A severe interruption in the brain, depriving tissue of essential nutrients and oxygen can lead to a serious lack of blood supply, causing a stroke. In a matter of minutes, cells and tissues in the brain begin to die and the risk for permanent brain damage increases dramatically. For this reason, a stroke is considered a medical emergency. Early action and immediate medical attention can help save a life or reduce the risk of serious brain damage and other complications.
During a stroke, a person loses the ability to speak and control their own movement, as well as displays a lack of perception. A person has virtually no control over their own bodily or mental functions, and may also lose consciousness.
A stroke occurs in one of two main forms – an ischemic stroke (wherein blood flow is blocked by blood clots or narrowed blood vessels in the brain) or a haemorrhagic stroke (wherein a weakened blood vessels bursts or ruptures, causing bleeding in the brain). Both forms of stroke are considered life-threatening with severe consequences.
How quickly a person having a stroke is tended to by medical professionals, as well as the severity (i.e. how long blood flow to the brain was disrupted) determines whether damage will likely be temporary or permanent. The sooner warning signs are tended to, the better for avoiding serious damage to the brain or causing severe disability, and the better the chances of recovery.
Are there different types of stroke?
The different types of stroke are dependent on the specific cause – is the underlying reason because blood flow has been blocked by blood clots or has a blood vessel ruptured?
Blood vessels or arteries which supply blood to the brain narrow or experience a blockage. Blood clots can severely reduce blood flow, causing a life-threatening situation within a matter of minutes.
The most common types of ischemic stroke are:
- Thrombotic stroke (a blood clot forms in the arteries): A thrombotic stroke is often caused by plaque or fatty deposits which have accumulated in the arteries and result in a blockage known as atherosclerosis.
- Embolic stroke: A blood clot, known as an embolus or other form of debris forms elsewhere in the body, such as the heart and when moving through the blood stream causes a blockage to the blood vessels supplying the brain.
- Transient ischemic attack or TIA: This type of stroke is sometimes referred to as a mini-stroke. Blood flow to the brain becomes blocked for less than 5 minutes. Symptoms as a result of the blockage are temporary and appear to ‘resolve’ within a handful of minutes without a seemingly damaging effect. A TIA is considered a serious form of stroke as well and shouldn’t be taken lightly. In most TIA cases a blood clot is responsible for causing the blockage and serves as a warning for a possible major stroke down the line. It is strongly advisable to seek medical attention for a TIA, as you would for any other major stroke. Arteries may be partially blocked, which places a person at higher risk for a more serious stroke at any stage. A partial blockage can still cause damage to the brain.
Leaking blood from a ruptured artery in the brain can cause excess pressure in the skull. This pressure can lead to swelling and severe damage to cells and tissue as blood accumulates in the tissues surrounding the brain.
Types of haemorrhagic stroke that occur include:
- Intracerebral stroke: When an artery ruptures, tissue surrounding the brain fills with blood, often as a result of high blood pressure, vascular malformations, use of blood-thinning medications, and trauma.
- Subarachnoid stroke: Bleeding occurs between the brain and tissues surrounding it and is typically associated with a sudden and intense headache. A small sack-shaped pouch on an artery (an aneurysm) ruptures, causing blood vessels to widen and narrow erratically, which leads to the rupturing of the blood vessels during a subarachnoid haemorrhage stroke.
Hypertension (uncontrolled high blood pressure), aneurysms (weak spots in the walls of blood vessels) and overtreatment with anticoagulants (blood thinning substances) are often underlying causes of a haemorrhagic stroke. Less common causes include arteriovenous malformation (a rupturing of a blood vessels which are abnormal or thin-walled), which is often present at birth.
Causes of stroke explained
An ischemic stroke (caused by blockages of blood vessels or arteries) develops gradually and can be as a result of years’ worth of plaque build-up (blockage within the arteries). A clot may either be stationary, having formed on the spot (known as a thrombus) or as a result of an accumulation of plaque, blood and other debris which formed elsewhere in the body and has travelled through the blood stream to the brain (known as an embolus).
Blood flow may become sluggish and can sometimes result in clots having formed because of other health problems, such as an irregular heart rhythm (atrial fibrillation).
Haemorrhagic strokes are caused by bleeding in the brain as a result of aneurysms and ruptured arteries due to long-term damage, such as that from high blood pressure.
The most common underlying causes of ischemic or haemorrhagic stroke include:
- Heart disease
- High blood pressure
- High cholesterol levels
- Type 2 diabetes
- Excessive alcohol consumption
- Use of stimulant (or illicit) drugs, such as anabolic (muscle enhancing) steroids, cocaine and amphetamines
Signs and symptoms of stroke
The nature of a stroke means that swift action must be taken to ensure that medical attention is given to someone experiencing a stroke as soon as possible. Any sign of a stroke is an emergency situation. Being well aware of what to look out for or be aware of is vitally important.
It’s just as important to know the length of time a person experienced symptoms, as it is to know what warning signs to look out for. Many symptoms appear to develop suddenly (although they have been developing gradually, it’s possible to only notice signs in someone else or yourself when they’re at their peak).
