ISCHEMIC STROKE

Clinical Consequences of Stroke

Updated on 15/02/2024, published on 15/12/2023

  • stroke is associated with a wide range of clinical signs and symptoms
  • resulting disability depends on:
    • the location and extent of the brain lesion
      → signs and symptoms of cerebral lesions
      → brainstem syndromes
    • the degree of neurological recovery (influenced by factors such as recanalization therapy, early rehabilitation, and ergotherapy)
      • early treatment and rehabilitation after a stroke can significantly improve recovery, allowing many patients to regain a substantial level of functionality
    • the patient’s premorbid status
  • the stroke recovery process is long and can come with many challenges; many people never fully recover
    • the greatest neuroplasticity, or rewiring of neural pathways and connections in the brain, occurs in the first 6 months after stroke onset 
    • stroke recovery is not linear and most patients experience ups and downs during recovery
    • potential causes of temporary worsening:
      • new medication
      • overworking
      • emotional changes
      • stopping rehabilitation and exercising
  • NIHSS scale is a standardized neurological scale designed to assess the severity of ischemic stroke objectively
  • modified Rankin scale (mRS) is used to assess functional outcome (the overall level of disability or dependence in daily activities) among patients who have suffered a stroke

Overview of long-term stroke effects

  • paresis

    • hemispheric stroke usually causes contralateral deficit (hemiparesis); brainstem or spinal cord lesions lead to quadriparesis or paraparesis
    • use the Oxford strength scale to asses the muscle strength in more detail
  • spasticity
  • ataxia
  • perception disorders
    • visual field defects (typically hemianopsia, quadrantanopia, scotoma, or monocular blindness)   Visual field defects
    • diplopia
    • hypesthesia (impaired tactile, thermal, or pain sensation)
    • pain (such as thalamic pain, pain due to spasticity, frozen shoulder, etc.)
    • complex perceptual disorders due to lesions of association areas
      • face or color agnosia, neglect syndrome, anosognosia, etc.
      • problems with recognizing shapes and objects or even one’s own body
  • dysphagia
  • problems with speech
    • aphasia (difficulty finding the right words or understanding what others are saying)
      • global, Broca´s, Wernicke´s
    • dysarthria
      • paresis of oropharyngeal muscles (bulbar x pseudobulbar syndrome)
      • apraxia
    • reading and writing problems (multiple factors – aphasia, a writing hand paresis, altered vision, etc.)
  • poststroke mood disorders
    • anxiety (20%)
      • survivor focuses on worries and concerns
    • poststroke depression (PSD)
      • affects 1/2-2/3 of survivors
      • feelings of overarching sadness, lack of pleasure in old activities, or changes in eating and sleeping patterns
    • personality and behavioral changes, emotional lability
      • pseudobulbar affect (PBA), also known as emotional incontinence, causes sudden and unpredictable episodes of inappropriate involuntary crying or laughing, often in socially inappropriate situations  (Ahmed, 2013)

        • caused by disconnection between the frontal lobe (which controls emotions) and the cerebellum and brain stem
      • irritability and aggressiveness (physical or verbal)
      • apathy with a lack of motivation
      • disinhibition (tendency to say or do socially unacceptable things)
  • vascular cognitive impairment (VCI)
    • problems with memory, attention, problem-solving, and executive functioning
  • poststroke fatigue or tiredness
    • caused by physical changes or medications, but also mood changes, depression, anxiety, or difficulty sleeping
    • includes a decrease in both mental and physical energy levels, affecting the ability of a survivor to participate in daily or rehab activities
  • incontinence
    • incontinence or difficulty controlling bladder/bowel
    • often multifactorial; may be caused by medication, muscle weakness, changes in sensation, thinking, and memory
  • stroke-related epilepsy (STRE)
    • stroke is the cause of about 10% of all epilepsy cases and 55% of newly diagnosed seizures among the elderly  (Feyissa, 2019)

Rehabilitation, which may include physical, occupational, speech therapy, and psychological support, plays a crucial role in recovery and adaptation to these changes.

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Clinical Consequences of Stroke
link: https://www.stroke-manual.com/consequences-of-stroke/