How a stroke affects someone is different for everyone. One stroke may be so sever the patient will need to be cared for in a critical care unit. The patient may not survive. If the patient survives, there may be permanent disability. Recovery may take a long time.
Another stroke may be so mild that the patients is able to go home from the hospital within a day or two. The effects from the stroke may be minimal, or there may not be any lasting effects at all.
Each area of the brain is responsible for different functions. The effects of a stroke will depend on which area the stroke occurred in. It will also depend on how much of the brain was involved.
The problems seen will also depend upon which side of the brain the stroke occurred in. For example, the right side of the brain controls movement and sensation on the left side of the body. So, a stroke that occurs in the right side of the brain will affect how the left side of the body moves or feels.
Since the left side of the brain controls movement and sensation on the right side of the body, a stroke occurring in the left side of the brain will affect how the right side of the body moves or feels.
A person who has had a stroke may act differently than he or she did before the stroke. This will depend on which part of the brain was affected, and how severe it was. A patient who had a stroke on the left side of the brain will act differently than a patient who had a stroke in the right side. It is important to remember that the changes are caused by the stroke, and may lessen or resolve over time.
Left hemisphere stroke--if the stroke occurred in the left side of the brain, the person may tend to be slow and cautious. Disorganization or hesitation may occur when trying new tasks. A person with this type of behavioral style may need guidance dong common tasks. They need positive feedback and what they are doing is okay.
Right hemisphere stroke--a person who has a stroke on the right side of the brain may have difficulty judging distance, size, position, speed of movement, and how parts relate to wholes. He or she may act impulsively, or too fast and may tend to overestimate their abilities and try to do things they cannot. He or she may act as if they are unaware that there are any problems. This behavioral style could cause an increased risk for falling or bumping into things. He or she may have difficulty dressing or picking up objects, and it would most likely be unsafe to drive a car. Checking how well the person with a right brain injury can actually do certain tasks will provide a more clear idea of how safe the person will be doing things on their own. They will also need encouragement to slow down and carefully check each step as it is completed.
Bowel & Bladder
A stroke may sometimes cause a decrease in sensation and control of the bladder. This may lead to the person experiencing frequency and/or urgency with urination, or possibly incontinence. In some cases, especially if the stroke has occurred in the brainstem, there may be total loss of bladder control. Bowel control and constipation may also be problems following a stroke. Bowel and bladder problems after stroke are often temporary and can be helped by your rehabilitation team.
We don't think about breathing, we just do it automatically. Things that we do automatically are called involuntary. Breathing is an involuntary action. We don't think about it, but a part of our brain controls it.
The brainstem is the part of the brain that controls our breathing. It is also responsible for other vital life support functions such as blood pressure and heartbeat. And, it controls sleep and wakefulness, as well as other reflexes. A stroke that occurs in this part of the brain is usually very serious. It may cause changes in the patients breathing rate and rhythm. The breathing may be too shallow, or it may be irregular.
Some patients are too sleepy to handle their saliva. They may not swallow well. This can affect how well they do with their breathing. Assistance may be needed from the medical staff. A breathing tube or airway may be inserted into the throat or nose to help the patient breathe better. A ventilator, or breathing machine may also be needed. The medical staff will suction saliva and sputum out of the breathing tube or airway to help keep it from plugging up. This will help to prevent choking and to keep fluid from going into the lungs.
The brain is responsible for all of our cognitive or intellectual functioning. Cognition refers to the way a person thinks, learns, and remembers. A person who has had a stroke may have problems in any of these areas. The stroke may also affect the patient's ability to judge and reason and understand, as well as to concentrate and plan.
Problems with cognition may not be seen right away. They may become more noticeable when the patient begins to do things on their own. A formal evaluation by a neuropsychologist may be useful in determining the extent of the problem. Therapists can help with the re-learning process. Cognitive retraining is important so that the patient can function as safely as possible once they return home.
Since the left side of the brain controls speech and language abilities for most people, it is more common to see problems with communication in a person who has had a stroke in the left hemisphere of the brain.
Language problems caused by an injury to the brain is called an aphasia. The patient with aphasia usually has a total or partial loss of the ability to understand to to use words. The patient may have difficulty finding the correct word. He may use the wrong word altogether. He may not be able to get the word out at all. This is called expressive aphasia. The patient has trouble expressing himself.
Sometimes a patient with aphasia has difficulty understanding what is being said. This is called receptive aphasia. Reading, writing, and arithmetic are also areas that the patient may have difficulty with. If a patient has expressive and receptive aphasia, this is called global aphasia.
Speech problems can range from mild to severe, and can cause much frustration to patients and families. A person who does not understand this problem may thing the patient is confused. Patience and understanding are very important when trying to communicate with the patient who has this problem.
A speech pathologist is a valuable resource for the speech-impaired person. After testing and evaluating the extent of the problem, appropriate suggestions and recommendations are made. Therapy is then begun to aid recovery.
