About Stroke

An ischemic stroke occurs if a blood vessel that supplies the brain is blocked or greatly narrowed. This can happen when fatty deposits (plaque) build up along the vessel wall and cause blood to collect (clot). There are two types of Ischemic Stroke - Thrombotic Stroke and Embolic Stroke:

A thrombotic stroke is a type of ischemic stroke that's caused by a blood clot that forms inside a blood vessel in the carotid artery in the next or an artery in the brain. The blood clot that triggers a thrombotic stroke usually forms inside an artery that's already been narrowed by atherosclerosis, or hardening of the arteries. This type of stroke is usually seen in older people, people with high cholesterol levels and those with atherosclerosis or diabetes. Thrombotic strokes may be preceded by one or two TIAs.

An embolic stroke is also caused by a blood clot, however this blood clot forms somewhere else in the body and then travels through the bloodstream to the brain artery. The blood clot usually comes from the heart and often is present in people with atrial fibrillation.

Hemorrhagic strokes are less common of the two main types of strokes, but are the more dangerous. They happen when either a brain aneurysm bursts or a weakened blood vessel leaks. This causes blood to spill into or around the brain, which causes swelling. The pressure that builds up then damages brain cells and tissue. Very high blood pressure can cause blood vessels to burst as well, which is why hemorrhagic strokes can occur to patients taking blood-thinning medication. 

A transient ischemic attack (TIA), also known as a "mini-stroke", is caused by a temporary decrease in blood supply to a part of the brain. A TIA is more accurately described as a "warning stroke." It can also be caused by a clot, the only difference between a stroke and a TIA is that with a TIA, the blockage is only temporary. The symptoms, like these below, occur rapidly and last a relatively short time.

• Weakness, numbness or paralysis in the face, arm or leg, typically on one side of the body
• Slurred or garbled speech or difficulty understanding others
• Blindness in one or both eyes or double vision
• Dizziness or loss or balance or coordination

In about 25% of cases, stroke victims suffer a second stroke within five years of the first. The risk is greatest right after a stroke and decreases over time. The likelihood of severe disability or death increases with each recurrent stroke. About 3% of stroke patients have a second stroke within 30 days of their first stroke, and about one-third have a second stroke within two years.

When a stroke occurs on the right side of the brain, the left side of the body is affected. Some of the effects can include:

• Left-side paralysis
• Memory loss
• Vision problems
• Faster, more inquisitive behaviors

When a stroke occurs in the left side of the brain, the right side of the body is affected. Some of the effects can include:

• Right-side paralysis
• Memory loss
• Speech/language issues
• Slower, more cautious behavior

When a stroke occurs in the brain stem, depending on the severity of the injury, it can affect both sides of the body and may leave someone in a "locked-in" state. When a locked-in state occurs, a personal is generally unable to speak or achieve any movement below the neck.

With apraxia, the brain sends incorrect messages to the muscles. Apraxia can affect the muscles in the arms, legs, voice box or mouth. This results in a loss of the ability to:

• Perform learned or purposeful movements
• Make proper use of objects
• Do things that are normally automatic

Stroke damage can cause changes in the way victims think and understand, making formerly simple behaviors harder. Cognitive changes may include not being able to:

• Recognize family members, friends or familiar places
• Remember how to do daily activities
• Recall things like the date, the season or your age
• Follow simple commands
• Act in the manner that seems appropriate to a situation

It is estimated that approximately one third of stroke survivors will develop memory problems. The memory problems can be so severe that they interfere with normal functioning. When they do they’re called dementia.

There are several types of memory loss:

• Verbal: related to names, stories and language
• Visual: related to shapes, faces and places
• Informational: related to information and skill development
• Vascular dementia: related to thinking

Symptoms of memory loss include:

• Confusion or problems with short-term memory
• Wandering or getting lost in familiar places
• Difficulty following instructions
• Trouble with monetary transactions

A victim’s memory can improve over time, but the symptoms can last for longer. Treatment typically involves brain-training techniques that improve thinking and memory.

If you suffer from memory loss, here are some helpful tips:

• Have a place for everything and put things in their place.
• Have a calendar and stick to a daily routine.
• Write things down.
• Use clues and cues to remember things.
• Break things down into easy-to-remember steps.
• Repeat things or ask others to repeat things if necessary.

Sensory deficits usually occur on one side of the body. When the sense of touch is involved, there may be tingling or numbness in the face, arm, or leg. The ability to feel or sense hot or cold may be decreased or missing. You may have blurred vision or a loss of vision in one or both eyes.

