Lavinia Codd Stroke SurvivorWould you know what to do if someone were having a stroke? What if it were you, and you were 31? That's exactly what happened to Dr Lavinia Codd, who survived a stroke at 31 and went on to become a stroke researcher. 

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Transcript

[MUSIC]

Donna Lu

I’m Donna Lu, and welcome to A Grey Matter, the neuroscience podcast from the Queensland Brain Institute. In this our first episode, we’re talking about stroke.

Dr Lavinia Codd

I had a lot of trouble with faces, to the point where I would even memorise what my children were wearing before they went to kindy, so that I’d recognise them when I picked them up.

Donna Lu

That’s Lavinia Codd. She’s a post-doctoral research fellow in Professor Perry Bartlett’s lab, here at QBI. Her research focuses on an area of the brain called the hippocampus, which is important for learning and special memory. She’s a stroke researcher, and a stroke survivor.

Lavinia was 31 when she had a stroke.

Dr Lavinia Codd

I was at a ball, I’d had a headache for a few days which may have been one of the causative factors for my stroke, although that’s fairly uncommon to have a migrainous stroke. Somebody was giving a speech and there were some flashing lights, and that’s when I had the stroke.

So, I immediately felt quite weak, but that was about the only thing I noticed. I had trouble reading the menu, I couldn’t count how many fingers my husband was holding up, I was in a fair amount of pain so we decided to leave and we went straight to the hospital.

Donna Lu

Now you might be familiar with the Stroke Awareness Campaign run by the National Stroke Foundation. There’s a particular acronym they use.

Dr Lavinia Codd

F.A.S.T. So facial weakness, weakness in the arm, speech problems, and then obviously it’s time to go to hospital.

Donna Lu

What you might not know is that other warning signs of stroke include dizziness, numbness, and visual disturbances.

Dr Lavinia Codd

I didn’t have any of the classical sign – I had no facial weakness, no paralysis in my arms, I just felt unwell.

[FRENCH MOVIE SCENE PLAYS]

Donna Lu

That’s from the 2007 film The Diving Bell and the Butterfly, which was based on the memoir of the same name by Jean-Dominic Bauby. Bauby, who was editor-in-chief of French Elle magazine, suffered a stroke at age 43, which left him almost completely paralyzed, locked into his body. He dictated The Divind Bell and the Butterfly over a period of 10 months, and communicated solely by blinking his left eyelid. It makes for a really moving read.

But the thing about stroke is that while paralysis is a common result, it’s not the only outcome. As you might have realised, Lavinia sounds ‘normal’, so to speak. She doesn’t have slurred speech, and when you meet her, there are no visible indicators she ever had a stroke.

The reason she doesn’t have any motive deficits is because the area in her brain known as the motor-cortex was unaffected. The signs and symptoms depend on which area of the brain the stroke affects.

Dr Lavinia Codd

The different parts of the brain have different functions, and it’s really quite specialised. So, if cells in the motor-cortex die, then someone will end up with some form of paralysis, if cells in the hippocampus die, then they’ll end up with memory deficits. And then there are certain cells that are specialised in language, and there are sensory cells as well.

Donna Lu

So, what exactly is a stroke?

Dr Lavinia Codd

Stroke is classified as when there is a loss of blood supply at a part of the brain, and there are two forms of stroke – they can be haemorrhagic, or they can be ischemic.

Haemorrhagic strokes arise from say a rupture to an aneurism, so there’s a bleed in the brain, and an ischemic stroke is when there’s a clot in one of the arteries supplying blood to the brain. The reduction in blood supply means that the cells don’t have any access to blood or oxygen, and they die. 

Donna Lu

And how common are each of these types?

Dr Lavinia Codd

Haemorrhagic strokes account for about 20%, and ischemic strokes are by far more common, and there’s about 80% of those.

Donna Lu

Lavinia’s stroke was more common type – when there’s a blockage in a blood vessel.

Dr Lavinia Codd

I’d had a fairly large ischemic stroke that involved the occipital lobe, which is involve din vision, so consequently I couldn’t see on the left, although I wasn’t aware of that at the time. And then the right hippocampus, as well as the medial-temporal lobe. So, the hippocampus is involved in learning and memory, and the temporal lobe is involved, amongst other things, the part that I lost was involved in navigation, which explained my symptoms.

Donna Lu

According to a 2013 Australian Insitute of Health and Welfare report, the incidents of stroke increases markedly from about 65 years of age. But Lavinia is quick to point out that stroke shouldn’t be ruled out in young people.

Dr Lavinia Codd

Certainly age is one of the risk factors of stroke, but plenty of young people have strokes as well. You don’t have to have any predisposition to stroke – I didn’t have any of the predisposing factors. Obviously smoking, obesity and age increases your risk of stroke, but really stroke can occur at any time to anyone.

Donna Lu

At this point, I should mention the major interstroke study, which looked at the risk factors for ischemic and haemorrhagic stroke in 22 countries.

The study found that 10 risk factors accounted for 90% of the population at attributable risk for stroke worldwide. Risk factors included things like high blood pressure, physical inactivity, high waist-to-hip ratio, and smoking.

