Navigating Post-Stroke Challenges: strategies for managing 14 prevalent issues
survivors may face numerous complications following a stroke. These conditions can impact their physical, mental, and emotional well-being and can be either temporary or long-lasting. The degree of complications may depend on various factors, such as the size, location, and cause of the stroke, as well as the patient's age.
Neurologist Sidonie Ibrikji, MD, discusses the 14 most common complications that survivors might encounter in the aftermath of a stroke and offers advice on managing symptoms.
Factors Impacting Stroke Complications
Each stroke is unique, and recovery varies significantly. Several factors can influence the severity and type of complications, including the size and location of the stroke, its underlying cause, and the patient's age. Strokes can be classified into two types: ischemic and hemorrhagic.
Ischemic strokes occur when a blood vessel in the brain becomes blocked, usually due to the buildup of cholesterol plaques caused by risk factors like high blood pressure, high cholesterol levels, diabetes, or smoking. The clot can form in a vessel within the brain or originate elsewhere, such as the heart, before traveling to the brain.
Hemorrhagic strokes result from a weakened blood vessel in the brain that ruptures, causing bleeding. The bleeding may occur within the brain or the surrounding spaces, such as the subarachnoid, subdural, or epidural space.
Common Stroke Complications
Stroke survivors must remain vigilant to changes in their body and mind, even when seemingly minor complications occur. It is essential to notify the healthcare provider of any changes to facilitate timely management and prevent future strokes.
Brain Swelling (Cerebral Edema)
The buildup of fluid in the brain, known as cerebral edema, can lead to pressure that restricts blood flow and oxygen supplies to the brain. This condition is potentially life-threatening and requires prompt medical attention. Symptoms usually appear within the first three to five days after the stroke, and may include headache, nausea, vomiting, decreased level of consciousness, incontinence, stiffness in the neck, loss of vision or memory, difficulty speaking, or walking. Seizures are also possible symptoms.
Blood Clots and Deep Vein Thrombosis (DVT)
Immobility after a stroke increases the risk of developing blood clots, most commonly in the legs or lungs. Clots can dislodge and travel through the bloodstream, potentially causing a life-threatening condition called pulmonary embolism. Symptoms of DVT may include swelling in a leg or arm, pain, redness, and warm skin. Treatment may involve anticoagulant medication to reduce the risk of clotting and prevent complications.
Aphasia or Speech Disorders
Damage to parts of the brain responsible for language may cause aphasia, a condition characterized by impaired expression and understanding of language, as well as difficulties with reading and writing. A speech-language pathologist can formulate therapy plans for stroke survivors and their families to help improve communication.
Trouble Swallowing (Dysphagia)
Muscle issues accompanying a stroke can lead to difficulties swallowing food and liquids. Signs of dysphagia include struggling to chew, keeping food or liquids in the mouth, repeated throat-clearing, or food coming out through the nose. Severe cases may require adapted feeding methods or swallowing therapy.
Pneumonia
Aspiration of food or liquids due to dysphagia can lead to pneumonia. To prevent aspiration, it is recommended to maintain proper posture during eating, avoid aspirating, or, in severe cases, receive nutrition through a tube if dietary modifications are not enough.
Bladder and Bowel Problems
Stroke-induced damage to the brain parts responsible for bladder and bowel control can result in complications, such as increased frequency, urgency, nocturia, or difficulty emptying the bladder. Additionally, immobility can increase the chances of fecal impaction, urinary tract infections, or other gastrointestinal issues. Treatment may involve medications, physical therapy, occupational therapy, or pelvic floor therapy.
Seizures or Epilepsy
Depending on the location and severity of the stroke, seizures or possible epilepsy may develop. Most seizures occur shortly after severe hemorrhagic strokes. Multiple seizures over time can result in an epilepsy diagnosis. Medication and collaboration with the healthcare provider can help manage the condition.