This type of dementia involves reasoning, planning, judgment, memory and other thought processes. It’s common following a stroke, and the risk for vascular dementia increases with recurrent stroke. Symptoms of vascular dementia include:

• Memory loss
• Confusion
• Language problems
• Difficulty paying attention or following along
• Difficulty planning and organizing
• Difficulty with problem solving and decision making
• Having visions
• Impaired motor skills

You can control further decline from vascular dementia by lowering blood pressure, reducing cholesterol, controlling blood sugar and even some medications. Speak with your healthcare professional about which options are best for you.

If you are living with vascular dementia, here are some tips that may help keep you independent:

• Write notes to yourself
• Create lists
• Keep to a routine
• Work with a speech, physical and/or occupational therapist
• Play card games and work puzzles
• Manage your stroke risk factors
• Get out and be social
• Avoid emotional stress and depression

Depression is common after a stroke, including feelings of anger, frustration, anxiety, sadness, fear and hopelessness. Other symptoms can include losing interest in activities, difficulty sleeping, feeling tired and difficulty concentrating.

Depression can slow down recovery from a stroke and needs to be treated if it occurs. If your depression is left untreated or unmanaged, it can make other common post-stroke conditions worse, including malnutrition, incontinence, pain, fatigue and sleep issues. There are a variety of treatment options for post-stroke depression, including those listed below. Consult with your healthcare provider to determine the best path for you.

• Antidepressant medications
• Mental health therapy
• Cognitive behavioral therapy
• Physical or speech therapy

In addition to these treatments, it’s also important to make some lifestyle changes to manage your depression:

• Communicate. Talk about your feelings with friends and family.
• Improve nutrition
• Attend a support group
• Practice stress and anxiety management techniques
• Be patient with yourself and loved ones
• Set realistic goals
• Stay as active as possible
• Get out into the community
• Stop drinking or smoking

Pseudobulbar Affect, or PBA, is a common post-stroke behavioral concern. It causes things like pathological crying or laughing or loss of emotional control, often at inappropriate times.

PBA can be treated, but it needs to be properly diagnosed since PBA is often confused with depression. If you suffer from PBA:

• Be open about the problem
• Try to distract yourself if you feel an episode coming on
• Take slow, deep breaths until you are in control
• Relax
• Change your body position

Aphasia results in difficulty using and understanding language. This includes speaking, understanding, reading and writing. The severity of aphasia varies widely.

Most people with aphasia have not lost intelligence or common sense. Instead, their understanding and use of language have been changed. This makes aphasia very frustrating.

People with aphasia may:

• Struggle to produce sounds or words
• Have trouble repeating words or imitating simple sounds
• Speak in short phrases or "broken" sentences
• Use constant jargon or "nonsense" speech
• Swear, without really meaning to use that language
• Have trouble with reading, writing or simple calculation
• Not be able to understand what others are saying, even though it may appear that they do

When talking to someone with aphasia:

• Include him/her in conversations
• Speak slowly and clearly
• Give information in small amounts
• Allow extra time for processing thoughts
• Use gestures, pictures or drawings
• Avoid constant "quizzing" or "testing"
• Offer encouragement and support without pressure to perform
• Use props
• Stay calm

With apraxia, the brain sends incorrect messages to the muscles. Apraxia can affect the muscles in the arms, legs, voice box or mouth. This can result in a loss of the ability to:

PBA can be treated, but it needs to be properly diagnosed since PBA is often confused with depression. If you suffer from PBA:

• Perform learned or purposeful movements
• Make proper use of objects
• Do things that are normally automatic

Ataxia is the lack of control and coordination of muscles and movement. This many involve clumsiness, staggering or dizziness.

Dysarthria is slurred speech that is caused by weakened muscles and nerves in the tongue, voice box (larynx), or mouth. A person with dysarthria may be able to say words and understand language, but may not be able to speak the words clearly enough to be understood by others.

Someone with dysarthria may:

• Not be able to control and manage breathing to produce sounds
• Sound monotone, nasal, or strained, or have a different voice than before the stroke
• Have problems with chewing food or drinking liquid

To help someone with dysarthria, encourage him or her to:

• Take a deep breath before speaking
• Slow down when speaking
• Exaggerate tongue and mouth movements when speaking
• Sing songs

Difficulty with swallowing is called dysphagia. It can affect eating, drinking and taking medication. It’s important to treat swallowing problems to avoid upper respiratory diseases, from food and liquids going down the wrong way, dehydration from not being able to drink enough, and malnutrition from not eating enough. Difficulty swallowing is most common immediately after a stroke, but usually declines over time.

