1. Mediacrity said:

As I indicated in an item in my blog, Barak's scoop in IRIS was truly a world-class news beat -- that is no exaggeration. This is a sad time but he should be congratulated for doing the kind of shoe-leather work that didn't even occur to the MSM.

2. Per said:

Is this another conspiracy theory, telling us between the lines that there is a "doctor's plot" going on in Jerusalem, modelled on the one in Moscow in 1953?

3. DWPittelli said:

Conspiracy? No.
Incompetence? I think not that either.

This is an example where it's the special treatment given to VIPs which leads to their receiving bad care. Ordinarily a stubborn 77-year-old with a stroke would be sedated and essentially forced to relax, stay in a nursing home, not go to work, etc. But who can tell the stubborn head of state not to work? It's a constitutional difficulty, if not impossibility. And who's to say that Sharon was wrong, either? If relaxing meant losing power forever, and losing his new party, then the logic of his metaphorical game of Russian Roulette is unassailable -- assuming that the "real" (pre-stroke) Sharon was as interested in power as are most successful politicians.

4. MeTooThen said:

FWIW,

I am a neurologist with many years of expertise in stroke medicine.

I'm not so sure anyone can say what was negligent without knowing all the details surrounding Sharon's history and condition.

It sounds as if Sharon suffered what is known as a "paradoxical" embolus. In this case, an embolus originating in a leg (or pelvic) DVT (deep vein thrombosis) "paradoxically" entered the arterial circulation (instead of going to the lungs) through a patent foramen ovale, resulting in a minor (ischemic) brain infarction.

DVT's are by themselves not that dangerous, but those that embolize, as was the case for Sharon, can be deadly. The treatment of DVT's is based on anticoagulation, commonly referred to as "blood thinning" to limit further propagation and organization of the clot. In addition there is the option of placing a venous basket or "filter", so that if there are additional emboli, they won't travel to the lungs (or in Sharon's case to the brain pending closure of the patent FVO).

We do not know the status of Sharon's extracranial or intracranial vasculature. Sharon may have had flow limiting disease (stenosis) that would have increased his risk for stroke independent of the DVT and patent FVO. He may also have had small vessel occlusive disease; which is quite common.

As to the DVT itself, we do not know its size or composition; it may have had a friable appearance, again suggesting a high risk for reembolization.

In any analysis the need for anticoagulation here was almost absolute.

Now, as to the level of anticoagulation this is tricky. Even with careful monitoring there can be sudden and profound changes in the blood's coagulation levels that are unexpected and idiosyncratic. If no one was checking Sharon's coagulation indices, well that of course, would have been terrible negligence. It is possible though that he experienced abrupt and unpredictable changes in the blood after anticoagulation therapy had been initiated, inducing a coagulopathy, or blood clotting disorder.

But again, we don't know what happened.

One likely scenario is that Sharon suffered a sudden (and new) massive right hemispheric ischemic infarction, probably one involving the entire right internal carotid artery distribution, or one at the level of the right middle cerebral artery. And because of the stroke's size, it transformed into a hemorrhagic stroke. Or, that because of the underlying anticoagulation, the otherwise ischemic infarction converted into a hemorrhagic one more easily than it would have without the anticoagulation.

In any case, a stroke of this size would have been catastrophic, even potentially life-threatening without any attendant hemorrhage.

Another possibility is that the stroke was hemorrhagic from the start. This may have occurred because of an underlying and preexisting vascular abnormality, like a cerebral aneurysm or an arteriovenous malformation (AVM) that ruptured. Either the severe bleeding was due to the size and pressure of the rupture, or again may have been worsened by the above-mentioned anticoagulation. This possibility is made perhaps more likely as Sharon reportedly has suffered multiple episodes of rebleeding, suggesting a discrete source for the hemorrhage.

Injured brain tissue from any kind of insult will swell. Blood admixed with injured brain tissue often leads to massive and lethal swelling. I suspect that Sharon suffered brain herniation, or lethal swelling in the brain.

It is certain that Sharon has suffered permanent and irreversible brain injury. He may yet still survive, and if so, he will be disabled, almost certainly severely so.

But even if Sharon was in the hospital at the time of the stroke, whether ischemic or hemorrhagic, if the stroke was massive from the start, there is little else that could have been done to "save brain", as he was already on anticoagulation thus precluding his receipt of thrombolytic therapy and herniation can occur within minutes.

Furthermore, there are no data to suggest that "stress" or continued work raises the risk of recurrent stroke. Would it have been reasonable for Sharon to rest for several weeks following the first stroke? Yes, of course. Was it mandatory that he do so? No, especially given the unique circumstances he found himself in at this time.

5. Rajiv Singh said:

As a doctor (but not a neurologist), in general terms a haemorrhagic stroke is more devastating than a thrombotic one. In an anti coagulated person even more so. I do not know the nature of the first stroke. If it was thrombotic and so called "paradoxical" as noted above, he most certainly should have been anti coagulated and not to have done so at that time would have been serious negligence. Anticoagulation per se will NOT cause bleeding. For that to occur there MUST be a breach of blood vessel integrity. Once that happens however, the bleeding will catastrophic.

I have no doubt that he should not have returned to work so soon after his 1st stroke. Indeed there is footage about which i think shows that there was indeed physical effect and damage as a result of it. Facial expressions and the like. Most people with even a minor stroke would have been off work for at least 3 months to allow things to consolidate. Given that he was due for cardiac catheterisation for an atrial septal defect, he should have had this expedited and should have been under observation in the interim, possibly in a convalescent facility. He also should have been advised that his retirement had now become essential, for the good of the country even if not, for what I believe would be sound medical reasons.

Should he now survive, my guess is that it will be in a semi vegetative or full vegetative state.

We are dealing with a democracy here. there is no such thing as "Succession". This is not a dictatorship even though it sometimes looks that way. Government is not a one man show, again even though it sometimes looks that way. No one is indispensable.

There should be a compulsory retiring age for politicians like there is for everyone else. Peres, at 83? is seriously being considered a replacement ? Give me a break.