The most common signs of stroke are:
- Confusion or difficulties with thinking and understanding (or comprehending something happening at the time)
- Slurred speech
- Difficulty understanding speech
- Loss of balance or coordination (poor ability to walk)
- Sudden numbness, body weakness or paralysis (drooping) in the arms, legs or face (particularly on one side of the body)
- Vision problems in one or both eyes (blurry or blackened vision, and sometimes double vision)
- Sudden, severe headache (a person having a stroke as a result of rupture and bleeding may experience this and lose consciousness very quickly)
- Neck stiffness
- Dizziness (sometimes followed by a complete collapse)
- Difficulty swallowing
- Altered consciousness or loss of consciousness (this can happen quickly or may happen for a brief period of time)
In severe instances a person can also:
- Become rigid (the entire body)
- Or slip into a coma
A good way to react to any signs of stroke is to remember the acronym FAST and follow the below method:
- F: The first thing to do when you suspect a person is having a stroke is to assess the person’s face. Is one side of the face drooping? When you ask them to, can the person smile (with both sides of their mouth)?
- A: Next, assess the person’s arms. Are they able to raise both arms and hold them in the air? Is the person unable to raise one arm? When up, does one arm fall downwards immediately?
- S: Try and speak to the person. A good way to assess their speech ability is to ask them to repeat a simple phrase, such as “the sky is so very blue today” or “the early bird catches the worm”. Is the person able to repeat the sentence or do they sound strange (are they slurring their words)?
- T: This step is vital and relates to time. If any of the aforementioned signs are apparent, ensure that you call for medical assistance immediately. It is just as important to ensure that you assess a person’s face, arms and speech as quickly as possible and do not allow too much time to pass in between. If the person is indeed having a stroke, every second is crucial. You should not linger to ‘see if they begin to feel better’. The longer a stroke goes untreated, the higher the risk for brain damage and lasting complications or disability. While you wait for emergency services, do not leave a person alone and watch them carefully so that you can pass on any potentially important information for effective treatment.
If you, yourself begin to feel like something is wrong and suspect a stroke, you will need to react just as quickly, taking odd symptoms and sensations very seriously. Sometimes you may not even realise why you’re feeling strange until it may be too late to react (only reacting some-time later when your condition suddenly worsens).
Symptoms of stroke may develop slowly during the course of a few hours or even days. You could experience a TIA (mini-stroke) before you do a major one. Being aware of any unusual symptoms that may be indicative of a stroke could mean the difference between life or death, in extreme instances.
Symptoms of a TIA (transient ischemic attack) should be taken as seriously as a major stroke even though you may begin to feel better within an hour or two. It’s easy to put odd sensations down to something stressful that may be going on in your life at the time and impacting your physical state, but a TIA may be a stern warning of something seriously wrong. A major stroke can follow at any time and is better treated well ahead of an emergency situation. It is best to seek medical attention immediately if you suspect a TIA. If you have indeed suffered a mini-stroke, appropriate treatment within a few hours can prevent a major stroke from happening, and ultimately could save your life.
For any type of stroke, fast action can help to improve odds of a better recovery and reduce the likelihood of disabilities caused by extensive damage. Severe damage can happen incredibly quickly once symptoms have developed. There is no time to spare. It’s vitally important to get assistance with either getting yourself or someone else having a stroke to a hospital immediately.
Diagnosing and treating a stroke
How will signs of a stroke be handled?
When a person is brought in to a medical facility with stroke-like symptoms, a flurry of activity can be expected. Being an emergency situation, specialists will be swiftly notified for appropriate diagnosis and testing, before any treatment can be effectively administered.
A neurologist (specialist of nervous system disorders) will be called to assess the person, confirm symptoms of stroke and also identify the type of stroke (depending on the parts of the body affected or showing the clinical signs of the stroke) and also the extent of damage caused to the person already. No effective treatment can really be implemented until all of this is known to medical professionals.
If immediate inappropriate treatment is administered before this is known, further damage to the brain and nervous system can occur. It is imperative that appropriate emergency care is given.
In the moments following arrival at a medical facility (hospital), medical staff will examine the person. If possible and the person is able to liaise with medical professionals, a medical history may be discussed as best as possibly can. Doctors and nurses will promptly begin checking blood vessels in the eyes (using an ophthalmoscope to see if there are any cholesterol crystal or clots at the back of the eyes), measuring blood pressure and pulse rate, as well as listening for abnormal sounds in the heart and prominent carotid arteries in the neck to assess any blockage of blood flow to the brain using a stethoscope.
Medical staff will be looking for any indication that a blockage of the arteries is perhaps an underlying cause (this is done by listening for a bruit or ‘whooshing’ sound), as well as other physical signs of stroke (such as balance problems, poor coordination, body weakness, confusion, vision problems and numbness or paralysis in the face, arms and legs).
If you are having a stroke and are able to communicate, the emergency team will also try and talk to you about your symptoms, determine any medications or supplements you may currently be taking, assess if you have recently experienced any head injuries, as well as try and gain some family medical history.
If any signs during the initial emergency assessment are clear indications of a possible stroke, medical professionals will then need to determine what specifically has caused it, where in the brain damage has been caused, and whether there is any bleeding in the brain. If you are unable to communicate, the team will see if perhaps a close relative or someone who knows you particularly well is available at the hospital to assist.
What tests are involved?
Tests will be necessary, not only to confirm a diagnosis of stroke, what type has occurred and the severity of damage for treatment, but also to try and rule out any other potential causes of the symptoms being experienced. This is critical. It could come down to an adverse reaction to a medication that was being taken at the time or even a brain tumour.
Tests which are likely to take place in the emergency room include:
- CT (Computerised tomography) scan: This imaging test combines a series of detailed X-rays using computer processing, from a variety of different angles to create cross-sectional visuals of bones, soft tissues and blood vessels in the body. A dye will be injected into the bloodstream to help create clear and detailed images of the neck and brain. This test will show exactly where in the brain bleeding is occurring (if haemorrhagic) or if an ischemic stroke has occurred.