Symptoms can include:

• Difficulty starting to swallow
• Choking
• Coughing or gagging while swallowing
• Liquid coming out of the nose after attempting to swallow
• Getting food caught in the lungs
• Lost or weak voice
• Drooling
• Lack of tongue control
• Losing the gag reflex

If your doctor suspects a swallowing problem, a speech-language pathologist (SLP) will test your swallowing. Treatment, in the form of swallow therapy, is done with the help of an SLP, occupational or physical therapist. Swallow therapy includes exercises for all mouth muscles and may even include electrical stimulation to muscles at the back of the throat.

Dietary changes or changes to food choices may make living with dysphagia easier if you fear dehydration or malnutrition. Ask your healthcare professional for the best plan for your individual needs.

Fatigue is something that affects lots of stroke survivors, especially during rehabilitation. • Fortunately is starts to relent after a few months. Making changes to some of your activities can help reduce the grinding burden of fatigue and promote recovery. Here are some suggestions to help combat fatigue:

• Communicate. Your fatigue may not be obvious to others so talk to your friends, family and employer about what you are experiencing.
• Rest. Give yourself plenty of time to rest, including naps or scheduled rest periods during the day.
• Moderation. Don't push yourself too hard, especially if you’re not having a good day. It will leave you exhausted the next day.
• Journal. Keep a diary of how much you are doing every day. Celebrate your successes as you look back and see how far you have come.
• Take your time. It may take you longer to get ready to go places, so give yourself plenty of time. Rushing is exhausting.
• Start small. Build up stamina and strength slowly. Maintain some level of regular exercise and gradually increase it.
• Watch what you eat. Eat a healthy diet.
• Listen to your body. You are the expert on how you feel.

Foot drop makes it difficult to lift the front part of the foot, causing sufferers to drag their toes along the ground or lift their foot higher to avoid dragging their toes. It can be temporary or permanent, and it can occur in one or both feet. Rehabilitative therapy can strengthen the muscles and joints and facilitate recovery.

After a stroke, a condition called incontinence may develop in some people. This happens when the muscles that help you control urine and stool are weakened, thus making it more likely to have an accident. Unconscious leaking is the most common, but there are many types of bladder and bowel control problems. In many cases, incontinence is overcome in a relatively short period after a stroke. This can happen as a natural part of the recovery process or as a result of treatment or therapy. Treatment options include:

• Medication
• Bladder and bowel training
• Surgery
• Use of a catheter
• Behavioral and physical therapies

To help you retrain your bladder or bowel and better manage your incontinence, follow these steps:

• Timed voiding – involves scheduling bathroom breaks at specific times to avoid the sudden and uncontrollable need to go. The goal is to increase length of time between scheduled bathroom breaks.
• Urgency control – uses a combination of deep breathing and complex mental tasks to ignore the need to go.
• Pelvic floor muscle training – an activity known as Kegel exercises can build strength in the pelvic floor muscles and lead to better muscle and bladder control.
• Medication – using stool softeners or laxatives can be helpful for bowel incontinence.
• Diet changes – involves avoiding foods that may affect bladder and bowel incontinence, like coffee, alcohol or spicy foods.
• Intake monitoring – involves changing the timing, amounts and types of liquids to help control urinary incontinence.
• Wearing loose clothing – allows clothes to be taken off easier and get help quicker.

These may include:

• Not being able to express things correctly
• Not being able to name objects or people (anomia)
• Knowing what you want to say, but having the wrong words come out
• Not understanding spoken language
• Slurred or garbled speech

Movement problems usually happen on only one side of the body. These range from mild weakness to not being able to move an arm or leg at all. If muscles in the face are weakened, there may be a drooping of an eyelid, the mouth, or a whole side of the face.

Paralysis is the inability to move a muscle, and is one of the most common disabilities resulting from stroke. When part of the brain is damaged after a stroke, messaging between the brain and muscles may not work properly. Paralysis usually occurs on the side of the body opposite the side of the brain damaged by the stroke.

Hemiparesis is one-sided weakness that can affect your arms, hands, legs and facial muscles. If you have one-sided weakness you may have trouble performing everyday activities like eating, dressing, and using the bathroom. Rehabilitation treatments, exercises at home and assistive devices can help with your mobility and recovery. Rehabilitation treatments that are commonly used to improve use and movement in arms and legs include modified constraint-induced therapy (mCIT), electrical stimulation, cortical stimulation, imagery, and assistive devices like wide-tied shoes, canes, walkers and wheelchairs.

In addition to therapy and exercises, repeated practice of everyday activities and regular activity will help increase control and flexibility and re-establish nerve circuitry.

