John Quincy Adams
John Quincy Adams, the sixth President of the United States, had a traumatic right brachial plexus injury as a child but was otherwise neurologically intact until he suffered his first stroke at the age of 79. On November 10, 1846, Dr. George Parkman was escorting him on a tour of the Harvard School of Medicine when he collapsed and became unresponsive. He regained consciousness and made a near-total recovery. Adams' family doctor, John Bigelow, diagnosed a slight stroke.
On February 21, 1848, he suffered his second and final stroke. Adams attempted to address the Congress on the Mexican War. After he arose, he fell into the arms of a colleague. His consciousness waxed and waned, and he died on February 23, 1848.
John Tyler, the tenth president, was in poor health throughout most of his life. Lacking confidence in the medical profession, Tyler chose to relieve his ailments by homeopathic means. He developed intermittent bouts of dizziness and vomiting. They were so frequent that he chose to ignore them. In January of 1862, Mr. Tyler was staying at the Exchange Hotel in Richmond when he felt dizzy, nauseated, and vomited bile. Later, he went down to the hotel dining room for a cup of tea to alleviate his symptoms. There he slumped to the floor, unconscious. Tyler eventually regained consciousness and was ordered to strict bed rest. On January 17, 1862, he awoke gasping for air and, shortly thereafter, died. Retrospectively, the bouts of dizziness may have been recurrent posterior circulation transient ischemic attacks (TIAs).
Millard Fillmore, the 13th president, never drank nor smoked. His one identifiable stroke risk factor was obesity. After his morning shave on February 13, 1874, Fillmore suffered his first stroke. His left hand dropped to his side, powerless. Paralysis continued to spread to the left side of his face and then to the larynx and pharynx. He showed some short-term recovery, but two weeks later another stroke completely paralyzed his left side, and he had severe dysphagia. Millard remained bedridden and showed minimal recovery before he died on March 8, 1874.
Andrew Johnson, the 17th president, reportedly drank mint juleps and whiskey. Some believe that his inauguration speech was rambling because of ethanol intoxication. On July 30, 1875, he suffered a fatal stroke. He was visiting his daughter's family. They had finished lunch, and he retired to an armchair. As he sat in the chair, he and his granddaughter spoke. She turned to leave the room. Before she reached the door, she heard the sound of Johnson falling to the floor. He was initially conscious and had left hemiparesis [paralysis]. The family was forbidden to call a physician. The following day, the stroke paralyzed his entire body, and he lapsed into unconsciousness. His family notified a physician. The recommendation was to bleed Andrew Johnson. He died two hours later.
Chester Alan Arthur
Chester Alan Arthur, the 21st president, was obese, consumed fine wines and after-dinner liqueurs, and led a sedentary lifestyle. He was diagnosed by the Surgeon General as having Bright's disease. During his term, his health deteriorated. In early 1886, he developed heart trouble. He had a massive cerebral hemorrhage and was found in bed on the morning of November 17, 1886, unconscious and with left hemiparesis. He died the next day.
Thomas Woodrow Wilson
Thomas Woodrow Wilson, the 28th president, was born in 1856 and died in 1924. In his early childhood, he was prone to illness. The stress and activities of school overwhelmed Wilson, and he suffered a total collapse in the winter of 1880. Problems with abdominal discomfort and prolonged headaches beset him at the University of Virginia and followed him throughout his life. Freud, et.al., documented 14 times during his career when nervousness, dyspepsia, and headaches became severe enough to interfere with his work. In 1906, Wilson went blind in his left eye. The visual loss was a result of an ophthalmic artery thrombosis.
While attempting to rally the electoral votes to enter the United States in the League of Nations, Wilson suffered an aphasic TIA followed by a stroke. On September 25, 1919, Wilson was in Pueblo, Colorado, addressing an audience. He stumbled on the steps of the entrance to the Memorial Auditorium. His voice was not strong, but he did well until suddenly he stumbled over a sentence: "Germany must never be allowed ..." He stopped and was silent. "A lesson must be taught to Germany...." He stopped again and stood still. "The world will not allow Germany ..." This likely represented speech arrest from a dominant hemispheric TIA. Wilson was noted to have cried during the speech. This was distinctly unusual for him, and the tearfulness may well have been an outward indication of his awareness of neurologic deficit. It is conceivable that Wilson had mixed hemispheric dominance. He was an ambidexterous child who was late in developing language and probably had dyslexia.
He complained of an intense headache later that evening. The next morning when he awoke, he got up to shave. When he returned from the bathroom, saliva came down the left side of his mouth, and the left half of his face was fallen and unmoving. His words were mumbled and indistinct. He was unable to move his left arm and leg.
He gradually regained some of his motor function, but had lost some mental faculties. He saluted empty sidewalks. On October 2, 1919, the President's wife, Edith, recounts in her memoirs that she found the president trying to reach a water bottle beside his bed. When she handed it to him, she noted his left arm was limp and he complained of numbness in his left hand.
The president remained bedridden in the private wing of the White House. His physician, Cary Grayson, never commented on the president's disability. Many historians suspect that Wilson's wife was the acting president during his convalescent period. By the end of the month, he could again sign his name. On his last day as president, he walked to the executive wing of the White House for the first time. Wilson said he had no feeling in his left hand. Edith went to call a doctor and returned to find her husband unconscious on the bathroom floor. He died three years later on February 3, 1924.