- MRI (Magnetic Resonance Imaging): Another imaging test which provides detailed images of the inside of the body is an MRI scan which uses strong magnetic fields and radio waves. This scan can also be used to determine the occurrence of a stroke, and its type. A doctor may inject a dye into a blood vessels to create clear and detailed images of arteries and veins, so as to determine the nature of blood flow in the body.
- ECG / EKG (Electrocardiogram): This test will be used to assess any potential heart abnormalities and possibly detect an underlying cause (especially those associated with an ischemic stroke). The test effectively records any electrical activity in the heart by measuring its rhythm and recording the speed at which it is beating.
- Blood tests: These can include a CBC (complete blood count), electrolytes, blood sugar level measurement, liver and kidney function, as well as a prothrombin time and INR assessment (measurement taken to see how long it takes blood to clot). These tests will effectively assist the emergency team with making appropriate treatment choices so as not to cause any further damage to the body. Essentially, the medical team will be looking for abnormalities which will be tell-tale signs in the blood. These can include things like abnormally high or low blood sugar, signs of infection, if critical blood chemicals are imbalanced, and assessing the blood’s ability to clot.
Emergency treatment may be followed by conducting the following tests (where necessary):
- If a doctor suspects that a stroke has occurred due to a narrowing of a carotid artery: Tests may include a cerebral angiogram (a thin, flexible tube is inserted through a small incision or cut and can be guided through major arteries – the carotid or vertebral arteries. A dye is injected to provide image clarity on an X-ray), carotid ultrasound (sound waves are used to created detailed images of the carotid arteries in the neck and may show the build-up of plaque and blood flow) or Doppler scan, MRA (magnetic resonance angiogram) or CT angiogram.
- If a doctor suspects that a stroke has occurred due to a heart abnormality: Tests may include a Holter monitoring, a telemetry test or echocardiogram (sound waves which create detailed images of the heart and help determine the presence of clots). A transoesophageal echocardiogram can also help a doctor determine the condition of the heart and potential presence of blood clots. A thin, flexible tube is inserted into the throat and down the oesophagus that connects the mouth and stomach. The close proximity of the oesophagus and heart allows a good view of potential abnormalities.
How will stroke be treated?
Emergency treatment will effectively coincide with assessments and testing upon a patient’s arrival. If a person is unconscious or losing consciousness, the emergency team will prioritise difficulties with breathing in particular, and provide supplemental oxygen. Testing will be conducted on an emergency basis and as things are determined, treatment will be administered. Time is of the essence and can mean the difference between life and death in extreme instances, or that of severe disability and an easier recovery.
If an ischemic stroke type is determined, treatment will involve:
- Emergency medications: The first thing a medical team will wish to do will be to restore blood flow to the brain, alleviating clot damage. Treatment will involve medications that will begin to alleviate blood clot blockages as soon as possible (within 3 hours of the onset of stroke symptoms). Emergency medication may include aspirin (this helps reduce the likelihood of having another stroke by thinning the blood and preventing new blood clots from forming), a TPA (tissue plasminogen activator administered through a vein to dissolve blood clots within 30 to 60 minutes).
- Emergency procedures: Blood clots may require emergency medication treatment administered directly to the brain. This may involve a long, thin tube (or catheter) inserted through an artery (usually in the groin) which is then threaded to the brain to deliver thrombolytic medication in the precise area requiring treatment. Another procedure used to treat blood clots is a mechanical clot removal procedure (known as a mechanical thrombectomy). This involves the insertion of a catheter with a tiny attachment that can be used to physically break off and remove a clot.
- Other procedures: A doctor may recommend a procedure to open up a narrowed artery, and thereby reduce the risk of another stroke. Options available will depend on the nature of the stroke a patient experienced. Some options available include a carotid endarterectomy (plaque from the carotid arteries is surgically removed through an incision in the neck), or angioplasty (an artery in the groin will provide access to carotid arteries where a balloon is used to try and expand a narrowed artery due to clots, after which a stent is inserted to support the opening).
If a haemorrhagic stroke type is determined, treatment will involve:
- Emergency care: If this type of stroke is determined, the primary goal is to control any bleeding that occurs in the brain. Emergency treatment will involve alleviating the pressure that bleeding will cause. Medications may be administered to prevent any blood clots, seizures or vasospasms (spasms of arteries that lead to the constriction of blood vessels and increased blood pressure known as vasoconstriction), as well as lower pressure in the brain. Once bleeding is under control, the emergency team will provide supportive care which allows the rest of the body to absorb blood and promote healing. If it is determined that a large area was affected by a rupture or aneurysm and bleeding, surgery may be necessary to remove excess blood and alleviate pressure.
- Surgical procedures: Damage caused by ruptures may require surgery whereby a doctor will repair blood vessel abnormalities. Some repair procedure options include surgical clipping (a tiny clamp is placed at the base of an aneurysm to restrict blood flow to it, preventing rupture), a coiling or endovascular embolization (a catheter is inserted into a groin artery and guided to the brain where detachable coils are placed into the aneurysm, effectively blocking blood flow and allowing blood to clot), a surgical AVM or arteriovenous malformation removal (smaller AVM’s can be removed if located in an accessible area in the brain and thereby reduce the risk of rupture and another stroke), an intracranial bypass (can be used to repair an aneurysm, complex vascular lesions or poor blood flow in affected areas of the brain), or stereotactic radiosurgery (this involves an advanced but minimally invasive procedure to treat vascular malformations using multiple beams of focussed radiation).