• Ignoring the side of the body that has been affected
• Dividing things at the midline – eating only from one side of the plate and leaving the rest

Post-stroke pain can occur immediately, weeks, or sometimes even months after a stroke. Research shows that more than half of stroke survivors have some form of post-stroke pain. In some cases, the pain is constant (chronic) and in others, it comes and goes. Post-stroke pain is generally categorized into two types:

• Local Pain - Most often felt in the joints.
• Central Pain - Can be constant, moderate or severe, and may be triggered by even slight sensations.

Post-stroke pain can be treated with the use of medications and physical therapy. It’s important that you keep a diary of the pain you experience, how long it lasts, and where you’re feeling the pain.

To avoid feeling pain at home:

• Avoid things that cause pain
• Position your body to reduce discomfort
• Use heat packs if helpful
• Stay active
• Be specific about the pain you experience

Seizures are common in the first few weeks after a stroke. Severe strokes, a hemorrhagic stroke, or a stroke in the cerebral cortex make them more likely. The risk of a seizure diminishes over time. Stroke survivors who suffer from recurring seizures and may be diagnosed with epilepsy.

Fortunately, anti-seizure medicines are very effective at controlling stroke-related epilepsy . Staying active and avoiding dehydration, overexertion and low blood sugar can limit seizures.

Sensory deficits usually occur on one side of the body. When the sense of touch is involved, there may be tingling or numbness in the face, arm, or leg. The ability to feel or sense hot or cold may be decreased or missing. You may have blurred vision or a loss of vision in one or both eyes. Blindness or defective vision is one half of the field of vision is called hemianopia or hemianopsia.

Sleep problems like insomnia, sleep apnea or sleep-wake cycle disorders are also common among stroke survivors.

• Insomnia - is the state of not being able to fall or stay asleep. Failing to get enough sleep can cause setbacks in post-stroke recovery. Treatment for insomnia may include prescription sedatives or changes in nighttime activities.
• Sleep Apnea - is a serious sleep-related breathing disorder that increases the risk of having a second stroke. Sleep apnea is usually characterized by loud snoring, choking and gasping sounds during sleep. One of the most common and effective methods of treating sleep apnea is continuous positive airway pressure, or CPAP. CPAP uses a machine to deliver short bursts of compressed air that prevent obstruction in the airway, and can help you get an uninterrupted night of sleep.
• Sleep-Wake Cycle Disorders - happens when the sleep-wake schedule is no longer affected by sunlight and the darkness of night. Sleep-wake cycle disorders are not usually permanent, and a combination of time and treatment will heal it in most cases. Treatment usually includes bright light therapy and/or the use of melatonin.

If you suffer from a sleep issue, making some of these lifestyle adjustments can help:

• Keep the bedroom dark and at a comfortable temperature
• Prevent and avoid noises that can be heard at night
• Increase movement and exercise throughout the day
• Expose yourself to light during the day
• Follow a regular sleep schedule
• Have a bedtime routine
• Do not eat food or watch TV in the bedroom
• Avoid beverages or foods with caffeine, like soda, coffee, tea and chocolate
• Eat dinner three hours before you go to bed
• Do not go to bed too full or hungry
• Do not drink any fluids within two hours of bedtime
• Avoid alcoholic beverages at night

After a stroke, damage to the brain can block messages between muscles and the brain, causing arm and leg muscles to cramp or spasm. These spasms can result in:

• A tight fist
• Bent elbow
• Arm pressed against the chest
• Stiffness in the arms, fingers or leg
• Stiff knee
• Pointed foot

Spasticity can be lessened and in some cases treated with the help of therapies and medications. Treatment can include braces, exercises, stretches, movement of the affected part of the body, medications, injections and surgery. Your healthcare professional can help you determine the best treatment plan for you.

Vision problems occur often after a stroke, including vision loss and perception problems.

Vision Loss is frequently experienced as blind spots in the field of vision. Different types of visual field loss include:

• Hemianopia - blindness in one half of the visual field.
• Quadrantanopia - blindness in a quarter of the visual field.
• Tunnel vision - loss of peripheral vision.

Vision Perception Problems is the difficulty processing what the eyes see. You may find it difficult to coordinate movement and focus your eyes, resulting in double vision. Common vision perception problems include:

• Double Vision - seeing two of one thing
• Visual Midline Shift
• Depth and Distance Perception
• Color Detection Problems
• Dizziness
• Hallucinations
• Agnosia – the failure to recognize common objects

There are many treatments for vision issues. Consult with an optometrist, ophthalmologist or primary care provider for suggestions about specific vision problems, symptoms and treatment.