The Bizarre Future of Stroke Treatment


[♪ INTRO] When it comes to strokes, doctors often say
“time is brain,” meaning that the more time that passes before
a stroke is identified and treated, the more damage it can do. Which is why medical professionals want everyone
to know how to spot a stroke F.A.S.T. Weakness in the Face or Arm? Speech problems? Time to call 911. But even with rapid action, there can be lasting
damage. So researchers are looking for better ways
to help stroke patients, and that’s led to some kind of creative ideas. A stroke happens when part of the brain’s
blood supply is cut off. The lack of blood flow means some of the tissue
stops receiving oxygen. So it essentially suffocates and starts to
die. That leads to neurological symptoms, like
slurred speech and weak limbs. And when brain cells die, losses to function
can be permanent. It’d be great to just never have these things
happen. Unfortunately, stopping strokes entirely isn’t
likely. The trouble is, there are two main types of
strokes. About 15% of strokes are hemorrhagic
strokes, which is when a burst blood vessel leads to
bleeding in the brain, which disrupts the normal flow of blood to
the surrounding brain tissue. Most strokes, however, fall under the banner
of ischemic attacks, which means a blood clot obstructs blood flow
to part of the brain. That means, to stop all strokes, you’d need
to make it so people have blood vessels that never fail or clog. And that’s just not really possible. So instead, scientists are looking at ways
to minimize the damage strokes cause. And they’ve gotten pretty creative about
it. Since time is a critical factor in how much
damage a stroke will do, any treatment that can buy doctors more time can help. Sadly, we have not yet figured out how to
freeze time. But doctors can do the next best thing: freeze
a person’s brain. It’s a technique called therapeutic hypothermia. And, OK, technically, the brain is not frozen. Using ice-cold IV drips and cold packs applied
to the skin, physicians lower the patient’s body temperature
to around 33 to 36 degrees Celsius, a bit below the typical 36 to 37. This aims to slow down something called the
ischemic cascade. See, your brain cells, like pretty much all
cells in your body, prefer to make their energy-shuttling molecules with a process that requires oxygen. When they stop receiving oxygen because their
blood supply is cut off, they switch to a less efficient method in
an attempt to keep up with the energy demand. Soon, though, there’s just not enough energy
to go around, and everything starts to fall apart. Before you know it, the cell is dead. The longer the tissue lacks oxygen, the more
cells will die, and the larger the damaged area becomes. But, since all of this stems from those cells
needing energy, if you lower their energy needs, they can
last longer before they crash. It’s kind of like how you can keep your
phone running longer if you dim the screen and turn on airplane mode. And that’s what therapeutic hypothermia
seems to do, it slows all sorts of processes in cells, thereby reducing their energy needs. Studies have found that for every degree you
reduce a person’s core body temperature, the rate at which their cells use energy decreases
by up to 5%. That buys more time to treat the clot or bleed. And, once the cause of the stroke is fixed,
the patient can be warmed up gradually, over the course of many hours, to avoid the complications that come with
a rapid increase in body temperature. But while therapeutic hypothermia can help
prevent brain damage from occurring, it doesn’t affect the damage that’s already been done. And unfortunately, strokes often have lasting
symptoms, because brain tissue is notoriously bad at repairing itself. Now some scientists believe that’s largely
because there isn’t enough structural support for the tissue that tries to grow back. Patients basically end up with small, fluid-filled
cavities in their brains once the debris from the dead cells is cleared out. That’s why some neuroscientists think they
can give the brain a helping hand using a technique called bio-scaffolding. A bio-scaffold is a structure that tissue
can grow over, an empty frame of sorts that encourages new cell growth better than the
fluid-filled cavity. One 2012 study even suggests the best material
for scaffolding is… pork bladder tissue? Or what’s left of it, anyway, after you
remove the actual cells, what scientists call the extracellular matrix. That’s basically all the proteins, starches,
and other molecules in between your cells which support them physically and biochemically. So the idea is, you plug a gap in someone’s
brain with the structural elements of bladder tissue and maybe add some neural stem cells
to get things rolling. And voila! But although there have been promising results
in rodent models, we don’t know for sure that this works in humans. And before we could start doing this in human
brains, we’d need to make sure the tissue wouldn’t grow back in a problematic way and that the immune system wouldn’t respond
unfavorably to the scaffold. There are also other ways to encourage healing,
like, by injecting molecular signals for regrowth. The thing is, it’s not just neurons that
need to grow back. The new tissue will also need the little blood
vessels that ensure those neurons get enough oxygen and nutrients. And that’s why one group investigating this
kind of injection tried something called vascular endothelial growth factor, or VEGF, a substance that, among other things, encourages
blood vessels to grow. Previous research had suggested injecting
VEGF into brains wasn’t so great because it causes inflammation and doesn’t
do much in the way of repairing stroke damage. But that was when it was injected all alone. So, the research team created a water-based
gel from a starch known to promote neurons to grow from stem cells and added nanoparticles that dampen inflammation. Then, they added VEGF and injected the mix
into stroke cavities in the brains of mice. And, as hoped, new blood vessels and new neurons
grew into that space The damaged areas even started working again, which didn’t happen for animals
that received a control gel. Like with scaffolding, this hasn’t been
tried in people yet, but with such promising results, human trials might not be too far
off. And these methods aren’t necessarily mutually
exclusive. A doctor may be able to use some combination
of therapeutic hypothermia, bio-scaffolding, and injectable growth promoters to give their
stroke patients the best possible outcome. Plus, these are just a few of the promising
developments from the field. Stroke treatment and rehabilitation are two
massive fields of research, so doctors are bound to come up with other exciting, creative solutions. We still have a long way to go before strokes
are easily treatable. But with a little luck, approaches like these
will go from theory to practice very soon. Thanks for watching this episode of SciShow
Psych! If you enjoy learning about your brain and
how it works, and, presumably you do
because you’re watching this, be sure to stick around! We are all brain, all the time here,
all you have to do is click on that subscribe button and ring the notification bell, catch
every single episode, never let us down… No, I’m kidding. Enjoy it how you like! But if you think out free, educational psychology
videos are really great and we do,
and you want to support the team here, you can learn more about joining our community
of supporters at patreon.com/SciShow. [♪ OUTRO]