One of the primary goals of any medication that is prescribed, especially during the emergency care stages, is to prevent another stroke from happening. The more damage that can be prevented the better.
Medications do depend on the type of stroke experienced and their specific underlying causes. Some medications work to break up existing blood clots or prevent new clots from forming. Others specifically target high blood pressure (hypertension) and cholesterol as a way to reduce the risk of blood flow blockages and narrowing of the blood vessels.
Some medication options may include:
- Anticoagulants: These medications interfere with the blood clotting process and purposefully prevent it from happening easily. Interference can also prevent any existing blood clots from becoming larger, and thereby causing pressure and distress in the body. These medications may be necessary once an ischemic stroke or TIA is identified as the type being experienced.
- Antiplatelet medications: A common medication used to promote blood thinning and prevent blood clots is aspirin. Sometimes aspirin is given in combination with other medications which work together to prevent blood from being able to accumulate / stick together, forming a clot. These medications are thus usually prescribed for those who have experienced an ischemic stroke. Medications are typically prescribed for an extended period of time as a means of prevention.
- TPAs (tissue plasminogen activators): This medication physically breaks up a blood clot and is commonly favoured during an emergency situation. It is administered intravenously (injected into a vein or artery). This way the medication can get to work quicker and break up blood clots that are causing distress associated with stroke. There is a risk of bleeding in the brain that, for some individuals, is too high a chance to take. Patients receiving this medication will be monitored with intense care.
- Blood pressure medications: During the initial physical examination upon arrival at a hospital, blood pressure will be measured and recorded. If blood pressure is too high, doctors may prescribe medications to lower it. High blood pressure aggravates symptoms of stroke and plays a key role in worsening the condition. High blood pressure can contribute to the breaking off of large chunks of plaque, which then help the formation of blood clots along. Beta-blockers, calcium channel blockers and angiotensin-converting enzyme inhibitors (ACE) are common medications which may be prescribed.
- Statins: These medications assist with lowering cholesterol levels as elevated cholesterol levels can also cause blockages when a build-up of plaque accumulates along the arterial walls. Prescribed medications work by blocking the enzyme in the body that typically helps to produce cholesterol (naturally). Blocking this enzyme effectively enforces the body to produce less of it and thereby reduces the risk of hyperlipidaemia (raised cholesterol). Preventing further build-up can contribute to prohibiting another stroke from occurring.
Recovery and rehabilitation
Once an acute situation is under control and emergency treatment has begun taking effect, most stroke sufferers will be admitted to hospital for careful monitoring for at least a few days. Once out of immediate danger, a doctor will discuss procedures for effective recovery and also highlight the importance of preventative measures going forward.
A doctor is likely to discuss changes in diet and overall lifestyle to keep blood pressure and cholesterol at a healthy level, as well as ongoing care such as medications, or physical therapy. In some instances, the possibility of further surgery may be necessary (removing plaque from large carotid arteries or widen narrowed or clogged arteries in the brain).
If an ischemic stroke type occurred, one may be given aspirin or other blood-thinning medications as a means to prevent the occurrence of more strokes. If an existing heart condition is also determined as part of the underlying cause, long-term therapy and appropriate treatment will also be discussed. Cholesterol levels are usually problematic in this instance and medications will be prescribed to lower it.
A doctor will also discuss all necessary follow-up medical care, as well as rehabilitation therapy. This is crucial as the brain is likely to have sustained some damage during the stroke. As a result, the brain may begin to compensate for specific areas affected by the trauma and form new neurological pathways. Rehabilitation therapy is an intensive means to help the brain recover from the trauma and function in the way it is ‘wired to’. Programmes effectively assist with functions such as speech, physical therapy, occupational therapy and nutritional needs.
A trauma such as stroke can affect a person from a psychological perspective too. The body has been through an intense physical experience and recovery may be a slow and gradual process too. This can take a toll on a person’s emotions. A positive mindset may not always be easily achieved through the process. Thus, psychological care may be necessary as part of a rehabilitative therapy programme. Post-stroke depression can be treated with counselling, support groups and anti-depressants.
How will rehabilitation be approached?
A physical trauma such as stroke affects the body’s ability to function as well as overall levels of strength. Recovery is going to take time and in some instances, may be an ongoing process for the rest of the patients’ life. The primary goal is to ensure that a person is able to restore as much normal function as is possible and be able to return to their independent lifestyle
A programme that enables this will depend on the nature of the stroke and the impact it had on specific areas of the brain (the amount of damage to tissue caused).
- If the stroke affected the right side of the brain: Sensation and movement on the left side of the body is likely to be affected.
- If the stroke affected the left side of the brain: Sensation and movement on the right side of the body is likely to be affected. Speech and language may also be affected and require therapy.
Any damage to the brain can also result in difficulties with balance, vision, coordination, swallowing and breathing, as well as bowel and bladder control. Rehabilitation will take into account the following factors as well:
- Overall health condition
- The degree of damage or disability
- A person’s normal lifestyle, interests, family or caregivers and other important priorities
The programme developed will be tailored in the most rigorous way and based on individual needs. An ‘aggressive’ and targeted action plan is necessary (the first few months following a stroke is the best period with the greatest chance of being able to regain most of a person’s ability to function normally and independently) and may begin even before being discharged from hospital and allowed to return home.
