Stroke Aftermath: Delayed Complications From Aborted Strokes

Stroke is a medical emergency that requires immediate attention and treatment. The effects of a stroke depend on the location of the obstruction and the extent of brain tissue affected. While prompt treatment improves survival and recovery rates, stroke can cause permanent loss of function, including physical, emotional, and personality changes, as well as thinking, memory, and perception impairments.

In some cases, individuals may experience an aborted stroke, where they exhibit stroke-like symptoms but do not show evidence of infarction on post-treatment imaging. This phenomenon is likely rare, and negative post-treatment imaging is often attributed to the treatment of stroke mimics or transient ischemic attacks (TIAs). However, the concept of aborted stroke warrants further investigation, especially with the increasing use of mobile stroke treatment units and faster thrombolysis.

The long-term effects of a stroke depend on the affected area of the brain and the severity of the damage

The long-term effects of a stroke depend on the area of the brain that was affected and the severity of the damage. The effects of a stroke can be physical, emotional, and psychological.

Physical Changes After a Stroke

Physical changes after a stroke depend on which part of the brain was affected. These changes can include:

• Difficulty with gripping or holding things
• Fatigue or tiredness, which can be caused by physical changes, medication, mood changes, depression, anxiety, or difficulty sleeping
• Incontinence, which can be caused by medication, muscle weakness, or changes in sensations, thinking, and memory
• Pain, which can be caused by actual or potential damage to tissues (nociceptive pain) or by nerve damage that sends incorrect messages to the brain (neuropathic pain)
• Restricted ability to perform physical activities or exercise
• Weakness or paralysis of limbs on one side of the body

Emotional and Personality Changes After a Stroke

It is common to experience changes in mood and personality after a stroke. Emotional changes may be caused by damage to the brain, or they may be a response to the life changes that come with having a stroke. Depression is common in the first year after a stroke, especially in people who have trouble understanding, finding words, and communicating (aphasia). Anxiety is also common, and it can manifest as difficulty calming down, constant worry, intense panic, recurring anxious thoughts, and avoidance of anxiety-causing situations. Personality and behavioural changes can include irritability, aggressiveness, apathy or lack of motivation, repetitive behaviour, disinhibition, and impulsiveness.

Changes to Thinking, Memory, and Perception After a Stroke

A stroke can affect your thinking and memory, as well as how you see, hear, and feel the world. This can impact your self-perception and your relationships with others. A stroke can affect your:

• Ability to learn new skills
• Ability to problem-solve
• Attention and concentration
• Orientation, or knowing the day and time
• Short-term memory

Perception refers to how you see, hear, and feel the world. After a stroke, you may experience changes in:

• Your sense of touch, pain, heat, or cold on the side of your body affected by the stroke
• Your ability to perform certain movements even without physical disability (apraxia)
• Your ability to recognise shapes, objects, or your own body
• Your field of vision, causing you to bump into things
• Your ability to watch TV or read
• Your vision, with some people losing half their vision in each eye (hemianopia)

Communication After a Stroke

For some people, a stroke affects the part of the brain that helps with speaking, reading, and communication. Symptoms of these strokes may include:

• Difficulty finding the right words or understanding what others are saying (aphasia or dysphasia)
• Weakness in the muscles that help with speech (dysarthria)
• Dysfunction of the nerve connection between the brain and mouth, making speaking difficult (dyspraxia)
• Reading and writing problems caused by a weak writing hand or problems with thinking or seeing

Everyday Life After a Stroke

Having a stroke can lead to changes in many aspects of everyday life, including:

• Living arrangements—you may need to move to residential care or modify your home
• Sexual function and relationships
• Your ability to drive or perform other complex skills
• Your ability to work, if you were working before the stroke
• Your level of independence—you may need to rely on carers at home

Support for Long-Term Effects After a Stroke

The types of healthcare professionals who can help with long-term effects depend on the challenges you face. A good first step is to speak with your doctor or rehabilitation team, who can refer you to other specialists as needed. These may include clinical psychologists, occupational therapists, rehabilitation nurses, and speech pathologists. Home help and respite care can also be beneficial, as can staying connected with family and friends or joining a support group.

Physical changes after a stroke include difficulty with gripping, fatigue, incontinence, pain, restricted physical abilities, and weakness or paralysis on one side of the body

A stroke can cause a wide range of physical changes, depending on which part of the brain was affected and the extent of the damage. Here are some of the physical changes that can occur after a stroke:

• Difficulty with gripping or holding things: This can affect a person's ability to perform everyday tasks and impact their independence.
• Fatigue: Extreme tiredness can be caused by physical changes, medication, mood changes, depression, anxiety, or sleep disturbances.
• Incontinence: Different types of incontinence can occur due to medication, muscle weakness, changes in sensations, thinking, and memory.
• Pain: This can be nociceptive pain, caused by actual or potential tissue damage, or neuropathic pain, resulting from nerve damage that sends incorrect signals to the brain.
• Restricted physical abilities: A stroke can lead to reduced mobility and difficulty performing physical activities or exercises.
• Weakness or paralysis on one side of the body: This is a common disability after a stroke, affecting movement and physical function.