69 Comments

  1. Ryan Kreder said:

    First. Had to do it!

    February 17, 2020
    Reply
  2. Loren Z said:

    Butt is Legs?

    February 17, 2020
    Reply
  3. A Better You - Evidence-Based Personal Development said:

    It's unbelievable how fast science is advancing. These findings will save thousands (if not millions) of lives. We should all be grateful for them. 🙏

    February 17, 2020
    Reply
  4. Brains Applied said:

    It would be kinda funny if instead of healing, you started growing a pig blatter in your brain 😬

    February 17, 2020
    Reply
  5. Anonymous said:

    Lumbrokinase? headache/migraine = biofilm infection? Federal Dept. Of Health or HHS not corrupt from top down?

    February 17, 2020
    Reply
  6. Zenytram Searom said:

    Cure for almost all cancer, reverse a stroke, man i love science

    February 17, 2020
    Reply
  7. rufioh said:

    pretty sure it's a soft G in VEGF

    February 17, 2020
    Reply
  8. Christel Headington said:

    Mice are not people. We do however, seem to have a lot of interchangeable parts with pigs.

    February 17, 2020
    Reply
  9. rgbii said:

    So if I think I'm having a stroke, I should eat ice cream as fast as I can. Got it. Thanks.

    February 17, 2020
    Reply
  10. chris Chris said:

    Not sure about strokes but this guys uncontrollable arm spasms while speaking create a strobe light affect that will definitely cause seizures. An alert should precede each video.

    February 17, 2020
    Reply
  11. Jason Gastrich said:

    Awesome man. Thanks. I have learned a lot from y’all. Keep up the good work bro! 🙏

    February 17, 2020
    Reply
  12. Michael Miller said:

    Its too bad none of this was around when my Grandfather had his stroke.

    February 17, 2020
    Reply
  13. Sentient Fetus said:

    Wonder if some devepmental disorders love me Fetal alcohol syndrome could be strokes early devepmental. Similar symptoms. Or what short term memory lose before much is learned
    Dory's problem was recall not incoding

    February 17, 2020
    Reply
  14. Celina K said:

    4:40

    February 17, 2020
    Reply
  15. Darkstar Photography said:

    my great grandmother died off a stroke last year, so this is particularly exciting what great news indeed

    February 17, 2020
    Reply
  16. Harvest said:

    I'd rather not have pig bladder in my brain.