Depending on the nature of a person’s condition, he or she may be discharged and transferred to another rehabilitation facility where skilled medical teams can assist, to an outpatient unit or to their own home.
Who will the rehabilitation team consist of?
- Physiatrist (rehabilitation specialist)
- Dietician (assist with a healthy diet that prevents problems which can lead to further strokes)
- Physical therapist (assists with movement, coordination and balance)
- Occupational therapist (assists with normal tasks such as dressing, eating, bathing, and writing or drawing etc.)
- A social worker or case manager (assists a person and their caregivers or loved ones with necessary care equipment for maximum comfort at home)
- Recreational therapist (assists with returning to general activities a person may have enjoyed doing before the stroke)
- Speech therapist or speech-language pathologist (assist with re-learning of speech and basic language skills which may be lost, as well as problems with swallowing)
- Psychiatrist or psychologist (assist with mental and emotional coping methods)
- Vocational counsellor (assists with finding a job a person can cope with to earn an income if necessary)
All specialists involved will assist a stroke survivor in being able to:
- Live as independently as possible
- Adjust to physical changes to the body, which may have long-lasting effects
- Make necessary adjustments to the lifestyle a person was used to before the stroke, including their home environment, family life, work life and integration with the community.
How long should rehabilitation therapy take?
There is no short road to recovery, and for most who have suffered a stroke, the journey becomes a life-long process. The process is one of gradual care and is likely to cause a few ups and downs as a survivor goes through the programme, both from a physical and mental or emotional perspective.
The important thing is to develop trust in the rehabilitation care team. Each member, with their specific set of skills, is there to help a survivor in the best way possible and should not contradict another specialist’s area of expertise. The stroke survivor is everyone’s primary concern and their well-being will come first. Each member of the team will guide, support and ensure that a survivor makes progress in every way possible. A survivor can help themselves too, by building a strong network of family, friends and colleagues to support and keep them motivated to get better.
The initial few weeks and months following a stroke are the most important when it comes to recovery. The process of getting better, however, can take years and a lot of hard work and effort, especially when it comes to improving cardiovascular health. This is where a network of people to support and uplift the spirit is important.
What else will rehabilitation therapy involve?
- Exercise and overall well-being: Gentle aerobic exercise, such as swimming, on a regular basis may be encouraged. Swimming is a good exercise activity (in a heated pool) as natural buoyancy in water can help restore any lost motor function and stimulate the body’s muscles. A survivor will be encouraged to quit smoking (if they do) or warned never to start. Women may be warned against taking oral contraceptive pills (birth control pills), especially if they frequently have or have had migraines with aura (visual disturbances). Migraines and the taking of oral contraceptives can increase a woman’s risk of experiencing a stroke. It may be beneficial to try relaxation techniques, such as yoga or meditation that assist with pain tolerance, or alleviate emotional frustrations and anger.
- Nutrition: A nutritious diet is a vital part of recovery and will need to be adjusted for the remainder of a survivor’s days. A proper diet not only contributes to preventing stroke in the future, but also to reverse a little of the damage caused by the one already had. A diet rich in minerals, vitamins and other nutrients which a person can get from lean protein sources, fresh fruits and vegetables, as well as low-fat dairy can help keep a person’s overall physical condition in tip-top shape. A dietician will advise that a survivor avoid processed foodstuffs, and especially those that are high in trans and saturated fats.
Can the brain completely recover after a stroke?
The simple answer is that it is not entirely understood how the brain recovers after a person experiences a stroke. One thing most will agree on is that a person is generally never quite the same again. Some things that have been noted through experience include the following:
- The brain is capable of resuming some function: Therapy can help to create new habits by changing the way the brain processes ways for some tasks to be performed. It may take some time, but a person can re-learn how to do certain things after having a stroke. It can also happen that one area of the brain may begin functioning in a way it had not previously – i.e. taking control of certain functions it wouldn’t normally be responsible for prior to a stroke.
- Blood flow: There will often be a distinct difference in what cells and tissues have merely been damaged and what has been destroyed. Through the recovery process, a doctor will be able to see if blood flow has been restored to the affected areas of the brain or not. Damaged cells should be able to resume functioning over a period of time through the healing process. Destroyed cells and tissues may not.
What can be improved through rehabilitation?
What skills and functions can a person regain through recovery? Primary areas of concern are cognitive motor skills, speech and sensory functions. These are the main areas typically affected by damage following a stroke. The main goal is to work through an intensive programme that improves or restores these functions.
- Speech: One of the first notable things about a person recovering from stroke is the resulting language impairment due to the damage caused to the nerves that innervate (or supply) muscles that control speech. This is known as aphasia (the inability to speak at all). Dysarthria is the inability to articulate language. A person may have trouble speaking, finding the right words to explain something or find it very difficult to speak in full sentences. Therapy will involve re-learning how to speak coherently and how to articulate effectively. If impairment is quite severe, rehabilitation may also involve methods to assist with helping to communicate in ways other than just with speech.
- Cognitive ability: The ability to think and reason is another main area affected by damage. A person may find that they have trouble with their memory and develop poor judgement skills. A common side-effect of this is adverse behavioural changes. Where a person was once outgoing and vivacious, they may become withdrawn and isolated. Sometimes, the opposite can happen. Others may even behave recklessly. The ability to anticipate consequences is often lost as a result of damage and therefore can lead to safety concerns for a person having experienced a stroke. Improving and restoring cognitive skills is thus very important during the recovery process. Therapists will make very specific recommendations with safety, particularly in the home, as part of the rehabilitation process, teaching someone to think and reason once more.