Headache
Headaches are more common in individuals who have had hemorrhagic strokes due to irritation from the blood that is reabsorbed. It is crucial to consult a medical professional before taking over-the-counter pain medication, as a headache clinic might be recommended.
Bedsores
Immobility caused by a stroke can lead to bedsores, or pressure ulcers. These can be painful, and increased risk factors include prolonged pressure on the skin, lack of movement, poor nutrition, and lack of hydration. Preventative measures include changing positions regularly, keeping skin clean and dry, and maintaining proper hygiene.
Involuntary Muscle Tightening (Spasticity)
Muscle tightening and pain in the limbs may occur due to stroke damage. Physical therapy, stretching exercises, and medications can help alleviate symptoms. In severe cases, injection of botulinum toxin may be necessary.
Limb Contracture
Prolonged immobility can lead to muscle, ligament, and tendon shrinkage, known as limb contracture. This condition may cause limited range of motion or pain. The healthcare provider can prescribe various therapies and devices, such as casting or splinting, to correct the contracture. In severe cases, surgery may be required.
Shoulder Pain
Many stroke survivors experience shoulder pain due to general muscle weakness and subluxation. Seeking early evaluation and treatment is crucial to manage the pain effectively.
Falls
Various factors, such as balance issues, dizziness, limb contracture, or spasticity, can increase the risk of falling in stroke survivors. The likelihood of falling increases as people age, but well-planned risk assessments, treatments, and lifestyle modifications can help reduce the risk and prevent injuries.
Depression or Other Mood Changes
Depression is a treatable condition that can occur following a stroke, although it may be underdiagnosed. Emotional symptoms can include mood swings, irritability, apathy, lack of motivation, and uncontrolled expressions of emotions. The healthcare provider may recommend counseling or prescribe antidepressants. Joining a support group can also provide emotional support.
Support During Stroke Recovery
The aftermath of a stroke can be challenging, whether or not the individual is dealing with physical and cognitive issues. With the help of loved ones and healthcare providers, stroke survivors can navigate any complications they encounter and move forward with confidence. Resources like the American Stroke Association exist to offer information and connect individuals with available support systems.
- Neurologist Sidonie Ibrikji discusses the 14 most common complications that stroke survivors may face post-stroke.
- Each stroke is unique, with recovery varying significantly due to factors such as size, location, and cause of the stroke, as well as the patient's age.
- Strokes can be classified as ischemic or hemorrhagic; ischemic strokes are caused by blocked blood vessels in the brain, while hemorrhagic strokes result from weakened blood vessels that rupture.
- One potentially life-threatening complication from strokes is cerebral edema, characterized by the buildup of fluid in the brain leading to increased pressure.
- Symptoms of cerebral edema include headache, nausea, vomiting, decreased level of consciousness, incontinence, stiffness in the neck, loss of vision or memory, difficulty speaking, or walking, and seizures are possible.
- Blood clots and deep vein thrombosis (DVT) are common complications, with immobility increasing the risk, especially after a stroke.
- Aphasia or speech disorders may occur due to damage to parts of the brain responsible for language following a stroke.
- Difficulties swallowing food and liquids, known as dysphagia, can result from muscle issues caused by a stroke.
- Aspiration of food or liquids due to dysphagia can lead to pneumonia.
- Bladder and bowel problems, such as incontinence, difficulty emptying the bladder, or urinary tract infections, can result from stroke-induced damage to brain parts responsible for bladder and bowel control.
- Seizures or epilepsy, as well as headaches, may develop depending on the location and severity of the stroke.
- Bedsores, or pressure ulcers, can form due to immobility caused by a stroke, increased risk factors include prolonged pressure on the skin, poor nutrition, and lack of hydration.
- Involuntary muscle tightening (spasticity), shoulder pain, and falls can be additional complications for stroke survivors.
- Depression is treatable and can occur following a stroke, with emotional symptoms such as mood swings, irritability, apathy, and uncontrolled expressions of emotions being common. Resources like the American Stroke Association are available to offer information and connect individuals with support systems.