    February 17, 2020
    Reply
  17. BovineRage said:

    AAAAAAAA I WAS LITERALLY TYPING A COMMENT ABOUT THE EXTRACELLULAR MATRIX AS YOU SAID THE WORDS

    February 17, 2020
    Reply
  18. Reed L said:

    Therapeutic hypothermia is exactly what my parents called it when they made me park my car outside in Wisconsin winter

    February 17, 2020
    Reply
  19. Welco said:

    Guess you never worked in drug development. Even simple mechanism of actions often don’t work, and take forever, or have safely issues. Best case this is decades away, and certainly wouldn’t make stroke care and afterthought

    February 17, 2020
    Reply
  20. GOP R TROLLS said:

    Wow terrifying

    February 17, 2020
    Reply
  21. masterimbecile said:

    I guess you can say that the scientists… got a STROKE of genius.

    February 17, 2020
    Reply
  22. Happy ClamGuy said:

    Is stroke treatment slang for masturbation? Asking for a friend.

    February 17, 2020
    Reply
  23. AzureSky317 said:

    What can I do to sign up my father for these studies. He suffered from a stroke a few years back and he haven’t been the same since. He goes to physical therapy and does exercises to keep his body from deteriorating but it’s just worst and worst.

    February 17, 2020
    Reply
  24. Danielle Spargo said:

    very very cool video, the second half gave me way more info than i expected. i knew about the first half, so was reluctant to click, but glad i did b/c of info on scaffolding and regenerating new cells

    February 17, 2020
    Reply
  25. Communism is the future said:

    It hurts so badly to see a science-based show say that it’s not possible to stop the clogging of arteries. Everyone please read The China Study. It’s not a long read and it will change your life. Heart disease, heart attacks and strokes, are optional.

    February 17, 2020
    Reply
  26. Mariama S. said:

    Can you do an episode on sleep debt?

    February 17, 2020
    Reply
  27. user73o1u 81716 said:

    it's called viiiiiigef

    February 17, 2020
    Reply
  28. Abby C said:

    I fell off a cliff and landed in a stream of snowmelt. I laid there, waiting for the ambulance for 3 hours with my brother (he was the conscious one). I heard I was able to recover so well because I was like 70 degrees Fahrenheit when the helicopter got to me.

    February 18, 2020
    Reply
  29. cynsen said:

    I had a major stroke and amazingly I’m sorta fine after 13 years. Filling in the brain cavity sounds very promising.

    February 18, 2020
    Reply
  30. Roman Mirasol said:

    This is medical science and neurology, why is it on SciShow psychology? >.>

    February 18, 2020
    Reply
  31. Nicole Hubbard said:

    Interesting that this episode came out the day my pet rat had a stroke. Since I dont have access to all those fancy proteins and what-not, how can I help my rat get better??

    February 18, 2020
    Reply
  32. Wil Harding said:

    I worked as a stroke recovery nurse before going into graduate studies and have seen some beautiful stroke recoveries. Therapeutic hypothermia is a fantastic reason for EVERYONE to keep a giant bag of ice in their freezer. Most stroke-related brain damage occurs due to delays in identification (calling 911) and treatment. So everyone should be able to identify strokes immediately, call emergencies services, and get their loved one's neck/head surrounded by bagged ice in less than a minute. Doing so could literally mean the difference between someone never walking/speaking again and being able to do all the things they love in life.

    February 18, 2020
    Reply
  33. nv.f said:

    Now that's a forced acronym…

    February 18, 2020
    Reply
  34. New Message said:

    "There are two main types of strokes"

    Well three, really.. Hemorrhagic, ischemic, and if you're into the NY rock scene, musical.

    February 18, 2020
    Reply
  35. Why not Dean said:

    That is the worst acronym I've ever seen.

    February 18, 2020
    Reply
  36. S. cloosive said:

    Aaaand I’m amazing 👌

    February 18, 2020
    Reply
  37. David Belen said:

    Hank is the freeking best, man. The whole freeking SciShow team are mad cool. Science is friken cool.

    February 18, 2020
    Reply
  38. Wayne Searle said:

    So time to induce strokes in non human primates?