Franklin Delano Roosevelt
Franklin Delano Roosevelt, the 32nd president, was plagued with poor health. At the time of his birth, his mother had an overdose of chloroform. He was blue at birth and without respiratory effort. Mouth-to-mouth ventilation had to be performed. While vacationing with his family at Campobello in July of 1921, he contracted poliomyelitis. Two weeks later he was left paraplegic. After long years of physical rehabilitation, he became able to support himself on crutches.
Roosevelt went to great lengths to hide his handicap from the public. Photographers were forbidden to take pictures of Franklin while he was in his wheelchair. Despite his attempts to mask his illness, it became common knowledge. The public was concerned with his physical limitations and its impact on his ability to perform the responsibilities of a president. In 1931, he released details of a medical examination to counter negative press. His blood pressure was 140/100 at that time.
In addition to years of cigarette smoking--against medical advice--Roosevelt was plagued by gradually worsening hypertension. His blood pressure rose from 136/78 in 1935 to 188/105 in 1941. In 1943, his personal physician arranged for a complete medical examination at Bethesda Naval Hospital. Among the findings were a blood pressure of 186/108, a fundus-copic examination consistent with arteriosclerosis and hypertension, bibasilar rales, cardiomegaly, and an apical systolic murmur. His EKG showed T-wave abnormalities, and a chest radiograph showed pulmonary congestion and cardiomegaly. He was placed on digitalis, a salt-restricted diet, and given codeine. By early May of the same year, his readings were 240/130. He began to complain of a dull pain in the back of his neck associated with a throbbing sensation throughout his body.
The president sat for a sketch on March 29, 1945. That afternoon he complained for a severe occipital headache. His physician arrived 15 minutes later and found him unconscious and sweating profusely. His pupils were initially equal, but a few moments later, the right became fixed and dilated. His blood pressure was 300/190. He was pronounced dead of a massive cerebral hemorrhage two hours later.
Dwight David Eisenhower
Around 2:23 p.m. on November 25, 1957, Dwight David Eisenhower, the 34th president, suffered a stroke resulting in expressive aphasia. Mrs. Ann Whitman, his personal secretary, noticed that the president was having difficulty with his speech and inclining a little to one side when he walked. She telephoned the president's personal physician, Gen. Howard Snyder, who found the president trying unsuccesfully to dictate a letter. Snyder reported that the president "kept repeating the name `Jones,' and Andy (Brig. Gen. Andrew Goodpasture) would say, `W. Alton Jones?' and attempt to further express himself but could only verbalize disconnected words."
Snyder recounted what the president was told of his illness. "He said, `Did I have a small ... small ...' but could not utter the next word he wanted to say. I asked him did he mean `a small stroke,' and he said, `Yes,' I replied that we would not at this time state that he had a stroke, but that at least he had a vascular spasm of a small artery in the brain." At 8:15 p.m., Snyder gave the president a grain and a half of Seconal. Eisenhower said, "My God, Howard, look at the time. How long will these last?" to which Snyder replied, "It doesn't make any difference. I am going to keep your doped tonight." Snyder notes that anxiety plays an important role in determining the functional deficiency of individuals with organic brain disease." In addition to sedation, the president was maintained on anticoagulation.
Dr. Houston Merritt and others found that the president's only disability after 24 hours was hesitancy in saying difficult words, but that reading, writing, and reasoning powers were spared. The president's attending physicians and consultants concluded that there was no relationship between the stroke and the president's previous heart attack.
Richard Milhous Nixon
Considerable detail can be found on the stroke and death of the 37th president in a series of articles published in the New York Times between April 20-23, 1994.
Mr. Nixon suffered a stroke on the night of April 18, 1994, and was taken by ambulance to New York Hospital. He suffered from chronic atrial fibrillation and had been on warfarin for stroke prophylaxis. His initial computed tomography (CT) of his brain was normal. He reportedly was considered for enrollment in a clinical trial of stroke therapy, but his doctors declined because of "concerns over his heart." A follow-up head CT showed an infarct involving the dominant middle cerebral artery territory. His stroke was complicated by postinfarct edema. Nixon had an advanced directive that he wanted no extraordinary measures taken, and in accord with this advance directive, he was not mechanically ventilated. He died at 9:08 p.m. on April 22, 1994.
Gerald Rudolph Ford
Gerald Rudolph Ford, the 38th president, suffered a stroke while attending the Republican National Convention in Philadelphia. On Tuesday, August 4, 2000, the 87-year-old former president began to slur his speech while giving an interview to television reporters. Lee Simmon, Ford's part-time special assistant, who witnessed his boss on television, commented to his wife that he thought the president had had a stroke. The president was hospitalized the next day with dizziness, slurred speech, and arm weakness. Imaging studies confirmed the presence of two brainstem strokes. Dr. Robert Schwartzmann, chief of neurology at Hahnemann University Hospital, told the press that the president was cognitively intact and that he would likely make a full recovery.
The president's illness demonstrates that even relatively mild stroke symptoms may be noticeable to the viewing public. Perhaps because stroke is common and public, it is not a highly stimatized disease. Advances in diagnostic procedures like brain imaging have allowed for confirmation of the diagnosis of stroke even when symptoms may be mild or when symptoms overlap with other common diseases.
It is becoming routine for patients who think that they may be having stroke symptoms to present promptly to their local emergency department. Not all patients who present acutely to their local emergency department will qualify for treatment directed at dissolving "blood clots" in the brain. However, patients who present acutely can be quickly started on medication that minimizes the risk of recurrent stroke.
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