- Motor ability: Damage weakens muscles in the body, often on one side and as such hinders joint movement. Following a stroke, coordination is thus affected and impairs a person’s ability to move, walk and perform a variety of physical activities. Painful muscle spasms are another frustrating side-effect of this. Part of therapy if to re-learn how to work the body so as to strengthen muscles and restore balance. Exercises will be tailored to help a person learn how to gain control over their body and also gain the upper hand on dealing with muscle spasms. Walking aids are commonly used during the recovery process, until a person is able to move about without any assistance.
- Sensory skills: The ability to feel heat, cold or even pressure is often impaired following a stroke. Rehabilitation will assist a person with being able to adjust to the sensory changes now being experienced.
The road to recovery is going to be a slow and intensive one, but it can also be complex. Other issues which may arise will also form part of the recovery and rehabilitation process. Professionals and therapists will work with each and every single weakness, impairment and complication as carefully and with as much dignity as possible.
Some other physical and emotional problems which can occur may include:
- Bladder and bowel control: Following a stroke, a person may have difficulty recognising when they have the need to use a bathroom, making accidents a common occurrence. Alternatively, a person may realise they need to use a toilet too late and not get to one in time. It’s not uncommon for a person to experience problems with constipation, diarrhoea or a total loss of bowel control, as well as problems with urination (having a frequent need or trouble with urinating) or loss of bladder control. A specialist can help treat all of the aforementioned problems, often with medications. It may sometimes be necessary to be in close proximity to a commode chair throughout the day and night. A urinary catheter can also be inserted to remove urine from the body during extreme circumstances.
- Ability to swallow: A person can easily forget to swallow while they are eating. Nerve damage sustained during a stroke can cause difficulties with swallowing too. Choking is a common problem in this regard, as is hiccups. Learning how to eat normally again and swallow at appropriate times is part of the rehabilitation process. A nutritionist or dietician can also help a person with selecting healthy food options which may be easier to consume and reduce choking risk and problems swallowing.
What is the likelihood of a successful recovery?
A very small percentage of stroke sufferers ever recover completely. A slightly higher percentage typically can recover with a few minor impairments. Nearly half of all people who suffer a stroke ultimately learn to work through and live with moderate to severe impairments as a result of damage. Many require special care where a disability directly affects a person’s daily function in the home or in the workspace. A small percentage of the severely impaired require long-term care with nursing staff, either at home or in a care facility.
Thus, it can possibly be said that there are degrees of success which can be achieved when it comes to recovery and rehabilitation. Factors which contribute to the level of success depend on how much damage occurred during the stroke, a person’s age, if there are other health conditions, how soon a rehabilitation programme began, as well as how motivated a person is and whether they are committed to the intense requirements of their therapy. All of these things can influence the outcomes of a rehabilitation programme.
Recovery is a team effort and can also come down to the level of commitment and skilled experience of medical experts. The more skilled and experienced they are, the more a survivor stands to gain during the recovery process. A support network of family and friends also forms a critical part of a survivor’s success. Encouragement and support in healthy doses can really go a long way.
If everyone involved is committed to as successful a recovery as possible, there’s no doubt that the outlook can be positive. A survivor may never quite be the same again after having a stroke, but there’s little reason why a person can’t regain the pieces of their life and live in such a way that fulfils them. It just takes time, intense effort and an unfailing level of commitment from everyone involved.
Caring for someone who has had a stroke
A stroke has been likened to a heart attack which happens to the brain. One of the scariest things about a stroke is that it can happen to anyone – young and old.
In many other emergency situations, a person is able to recover fairly well in the short-term and resume a fairly normal lifestyle. Behavioural and physical changes aren’t always extreme enough to impact each and every aspect of a person’s daily existence.
Stroke survivors experience dramatic change to their existence. It quite literally turns their world upside down and inside out, and it can feel like they are utterly helpless. The impact affects a stroke survivor’s loved ones too. The domino effect can be devastating at first. It can feel like everything has changed completely in the blink of an eye.
If a loved one has suffered a stroke, the most important thing that you can do for them is to ensure that they never need to have any doubt that you care for and love them. The nature of damage a stroke causes can leave a person feeling very isolated and alone. Physical impairments are not the only effect that can leave a survivor feeling helpless. It can be intensely draining on a person’s emotions and mental frame of mind too. Rehabilitation is intense and it is all-consuming for a survivor. Every second of every day will require them to be able to focus on recovery and improving their impaired state. It is a taxing process.
The first time you see your loved one following a stroke, it is bound to leave you feeling emotional and apprehensive about what to do and say (or not to do and say). It can be difficult for a loved one to deal with too. You may feel confused and worry about becoming a burden to your loved one in just the same way they themselves may worry.
It’s important to remember that every little bit of support you offer that shows love and care will make an enormous difference to their recovery process. Be there. Taking care of an errand, doing a little grocery shopping, handling the payment of a bill, feeding the dog or putting on a little music to improve the mood of a household can do wonders for helping a survivor and their families.
A little goes a long way in helping a survivor feel that they are not forgotten and reminds them that they deserve a sense of purpose. This is crucial for recovery.