    February 18, 2020
    Reply
  39. Kay said:

    I love learning about stuff I'll never be able to afford 😀

    February 18, 2020
    Reply
  40. MichiruEll said:

    Pronunciation guide: v-e-g-f, not veg-f 🙂 Otherwise fascinating research!

    February 18, 2020
    Reply
  41. FaerieDust said:

    The research around encouraging brain regrowth is really interesting and encouraging. A family friend had a stroke and ended up forgetting most of his languages (including the language of the country he's been living in for the past 30+ years, which is the only language his children speak, and one of the languages he's known from childhood). He's forgotten most people in his life, too – his entire extended family is just gone. No idea who people are, their names, nothing. A random stroke, no previous health issues…Strokes are freaking terrifying tbh.

    February 18, 2020
    Reply
  42. Dexy83 said:

    We are all 🧠 all the ⌚ lol

    February 18, 2020
    Reply
  43. Alex said:

    Future?? My grandpa was put in ice in the 1950s when he had a stroke. Not really futuristic, he?

    February 18, 2020
    Reply
  44. PuffTheCat Puff said:

    Pig man, or man pig.

    February 18, 2020
    Reply
  45. Alexi Xeno said:

    I feel like he was about to rickroll us….

    February 18, 2020
    Reply
  46. Mads Johnsen said:

    Jojo's Bizarre Stroke Adventure.

    February 18, 2020
    Reply
  47. TeslaElectrica said:

    When you say the 5% energy decrease do you mean for every degree in Celsius or Fahrenheit?

    February 18, 2020
    Reply
  48. Lord Grotesk said:

    So someday traumadocs may have a can of BrainSave that they can shake up, attach the appropriate injector nozzle, and shoot as a cryogenic foam into penetrating wounds of the cranium or during surgery that will provide thermal, structural, metabolic and medicinal support for the brain and stop people from dying like my mother did?

    …OK.

    February 18, 2020
    Reply
  49. Isak Hermansson said:

    Could the potential brain tissue regrowth also work for example Alzheimer's disease? You of course need to stop the disease first, but if we had a cure, could this then be used?

    February 18, 2020
    Reply
  50. Krystof Dayne said:

    I think the most realistic depiction I've ever seen of what medicine might look in the future comes from the sci-fi novel/TV series The Expanse. Things like this seem to already come close to what's depicted there.

    February 18, 2020
    Reply
  51. Darth said:

    Zoomers are going to be immortal

    February 18, 2020
    Reply
  52. SaucerJess said:

    💙💙💙

    February 18, 2020
    Reply
  53. SaucerJess said:

    Hemorrhagic stroke survivor here! I was 27 years old when an aneurysm in my right frontal lobe ruptured 💙

    February 18, 2020
    Reply
  54. Malavoy L said:

    Of course there is 'caffeinol' which lowers the 'lemming effect' message from dying brain cells which is saying 'hey, I'm dying, why don't the rest of you join me D~". Then there is the problem of whether that 'scaffolding' will be considered 'kosher' for those for whom that might be important. 🙂

    February 18, 2020
    Reply
  55. Erik Borg said:

    Hank, get some MDs on your team… This is more science fiction than science news…

    February 18, 2020
    Reply
  56. Ugandan Knuckles said:

    I'm always weak in my arms after masturbating, I get tired so my face gets weak and I have problems speaking after the deed is done.

    Confirmed, every time I ejaculate my brain tries to evacuate by committing sudoku through stroke.

    February 18, 2020
    Reply
  57. John Perez said:

    Hello! Neurology resident here. I love the channel and thanks for the video on therapeutic hypothermia (TH)! Let's give a little more nuance to this topic, though.

    First off, while the mechanism of action of therapeutic hypothermia lends it a lot of promise, clinical data has not been robust enough to support the use of TH in acute stroke. This has been echoed by the very source cited in the video [1]. As far as neurology is concerned, the only evidence-based situation where TH between 32°C-36°C is strongly recommended and proven beneficial is in cardiac arrest [2]. In fact, TH is standard of care in cardiac arrest (given some inclusion/exclusion criteria). There might be other uses for TH in other specialties, but I will defer that discussion to their respective experts.

