A blow to the brain; Stroke: A scientist tells what it's like to be a victim and how it has changed her life for worse - and for better.

THE BALTIMORE SUN

On the morning of Dec. 10, 1996, I awoke with a pulsing pain behind my left eye. I got up to begin my morning routine and jumped onto my cardio-glider. The exercise, I thought, would get my blood flowing and banish the throbbing inside my head.

While I exercised, however, the pain became more intense. Within a few moments I started to feel very peculiar -- confused, yet clearheaded and alert.

When I got off the machine, I noticed that I was slightly off balance and feeling strangely detached from my body. I climbed into the shower, my movements slowed and deliberate.

When I held my hands up in front of my face, I felt as though my consciousness was suspended somewhere between normal reality and some esoteric space. The running water of the shower felt like little bullets spattering into my flesh.

I knew something was very wrong with my brain. I dimmed the lights, because they made the throbbing behind my left eye worse.

Time seemed to stand still. I was disturbingly aware that the intricate networks that operate the different functions of my mind were shutting down.

I tried to visualize myself driving to work, and in the next instant my right arm went totally dead.

In that moment I knew I was having a stroke.

I was 37 years old and, testifying to the impact of my scientific training, my next thought was "Wow, this is so cool!" I am a trained neuroanatomist, and this was an opportunity for me to study my brain -- from the inside out.

I witnessed the breakdown of my higher cognitive skills. I could no longer integrate and associate my thoughts with the incoming sensory information.

Although I felt no sense of urgency, I understood that the prognosis of stroke is often determined by how quickly a patient gets to the hospital. To save my life, I had to make a plan, then consciously hold it in my memory long enough to execute it. But I kept forgetting what it was I was trying to do.

After minutes of effort, I dialed the phone number of the Harvard Brain Bank at McLean Hospital, where I worked. I tried to ask for help, but my throat wouldn't form the words. I simply grunted.

Eventually I blurted something out, but it was unintelligible. I heard my colleague speaking, and I knew that I knew what was being said, but I couldn't grasp the meaning. Fortunately, he sensed the danger of my condition and assured me that he would send help.

It wasn't long before I found myself at the hospital and in a CT scanner. The resulting images revealed that I was indeed having a stroke, with severe bleeding in my left temporal lobe.

Later I learned that 10 percent of people who experience this kind of stroke die immediately. Another 50 percent remain in a vegetative state.

Most strokes are caused when a blood clot lodges in an artery that is supplying life-giving oxygen-rich blood to the brain. The artery that is blocked determines which cells will be starved and die. For some people there is extensive neurological destruction, while for others there is minimal effect.

My stroke, however, was not caused by a clot but by an arteriovenous malformation (AVM). Normally, capillary networks -- fine-mesh structures of tiny blood vessels -- function as a buffer zone between sturdy arteries, in which blood flows forcefully, and thin-walled veins, which return blood to the heart and lungs. With an AVM, there is a shortcut between arteries and veins, and a low-pressure vein is directly hooked up to a high-pressure artery.

Some people have the condition and never have symptoms. But in others the direct connection between the artery and the vein becomes so weak that the connection bursts.

In my case, the hemorrhage occurred over a fold in the left hemisphere of my brain: the superior temporal gyrus.

The bleeding in my brain placed pressure on certain nerve fibers, blocking my ability to speak or understand spoken language. The most lasting injury occurred in a nearby region that allows for the performance of both simple and complex mathematical calculations.

Later in the afternoon, I regained full consciousness and discovered I was completely mentally disabled.

Seventeen days after the stroke, I underwent brain surgery at Massachusetts General Hospital. The brain swelling from the hemorrhage had receded, but my doctors needed to open my skull and remove the affected tissue and residual debris.

When I awoke from surgery, I faced the challenge of rebuilding my brain. A small amount of tissue had been permanently destroyed. Neuronal connections that had been broken by the injury would have to be reconnected, and in some cases I would have to build entirely new pathways.

It is one of the marvels of the brain that neurons can be recruited to take on new functions. The recovery would not be swift: It would be two years before we would know how well I would recover from both the stroke and the surgery.

Some tasks came back more easily than others. Although I could remember what it felt like to do simple things like walking smoothly, my body wouldn't cooperate.

But I could visualize how I did things before. And I believed that if I held on to the memory of what it felt like to perform basic actions, I could more quickly re-establish the connections that had been broken before they completely deteriorated.

More than two years have passed since my stroke. Besides having a beauty of a scar, I still have some cognitive impairment. I can handle only elementary mathematical calculations, and when I'm tired I have trouble finding the right word.

I have also shifted away from being a superanalytical, confident risk-taker who relied on the analytical skills housed in my brain's left hemisphere.

Instead I experienced a fascinating and pleasurable shift in my perspective. My brain's right hemisphere is now dominant. I am much more mellow and secure in my understanding of who I am and what I want to accomplish with the finite time I have.

I have crossed the bridge from the academic description of illness to personal insight, and my resolve is stronger than ever. Now I enjoy helping people understand what it is like to experience mental deterioration.

Most importantly, I have great compassion.

Jill Bolte Taylor is a neuroscientist and the Harvard Brain Tissue Resource Center's national spokeswoman for the mentally ill.

What you can do

February is the American Heart Association's observance of American Heart Month, designed to raise awareness of healthful habits. Here are some recommendations.

* Don't smoke.

* Hold your overall cholesterol level to 200 mg/dL (below 130 for LDL; 35 or higher for HDL).

* Keep your triglycerides to less than 200 mg/dL.

* Keep your blood pressure below 140/90.

* Limit sodium to 2,400 mg per day, alcohol to one drink a day.

* Exercise -- at least moderate intensity, for 30 minutes a day.

Share your hope

It took two years for neuroanatomist Jill Bolte Taylor to fight back from a stroke that left her mentally disabled. When language failed her, she used visualization. Though she's lost certain mental skills, she's gained insight.

If you have similar advice or words of hope after a stroke or heart attack, please tell us in 100 words or less and we'll share them with Sun readers for American Heart Month.

Write to: Health & Fitness Page/Hearts, The Sun, 501 N. Calvert St., Baltimore, Md. 21278. The deadline is Feb. 28.

Top advances

The American Heart Association says key research advances were made in 1998:

* Gene therapy to create a "natural" bypass to circumvent plaque in the heart's blood vessels moved forward.

* Platelet blockers -- "super aspirins" -- were found to do a super job in fighting heart attack and stroke in heart patients.

* Studies showed at-risk people can take aspirin to lower risk of blood clots.

* It was found that nonsurgical imaging (MRI) can be used to detect people at risk of a heart attack or stroke.

Strokes: the numbers

* Cardiovascular diseases -- strokes, heart disease, high blood pressure, etc. -- are the No. 1 killer in the U.S., killing more people each year than the next seven causes combined.

* Strokes killed 159,942 people in 1996, accounting for 1 of every 14.5 deaths in the United States.

* Maryland ranks 20th among the states in number of strokes per year; 61 of every 100,000 Maryland deaths are from strokes.

* Stroke is a leading cause of long-term disability in the United States.

* 31 percent of brain attack survivors need assistance caring for themselves: 20 percent need help walking, 71 percent lose some of their ability to work within seven years, and 16 percent have to be institutionalized.

* 29 percent of strokes result in death within one year; the percentage is higher for those 65 and older.

* 28 percent of those suffering from a brain attack in a given year are under 65.

* Stroke incidents are roughly 19 percent higher for males than females; the difference is greater for males under 65.

Sources: American Heart Association's "1999 Heart and Stroke Statistical Update"; Maryland Statistics courtesy of the American Heart Association, Washington.

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