Dr. Roach: Spinal cord injury gets misdiagnosed as ‘blood pressure stroke’

Dear Dr. Roach: Have you ever heard of a “low blood pressure stroke”? That was my husband’s (incorrect) diagnosis several years back when he suddenly could not move his arms and legs. He was told that not enough oxygen was getting to his spine. (His blood pressure is historically low, usually around 90/60.)

That lasted about seven months, and he was bedridden the entire time. He then went to a neurosurgeon and was (correctly) diagnosed with a spinal cord injury. He had C1-C2 surgery and had use of his limbs the next day. After months of physical therapy, he regained a lot of function.

We’ve never heard of that diagnosis before or after his experience. Does it really exist?

— E.S.K.

Dear E.S.K.: The brain has tremendous ability to regulate its own blood flow under a very wide range of blood pressures, but there are some limits. When a person is used to very high blood pressure levels, such as 200/110 for months or years, a sudden drop to 90/60 (or even 120/80, sometimes) can cause a stroke. That’s the main reason we don’t lower blood pressure very quickly in people who have had very high blood pressure levels for a long time. It takes weeks or months for the brain to recover its ability to regulate blood flow.

In a person who has a heart attack, the prolonged low blood pressure (or no blood pressure) will also cause brain damage. That’s why starting CPR as quickly as possible is so critical in order to preserve brain function.

In both of these cases, not enough blood is getting to the central nervous system (the brain, the spinal cord and the retinas), which can lead to cell death — the hallmark of a stroke. But these are extreme cases.

A healthy person whose normal blood pressure is around 90/60 is at risk for fainting when suddenly standing; however, they are at a lower-than-average risk for heart disease and stroke. The diagnosis of “a low blood pressure stroke” for your husband doesn’t make any sense at all to me, and advanced imaging of the brain should have made it abundantly clear that it was not the right diagnosis.

I’m shocked that he wasn’t treated correctly for such a long time. But I’m very happy to hear that his neurosurgeon did not assume the diagnosis of a stroke, and instead made the correct diagnosis and performed the procedure to help him recover. Your husband is fortunate that he still had neurological function to recover after such a long time, since spinal cord injuries generally do better when treated promptly.

Dear Dr. Roach: My primary care physician and blood specialist say there is nothing that will increase white blood cell count. Are there supplements that I can take or foods to eat to improve the low count?

— R.J.L.

R.J.L.: The question is, why is your white blood cell count low? Some people have low white blood cell counts for no reason; it runs in families, so there aren’t any health concerns there. However, there are a large variety of blood diseases that cause low white cell counts. Some affect the lymphocytes, while others affect the granulocytes (the two main types of white cells).

Nutritional deficiencies are extremely rare in North America (vitamin B12, folic acid and copper are the exceptions that should be looked for), so neither diet nor supplements are usually helpful. In absence of blood disease or symptoms, low white blood cell counts usually do not need treatment.

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