    Second, "therapeutic hypothermia" has been replaced by the term, targeted temperature management (TTM). This change in terminologies was due to findings that in some cases, it's not hypothermia per se that's beneficial, but keeping temperature tightly controlled within a certain range using various methods. In the case of stroke (both hemorrhagic and ischemic), maintaining NORMOthermia has been proven beneficial and is part of standard of care [3].

    I doubt that TH is beneficial in hemorrhagic stroke as hypothermia induces bleeding and is in fact one of the things we watch out for in patients undergoing TH. This meta-analysis does not find TH beneficial in hemorrhagic stroke [4]. As for severe brain trauma, guidelines do not recommend TH [5].

    While it is really exciting to discover the theoretical underpinnings and experimental models of these potential treatments, we must still evaluate the clinical data available before we start recommending TH to our critically ill patients in the real world.

    Thanks, SciShow! Keep it up!

    [1] Almekhlafi M, Kuczynski A, Demchuk A. Therapeutic hypothermia: Applications in adults with acute ischemic stroke. Brain Circulation. 2019;5(2):43. doi:10.4103/bc.bc_5_19
    [2] Donnino MW, Andersen LW, Berg KM, et al. Temperature Management After Cardiac Arrest. Circulation. 2015;132(25):2448-2456. doi:10.1161/cir.0000000000000313
    [3] Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49(3). doi:10.1161/str.0000000000000158
    [4] Yao Z, You C, He M. Effect and Feasibility of Therapeutic Hypothermia in Patients with Hemorrhagic Stroke: A Systematic Review and Meta-Analysis. World Neurosurgery. 2018;111:404-412.e2. doi:10.1016/j.wneu.2018.01.020
    [5] Carney N, Totten AM, O’Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2016;80(1):6-15. doi:10.1227/neu.0000000000001432

    February 18, 2020
    Reply
  58. metroid 6464 said:

    All thanks to science and research.

    February 18, 2020
    Reply
  59. Riko Lime said:

    I was taught FAST stood for Face, Arms, Smile, and Talk. If their fave is droopy on one side or seems crooked, hold your arms out straight forward and if one is notably lower or wrong, have the person smile and look for a crooked smile, and have the person say a moderately difficult sentence and listen for slurring or confusion on words.

    My gramma had a stroke once after my granny passed. No one knew. She had no real symptoms other than she has slightly slurred speech. She cried a lot so she chalked it up to the tears, until my aunt made her go in, and they found out she had had a stroke.

    February 18, 2020
    Reply
  60. Fringes said:

    Therapeutic hypothermia have been proven to be really effective in preserving brain integrity especially from stroke, tbi, convulsion d/t fever or epilepsy and many other things.
    The problem is, is not as easily accessible and convenient in tropical 3rd world countries.

    February 18, 2020
    Reply
  61. Christy T said:

    I run cold (97.1°F) so maybe I won’t ever need to be made into a braincicle. Brrr!

    February 18, 2020
    Reply
  62. Ace Hardy said:

    📙💯

    February 18, 2020
    Reply
  63. First Last said:

    Hank, I don't like the new guy. Just letting you know.

    February 18, 2020
    Reply
  64. Ross Brubaker said:

    Very nice video. I wanted to let you know that in medicine, we generally pronounce the “VEG” of VEG-F they same way you pronounce the “veg” in vegetable.

    February 19, 2020
    Reply
  65. Beskamir said:

    Those FAST symptoms are only fully applicable for the majority of strokes. If you were to get a stoke in the posterior cerebral artery you wouldn't exactly exhibit slurred speech the say way that a stroke in the middle cerebral artery causes.

    February 19, 2020
    Reply
  66. Iron Bars Jack said:

    Why do these videos ALWAYS come out the SECOND I experience them??

    February 19, 2020
    Reply
  67. Leffer suck it said:

    So if My Friend has a stroke should i spray Cold water on his head?

    February 19, 2020
    Reply
  68. heliosphaere sonnen_wind_kind said:

    my father was cooled down after his heart had stopped. saved his life.

    February 19, 2020
    Reply
  69. Mika Peltokorpi said:

    This is called nutritional ketosis. I have continuous +34,0 °C … 34,5 °C body temp, fewerish: +35,5 °C … +36,0 °C.

    February 19, 2020
    Reply

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