Unfortunately for Lavinia, she was in the other 10%.

When Lavinia experienced her symptoms, she and her husband went straight from the ball they were at to a hospital, but because of her age, she was misdiagnosed with a migraine and sent home.

Dr Lavinia Codd

I did get to hospital in time to have TPA, which is a clot-busting drug, but because of the misdiagnosis I wasn’t given that.

Donna Lu

Instead, she was given vasoconstrictors, which are drugs that further decrease blood flow, which wasn’t helpful in her case. She returned to hospital a few days later when her symptoms still hadn’t resolved.

Dr Lavinia Codd

There was nothing really they could do for me, the damage had been done, because os many days had passed since the stroke. All they could do was pain relief, and I was sent home. There was actually nothing they could do. I couldn’t have a speech therapist because I didn’t have speech problems, I couldn’t see an OT (occupational therapist) because I didn’t have any paralysis, or a physio, so it was pretty much ‘get better on your own’.

Donna Lu

Part of Lavinia’s recovery involved a career change from chartered accountant, to neuroscientist.

Lavinia Codd

When I stopped work to have my first child, I came back to uni, because really as a hobby, and so I started a science degree because I’d always been interested in science. It was a fabulous experience – I loved starting the science degree, it was great.

Unfortunately, part way through what is effectively first year, although because I was doing it part time I’d been going for a few years, is when I had the stroke. Up until that point I’d been really interested in plant biology. After the stroke, so I didn’t come back to uni for a year, when I did come back, I actually concentrated mainly on psychology subjects, because my neuropsychologist had been such a help to me, and I was interested in the brain.

Because I was doing fairly well, I was offered a place in the Advanced Studies in Science program. As part of that program, I needed to find a mentor, which prompted me to look at all the professors at UQ, which is when I found Perry. QBI was only recently started, we were still in the old building at that stage. I met with Perry and he was very keen to have me on board, and he’s been very supportive all the way through my recovery, in fact I’m fairly sure he has no idea how much of my recovery happened in his lab.

Donna Lu

Over a decade later, Lavinia has completed a PhD in Neuroscience, and is now dedicated to researching the treatment of stroke.

Dr Lavinia Codd

There are several ways that we can tackle stroke research as scientists.

Obviously preventing stroke is an important avenue of research, but unfortunately, as in my own case, many strokes aren’t actually preventable.

Another way of approaching stroke research is neuroprotection. So when someone has a stroke, there is a lot of investigation into identifying molecules that help reduce the size of the resulting legion. So trying to make the stroke as small as possible, and therefore having the least amount of affect on the individual. Unfortunately, those molecules tend to be needed to be given fairly soon after the stroke, so like with the clot-busting drugs, you really have a short period of intervention.

So what I’m interested in is actually promoting recovery from stroke at a later time point. And the avenue that we’re investigating is neurogenesis. So, neurogenesis is the production of new brain cells, new neurons, and it actually occurs naturally throughout our entire lifespan. There are several parts of the brain that are actively engaged in neurogenesis, all the way through our lifespan, and the hippocampus is one of those. As I mentioned before, the hippocampus is involved in learning and memory, and it is a site of this ongoing neurogenesis. The Bartlett group has been particularly good at identifying several methods by which we can stimulate this ongoing endogenous neurogenesis. So it’s a naturally occurring process, and we’re just attempting to increase the level of new neuron production, with the hope this will have an impact on function.

And then there is some data that suggests the rate of neurogenesis does change in various situations, and this does impact on leasrning and memory function of the hippocampus. So, I’m looking at creating a stroke in the hippocampus in a mouse model, and then treating the animals in an attempt to stimulate neurogenesis and hopefully improve recovery of function.

Donna Lu

Lavinia’s symptoms have improved after the first few years of her stroke. Her left field of vision is permanently gone, but she has central vision, and everything on the right. Initally, she had to give up her driver’s licence, but was able to drive again a year later. These days, she says she still has difficulties with spatial memory, and gets lost easily. This is what she said when I asked her about the effect of a stroke on her two kids.

Dr Lavinia Codd

They do remember – well, Sam doesn’t remember, but Zoe remembers coming to hospital and visiting me, and I think that was fairly daunting. But as long as they’ve known me effectively, I’ve had these deficits. They notice now when I get panicked, because I do panic when I get lost if I’m driving, it annoys them a lot. [laughs]. But that’s life – they’ve got to deal with that.

Donna Lu

If you’ve suffered from a stroke, or know somebody who has, this is Lavinia’s message.

Dr Lavinia Codd

Recovery from stroke happens forever. It doesn’t just happen in the first year after the stroke like we’re told, it happens for the rest of your life. So although a lot of my recovery did happen in the first couple of years following the stroke, I’m still recovering today, and I fully intend on recovering for the rest of my life. So, even though it might feel like you’re not progressing very far, it does accumulate over time, and people do get better.

Donna Lu

That’s all for this episode. Let us know what you think or if you have any requests for future podcasts. We’re on Twitter, @qbi_uq, and on Facebook. Or, you could give us a review on iTunes. Thanks for listening.