Coordination & Balance
The cerebellum is the part of the brain responsible for coordination and balance. If this area of the brain was affected by the stroke, the patient may have problems in these areas. Fine motor tasks may be difficult. Movements may be jerky and uncoordinated. Performing daily cares, eating, and writing are all tasks that may be affected.
A stroke that occurs in the cerebellum may also cause the patient to have a staggering, unsteady gait. Balance may be impaired or difficulties incurred by changing positions too fast. Assistance with walking and daily cares may be needed until the patient learns to adjust to this problem, or until the problem resolves.
Recovery and rehabilitation can be a long process, lasting weeks, or months, or years. Getting used to a new or different lifestyle may be difficult for some. It is not uncommon to have periods of sadness and depression, as long as they are not too deep or too prolonged. If the depression continues for a long period of time, the physician may suggest therapy or medication to help with this problem.
A person who has had a stroke may laugh or cry inappropriately or for no clear reason. This loss of emotional control can be confusing or upsetting to the patient, as well as to family or friends. This is a result of the stroke and usually does not last a long period of time. The person may also show signs of fear, hostility, frustration, and anger, which may lead to withdrawal and isolation. Much support is needed from family and friends, as he or she may at times feel like the situation is hopeless.
The patient may have problems with sensation, such as numbness of the face, arm, or leg on one side of the body. The patient's ability to feel touch, pain, pressure or temperature may be affected. A patient with decreased sensation is at risk for hurting himself. He may not be able to feel pain from being in one position for too long. He or she may not be able to feel pain from being in one position for too long, pressure from objects on the skin or distinguish between hot and cold.
Extra precautions must be taken to prevent the patient from injury. Changing positions on a regular basis will help to prevent pressure areas. Assistance may be needed with this if the patient is unable to help him or herself.
Sometimes the muscles that help a person swallow are affected by a stroke. This may cause problems with swallowing or dysphagia. The patient may cough or choke when eating or drinking. The patient may also pocket food in one side of the mouth without even knowing it. Close attention to this problem is needed to prevent food or fluid from being aspirated, or going into the lungs, and causing pneumonia.
Special swallowing tests are done to see how bad the swallowing problem is. A speech pathologist will help to make recommendations for any dietary restrictions or guidelines, if needed.
If the patient's swallowing problems are severe, it may be advisable for the patient to not take any food or liquid by mouth. The risk of aspirating may be too high. A feeding tube, inserted into the patient's stomach through the nose, may be needed. This will help to provide adequate nutrition until swallowing function returns.
The visual pathways begin in the back of the brain and travel to the front. Since they go through so much of the brain, it is not uncommon for vision problems to occur as the result of a stroke. Problems with vision can be very devastating to the patient who had normal or near-normal vision before the stroke.
Common vision problems caused by stroke include:
- Total loss of vision in one or both eyes.
- Partial loss of vision in one or both eyes.
- Loss of vision in half of the visual field--the patient may not see anything on one side.
- Double vision--the patient sees two of everything.
- Blurred vision
- Loss of the corneal (blinking) reflex-- the patient is unable to blink, or to close the eye completely.
Assistance from therapists and nursing staff will help the patient to adjust to this new problem. Food items may have to be place on one side of the table if the patient is having trouble seeing to one side. He or she may need to be reminded to turn their head from side to side to see everything.
An eye patch worn over one eye is often useful for patients with double vision. This can be used until the problem lessens or resolves.
If the patient has lost the blinking reflex, lubrication and eye protection may be needed to protect the eye from becoming too dry or from being scratched.
One-sided neglect is a problem that is associated with visual field impairments. It occurs more frequently in patients who have had a stroke in the right side of their brain. A person with one-sided neglect ignores or does not acknowledge objects or people to one side of him or her. The patient may not recognize his or her own arm or leg on one side of the body and think that it belongs to someone else.
Special adjustments may need to be made to help the patient become more aware of their entire surroundings. Using the "scanning" technique (turning the head from side to side) to be sure that both sides of the entire area are seen is one thing that the patient can be taught to do to help adjust to this problem.
Weakness or Paralysis
A person who has had a stroke may experience weakness or paralysis of the face, arm, and/or leg on one side of the body. This may cause problems with walking, eating, dressing, and other activities. Simple, everyday tasks may become difficult, and can be a cause of much frustration to the person who has had a stroke.
Getting started early with physical and/or occupational therapy programs will help the patient to get stronger and assist in getting the movement back. The special exercises will be important to aid in the recovery from or adaptation to these problems.
Apraxia is a type of movement problem that is not caused by weakness or paralysis. The person with apraxia may have difficulty performing a learned task. This happens because the brain is unable to produce the correct motor planning to carry out the task spontaneously, without thinking about it, but when asked to do the same task he is unable to complete it. Patients with apraxia will need help re-learning certain skills. Therapists and nursing staff can help. Family and friends can help by being patient and understanding. They should provide encouragement whenever possible.
Tests & Diagnostics
CT Scan. A very specialized and detailed X-ray. This is a sensitive study to check for signs of a stroke. It can also be sued to check for other problems that may cause stroke-like symptoms such as bleeding around the brain, tumors, cysts, and infections. Sometimes to make the picture clearer, a dye is injected into the patient through a vein. Other than a possible needle stick, a CT scan is painless and poses very little risk to the patient.