A stroke is no joke and should never be made light of either. It’s easy for various things to be made into a joke as a means of adjusting and learning to cope. Try not to do this. A sense of humour can be applied to other things in life and can be a healthy coping mechanism in less direct ways. It’s good to find ways to laugh and instill joy in daily life again, but not at the expense of a stroke survivor.
A blame game is also a nasty cycle which will not help things along. A stroke survivor has likely learned a very hard lesson. It may very well be down to previous shortcomings, like smoking, that caused the stroke. Highlighting shortcomings isn’t likely to inject positivity into the healing process, for anyone. A stroke survivor is not likely to need a reminder either. Rather find ways to live healthier for yourself and your loved one. Everyone stands to gain from that.
Coping with the after-effects of stroke
For a survivor, learning to cope when life as they once knew it has been altered completely can be very difficult emotionally. Mood changes and feelings of frustration, helplessness, apathy and even depression aren’t uncommon. A survivor should not feel ashamed about this. It’s important to remember that anyone else going through recovery can and will feel the same.
Physical impairments and emotional shortcomings affect everything, even a person’s sex drive. Self-esteem, interests and connections to others are also impacted greatly.
It’s crucial for a stroke survivor’s recovery for both themselves and their loved ones to remember the following:
- Be patient: Recovery is a journey and much of it may feel like an uphill climb. A rehabilitation team will help a stroke survivor through the difficulties and celebrate their triumphs with them. It will help things along if a survivor can find ways to learn to accept that it will all take time and a great deal of effort. A person should think of rehabilitation as the ‘new normal’ and adapt. A survivor is not alone in this and can lean on those that are there for them. This allows for breathing room and time to rest too. Small successes will come.
- Find support where it’s needed: From an emotional perspective, it may be difficult when a person finds themselves surrounded by healthy people who are able to do the simplest of things with ease. It may be challenging for a survivor to accept that others ‘understand what they’re going through’ at times, including the medical team. There are support groups which allow survivors a place to congregate, share information and exchange experiences. If a person feels that this will help and add value to their recovery, it is a good idea to find a group to join.
- Take care not to become isolated: Physical challenges can make it all too easy to want to hibernate from the world. Don’t. A survivor should try and find ways and means that enable them to get out of the house (or care facility) and take in some fresh air. Hiding in a hole is a gloomy place for anyone and can be more destructive than helpful. A stroke survivor may have days when they feel discouraged. Alternatively, they may have others where they feel self-conscious. Frustration and disappointment can hamper progress. A survivor should be mindful of this and take control over their emotions where they can. A good way to do this is to lean on loved ones. A survivor can tell them what they need and ask them for the kind of support they feel is in their best interests, giving each a day a purpose. There are places that a walker (Zimmer frame), cane or wheelchair can be easily manoeuvred. A survivor should get outside as often as they can and find an environment that is invigorating and fulfilling.
- A stroke survivor is never alone: Loved ones, colleagues and the rehabilitation care team all know about what a person has been through and what they’re going through during recovery. Everyone will want to help in some capacity or another. A survivor should let them. Not everyone will know what a person needs though. A survivor should find ways to tell them. A home cooked meal. Reading a book aloud. Putting on a film to watch on a Sunday afternoon. Getting some fresh air in a park on a Sunday afternoon. Driving to a therapy session. Helping to dress or assisting with hair brushing. Whether a person’s needs require a few seconds worth of effort or a whole day, a survivor should reach out to those who can help and are willing to help. A person need not struggle alone with things they can’t yet do themselves. It’s also important to remember, a stroke survivor’s state of being is also being experienced by a perfect stranger elsewhere too. A person going through recovery is never entirely alone.
- Keep going: Conversation and communication can be intensely challenging. It’s important not to give up. A survivor can use the techniques they’re learning in therapy and practice, practice, practice. This way, it’s easier to learn what works best (such as making an effort to communicate during more relaxing scenarios during the day), and by extension improve self-confidence. This will help a person to relax, connect better with others, as well as learn to enjoy the company of others. But, a person must be patient. The journey may begin with a handful of words, a specific tone of voice, cue cards or pictures and a selection of gestures. These can be effectively used to communicate through the process of therapy, improving slowly and carefully. In time, a survivor will improve. The brain is a marvel and will adapt in a functional way. If a survivor makes the effort and practices patience through the process, they can make successful progress, one step at a time.
What places a survivor at greater risk for stroke?
Many risk factors for a stroke are treatable and if caught in time, can prevent this potentially devastating experience from happening.
Common risk factors include:
- Obesity and excess weight
- Excessive alcohol consumption and binge drinking
- Physical inactivity
- Substance abuse – use of illicit drugs such as methamphetamines and cocaine
- High blood pressure
- High cholesterol
- Cardiovascular disease, heart infection, abnormal heart rhythm, heart defects, heart valve defects, enlarged heart chambers and heart failure
- Smoking (nicotine and tobacco) or exposure to second-hand smoke
- An unhealthy diet (high in salt, cholesterol, saturated and trans fats)
- Obstructive sleep apnoea
- Family history of heart attack, TIA or stroke
- Age – 55 and older
- Ethnicity (Hispanics, American Indians, Alaska Natives and African-American races are more prone to stroke than other races)
- Gender (males are at higher risk than females, but women tend to experience stroke more often when older in age and more severely – possibly resulting in death)
- Sickle cell disease (anaemia)
What complications can occur?
Complications range from temporary challenges and disabilities to permanent problems.
