.

The surgery was scheduled for October 5th. After the surgery, the surgeon let us know he was not able to do a direct bypass because the middle cerebral artery was too large, and "tapping" into it would not bring any more blood to the area. So the indirect method was done. We were told to continue to see Ken's symptoms (numbness, speech problems, TIAs) for two to three weeks.

We were discharged on October 8th.

Ken's speech got progressively worse, and on Sunday October 11th, I called the hospital, and they said to bring him into the ER and they would meet us there. He had had a 2nd stroke and was re-admitted that afternoon.