MRI. A specialized scan used to view internal organs. This computer technology is especially good at viewing the brain and spinal cord. The MRI shows the same information as the CT scan, but it may be more detailed and more sensitive for signs of a stroke. The test is not painful, but the patient must remain still and relaxed during the scan.
Carotid Duplex. This study examines blood flow through the carotid arteries (in the neck and brain) using an ultrasound machine. The carotid arteries are the major blood vessels carrying blood to the brain. This test can help to determine if there is any narrowing or blockage of blood flow to the brain. Carotid duplex is painless and poses no risk to patients.
EKG (electrocardiogram). This test measures the electrical activity of the heart. It is useful in looking for rhythm abnormalities such as atrial fibrillation, which is a risk factor for stroke. It can also detect signs of a prior or current heart attack. It is performed by attaching a series of patches and wires to the chest. EKG is painless and poses no risk to patients.
Echocardiogram. This test is an ultrasound of the heart. It uses sound waves to produce and record images of your heart. These images help to find abnormalities of heart muscles or valves, and fluid around the heart. Any abnormalities with the heart can increase the risk for stroke. Echocardiogram is painless and poses no risk to patients.
Transcrainial Doppler. This test uses the ultrasound machine to measure flow rates of blood through major brain arteries. This is done to look for blockages of blood flow to or in the brain. Transcranial Doppler is painless and poses no risk to patients.
Cerebral Angiogram. This test provides information about the blood circulation in the brain. A small tube, or catheter, is threaded into a main artery in the leg until it is in position above the heart. A dye is injected through the catheter into the arteries in the neck and brain and x-rays are taken. This test can help identify problems with the major blood vessels of the neck and brain. Numbing medicine is used where the catheter enters the body, but there may still be some minor discomfort with this test.
Brain cells usually die within minutes to a few hours after the stroke starts. Other brain cells in the area of the stroke may also be affected, but have a chance of being saved. The ability for these surrounding brain cells to recover will depend on the type of treatment received and how soon it is obtained. Physicians now believe that early stroke treatment is most effective when the person is able to get to a hospital in less than 4 hours of the onset of symptoms.
Thrombolytics. (Clot-busting or clot-dissolving drugs). These help to restore blood flow to the brain and prevent or lessen the damage by dissolving the clots. For maximum benefit, it must be given within a certain timeframe after the stroke symptoms start (generally about 3 hours). TPA or tissue plasminogen activator is one example of this type of medication. It has been shown to be effective in improving recovery after stroke. Patients must meet certain criteria to be eligible for TPA.
Antiplatelets (such as aspirin). These help to prevent blood clotting by preventing platelet function. Platelets are the part of the blood that have the capability of sticking to each other or to parts of the vessel wall, causing clots to form. There are several antiplatelet medications available. Some may have minor side effects. These should not be used without your doctor’s recommendation.
Anticoagulants (such as Heparin and Warfarin). These work to delay blood clotting. They do this by interfering with the production of certain blood components that are necessary for the formation of blood clots. They tend to work by slowing down the blood clots from getting larger. This helps to prevent the current stroke from getting worse. It also helps to prevent new strokes from occurring.
Antihypertensives (high blood pressure medication):
When used for stroke prevention: Studies have shown that lowering blood pressure to normal ranges can greatly decrease the risk of stroke. There are several antihypertensive medications available. Each work in different ways and have various side effects.
When used for acute stroke treatment: Adequate blood flow to the injured brain during a stroke is very important. So it is often necessary to allow blood pressure to run higher than normal during the first days after stroke. This is done so that oxygen and nutrients can reach the affected areas of the brain.
Experimental/research medication. Several different types of medications are being tested for their effectiveness in stroke prevention and treatment. Certain criteria must be met before patients may be considered for any of the research studies in progress.
Other treatments for stroke:
Maintenance of blood chemistry. Further injury to brain tissue after stroke can be limited by control of blood chemicals such as magnesium, calcium, glucose, and sodium. Monitoring of blood chemistry may be ongoing until the physician recommends otherwise.
Supportive measures. More patients die from complications of stroke than from the stroke itself. High quality patient care with careful attention to known stroke complications (such as respiratory difficulties, lung infections, or blood clots in the legs) and early rehabilitation efforts have been shown to improve recovery and increase survival.
Surgical intervention. The carotid arteries, located on each side of the neck, are the main arteries that supply the brain with blood. Over time a build-up of fatty deposits may occur in these arteries and cause a narrowing or blockage. If the blockage is severe enough, it may cause a stroke by preventing the passage of blood up into the brain. An operation called a carotid endarterectomy may be recommended to remove the blockage and reduce the risk of having a stroke or stroke symptoms.
Other types of treatment involve removing blood clots or arteriovenous malformations. Clipping or coiling aneurysms to prevent further bleeding, and placing stents inside narrowed blood vessels may also be suggested or recommended.