Some other complications can include:
- Loss of muscle movement and paralysis
- Difficulties with reading and writing
- Pain (central stroke pain or central stroke syndrome), numbness and odd sensations in the body
- Sensitivity to temperature changes
- Difficulties with sense of touch
- Vision impairments
- Anxiety and feelings of grief, sadness or anger
- Loss of bladder or bowel control
Many risk factors associated with stroke potentially could have been treated or changed as a means of prevention.
The best ways to prevent risk factors from reaching a danger point include:
- Keeping blood pressure and cholesterol levels under control through a balanced and healthy diet, regular exercise (aerobic and cardio), and stress management.
- Quitting bad habits such as smoking, the use of illicit drugs and excessive alcohol consumption.
- Maintaining a healthy weight.
- Controlling diabetes (and other health conditions already diagnosed and being treated).
- Going for regular medical check-ups to manage overall health
Can a migraine feel just like a stroke?
A bad headache that progresses to a migraine often has accompanying symptoms of sensitivity to light, smell, sound and touch, as well as nausea and vomiting. Pain can be intense and throbbing, particularly on one or both sides of the head and around the eyes and temples. A migraine is not a pleasant experience.
A migraine with aura is the form that can be confused with similar symptoms of stroke, particularly a TIA. ‘Aura’ refers to vision disturbances, such as blind spots, flashing lights and jagged lines, that also affect a person’s senses. Aura typically happens before the pain of the headache, and can sometimes also be accompanied by sensations (or lack of) such as numbness or tingling in the limbs and facial area. Some may even experience a ringing in the ears and find it difficult to speak coherently.
What is the difference and how can you tell?
- A stroke: Symptoms develop suddenly (seemingly ‘out of the blue’). When symptoms of stroke are active, a person may lose sight in one eye or have no feeling in in one hand or foot. These are sometimes referred to as ‘negative symptoms’ as they involve loss of something.
- A migraine with aura: Symptoms develop gradually, and progressively become more painful and uncomfortable. During a migraine, symptoms can sometimes be referred to as ‘positive symptoms’ as they are typically additional in nature. These added sensations refer to the vision sensitivities and tingling feeling on the skin.
Is there a distinct connection between migraine with aura and stroke?
The exact link is yet to be determined, but it is generally accepted now amongst medical professionals that those individuals who suffer migraines with aura are at increased risk of stroke – twice as likely as those who have never experienced a migraine before.
One theory is that migraine causes inflammation inside the arteries and this can lead to cell damage in the wall lining of blood vessels. When this happens the risk of blood clotting increases, which in turn primes the body for ischemic stroke types.
Risk of stroke increases if you are a young woman taking oral contraceptive pills (birth control pills), and especially if you smoke as well. Migraine without aura doesn’t appear to raise any alarm bells when it comes to stroke risk but can still potentially increase a person’s chances of other heart-related illnesses or conditions.
A migraine may not necessarily cause a stroke, but it is possible to experience a stroke while having a migraine with aura. If you are prone to migraines, especially those with aura, you should take precaution when medicating this form of headache. Some medications to treat migraine run the risk of potentially narrowing the arteries, which in turn can increase a person’s risk for stroke. Risk is even worse if a person experienced a stroke and medicates a migraine. When in doubt, a person should always talk to their doctor about the best ways to keep their risk at an absolute minimum.
What is a silent stroke and is it different from a TIA?
It is possible to have a stroke and not even know it. These are often known as ‘silent strokes’. Symptoms may not be as easy to recognise or a person may not even remember feeling anything out of the ordinary.
A silent stroke is no less dangerous or life-threatening. Permanent damage to the brain can still happen. Many will have lingering problems with memory and thinking after experiencing stroke. The risk for more severe strokes is higher as well. It is therefore imperative that if a person experiences a silent stroke that they seek immediate medical treatment.
So, is there a way a person can recognise a silent stroke?
It’s more than likely that a medical professional will be able to pick up that a person experienced a silent stroke even before they themselves are aware. A person may notice changes after the fact, such as subtle memory problems or sensing a slight difficulty with moving around. These concerns may be enough to motivate a person to see your doctor, but they won’t necessarily be certain as to why these changes occurred.
A doctor will be able to detect a silent stroke while conducting a brain scan and assessing the images produced for abnormalities and signs of damage.
Are tomatoes good for lowering the risk of stroke?
Studies have shown that a tomato-based diet can considerably lower the risk of stroke. Tomatoes and tomato-based meals contain high levels of lycopene, an antioxidant. Higher levels of this antioxidant in the blood stream can significantly reduce risk by as much as 50%. A tomato-based diet is not a definitive means of prevention, but it does highlight the importance of including a healthy supply of fresh fruits and vegetables into a diet for optimum health. It’s also not going to have as positive an impact if other risk- contributing factors, such as smoking, poor exercise and bad eating habits, are in play. If these are also avoided, a tomato-based diet stands a greater chance of lowering overall risk.
Better still, there are plenty of meal options and a variety of delicious recipe ideas with tomatoes that can be indulged in, with healthy benefits. Combining tomatoes with other heart-friendly foodstuffs is best in order to maximise on the benefits to overall health.
Many stroke survivors may be encouraged to follow the Mediterranean diet which is known for an abundance of positive health benefits. Maintaining the diet, which is rich in vegetables, fruits, legumes and olive oil, is known to help significantly contribute to lowering risk of cancer, obesity, heart disease, and a variety of other major medical conditions. The diet is packed with variety and flavour, so meal times should never be a boring experience. It is best to talk to a nutritionist or dietician who can offer the best advice on healthier choices for the best results possible.