These physical changes can have a significant impact on a person's daily life and may require specialized rehabilitation and support to aid in recovery. The recovery process can vary for each individual, and early treatment can improve outcomes.

Emotional and personality changes after a stroke include depression, anxiety, irritability, aggressiveness, apathy, repetitive behaviour, disinhibition, and impulsiveness

Emotional and personality changes are common after a stroke and can include depression, anxiety, irritability, aggressiveness, apathy, repetitive behaviour, disinhibition, and impulsiveness. These changes can be caused by damage to the brain or emotional problems resulting from the stroke.

Depression

Post-stroke depression is common, with up to 33% of survivors experiencing it. It can be caused by physical limitations, health worries, and changes in brain function. Treatment usually involves a combination of prescription antidepressants and counselling.

Anxiety

Anxiety affects about 20% of stroke survivors. It can be caused by changes in the brain or health challenges resulting from the stroke. Counselling and medication can help manage anxiety.

Irritability and Aggressiveness

Frustration and anger are common after a stroke, and can be caused by the emotional impact of the stroke as well as the resulting physical and cognitive limitations. Antidepressants may help reduce anger and aggression.

Apathy

Apathy, or a lack of motivation, can occur after a stroke due to a decline in cognitive abilities, depression, reduced responsibility, and structural and functional changes in the brain. Antidepressants and behavioural therapies can help manage apathy.

Disinhibition and Impulsiveness

A stroke can damage the parts of the brain that control emotional responses, leading to difficulties in controlling emotions. This can result in inappropriate behaviour, loss of social inhibitions, and impulsiveness. Cognitive behavioural therapy can help manage these changes.

Changes to thinking, memory, and perception after a stroke include difficulty learning new skills, problem-solving, attention, orientation, and short-term memory

A stroke can affect an individual's ability to think, remember and perceive things. This is known as cognition. Different parts of the brain work together to produce cognitive skills like thinking and memory. If one of those parts of the brain is damaged by a stroke, this can lead to cognitive problems.

Changes to thinking, memory, and perception after a stroke can include:

• Difficulty learning new skills: A stroke can affect an individual's ability to learn new skills.
• Problem-solving: A stroke can make it difficult for an individual to understand and fix a problem.
• Attention: Individuals may find it hard to concentrate and be easily distracted.
• Orientation: Not knowing what the day or date is, or where one is, are common issues post-stroke.
• Short-term memory: Not remembering things that happened a short time ago or people one met recently.

These changes can affect everyone differently, and rehabilitation programs can be tailored to meet individual needs and goals. Treatment might include practising problem-solving and everyday tasks, and using memory aids such as notebooks, diaries, alarms, and notes.

Communication after a stroke may be impacted, with difficulties in finding the right words, understanding speech, and reading and writing

Communication after a stroke

Communication after a stroke can be difficult, with problems finding the right words, understanding speech, and reading and writing. Around one-third of stroke survivors experience communication difficulties. These issues can be incredibly frustrating and isolating, and can even lead to depression. However, most communication problems do improve over time, and there are treatments available to help.

Types of communication difficulties

There are several types of communication difficulties that can occur after a stroke:

• Aphasia is a common problem, affecting around a third of stroke survivors. It impacts your ability to speak, read, write, and understand what others are saying. Aphasia does not affect your intelligence, but it can be extremely frustrating.
• Dysarthria occurs when you are unable to control the muscles in your face, mouth, and throat, making it difficult to speak clearly. Your speech may become slurred or slow, or your voice may sound quiet.
• Apraxia of speech happens when you are unable to move the muscles in your face, mouth, or throat in the correct order for speech. This can make it hard for others to understand you.
• Dysphonia is weakness or paralysis of the muscles in and around the vocal cords, causing your voice to become a whisper, hoarse, or rough. If you cannot make any sound, it is called aphonia.
• Cognitive difficulties can also occur, affecting your memory, thinking, and judgment. You may find it hard to pay attention when people are talking to you, understand complex sentences, or speak in a way that seems appropriate to others.

Treatments

Communication problems can be treated with speech and language therapy. A speech and language therapist can help you improve your speech, reading, and writing, as well as suggest alternative ways to communicate, such as gestures or electronic devices. They will work with you to develop a rehabilitation program tailored to your needs and goals. The more you practice, the more you will improve.

Tips for family and friends

If you know someone who is experiencing communication difficulties after a stroke, there are several things you can do to help:

• Make sure you are face-to-face when speaking.
• Choose a quiet place with no distractions.
• Ensure only one person speaks at a time.
• Speak slowly and use short, simple sentences.
• Use gestures, writing, or pictures to aid communication.
• Make it clear when the topic of conversation has changed.
• Check that you have heard and understood correctly.
• If you are not understood the first time, try to explain things in a different way.

Frequently asked questions