Recovering From A Bilateral Stroke: Is It Possible?

A bilateral stroke is a rare condition that affects both sides of the brain. It can be caused by multiple strokes or by a single stroke in a vessel that supplies both hemispheres. The effects of a bilateral stroke are typically more severe than those of a unilateral stroke, and can include a wide range of physical, cognitive, and emotional symptoms. However, recovery from a bilateral stroke is possible, and the rehabilitation process can help survivors regain their abilities and improve their quality of life. The key to recovery lies in early intervention, rigorous therapy, and personalised treatment plans that address the unique needs and goals of each survivor.

What is a bilateral stroke?

A bilateral stroke is a rare medical condition that affects both sides of the brain. It occurs when the blood supply to the brain is interrupted, either by a blocked artery or a burst blood vessel, causing brain cells to be deprived of oxygen-rich blood and die. This can lead to a range of physical, cognitive, and emotional symptoms, including movement difficulties on both sides of the body, language difficulties, memory problems, and depression.

Unlike typical strokes, which generally affect only one hemisphere of the brain, bilateral strokes impact both sides. This means that the effects of the stroke can be more widespread and diverse, as each side of the brain controls different functions. For example, a stroke in the left hemisphere may result in poor movement on the right side of the body, while a bilateral stroke can affect movement on both sides.

The treatment for a bilateral stroke consists of two phases: stopping the strokes and rehabilitating the brain. Ischemic strokes, caused by blood clots, can be treated with clot-busting drugs or surgery to remove the clot. On the other hand, hemorrhagic strokes, caused by a burst artery, may require surgery to repair the ruptured artery and relieve swelling in the brain.

The rehabilitation process for bilateral strokes focuses on restoring the survivor's abilities and typically includes physical therapy, speech therapy, and occupational therapy. It is a challenging process that requires consistent effort from the survivor, but neuroplasticity, the brain's ability to form new neural connections, makes recovery possible.

While bilateral strokes can have significant and diverse effects, timely treatment and rigorous rehabilitation can help minimize the impact and improve the chances of recovery.

What are the symptoms?

A bilateral stroke affects both sides of the brain. It can be caused by multiple strokes or a single stroke that affects a shared blood supply between both hemispheres. As with all strokes, timely treatment is necessary to prevent tissue damage.

The symptoms of a bilateral stroke can vary greatly between survivors. However, some common symptoms include:

• Language difficulties: such as aphasia (difficulty with or loss of speaking ability) or apraxia of speech.
• Movement difficulties: including weakness, paralysis, or poor movement on both sides of the body.
• Cognitive impairments: such as memory problems, difficulty with problem-solving, or confusion.
• Dysphagia: or difficulty swallowing.
• Sensory issues: including numbness, tingling, or post-stroke pain.
• Vision problems: such as blurred or double vision (diplopia).
• Emotional symptoms: such as depression or impulsivity.
• Fatigue: including heavy fatigue and trouble sleeping.

It is important to note that diagnosis of a bilateral stroke can be difficult because typical stroke symptoms may be displayed differently. For example, instead of weakness on one side of the body, both sides may be affected.

What is the treatment?

Treatment for a bilateral stroke occurs in two phases: stopping the strokes and rehabilitating the brain. Timely treatment is necessary to restore blood flow in the brain and prevent tissue damage.

If the bilateral stroke is caused by a blood clot (ischemic stroke), clot-busting medication can help reduce long-term effects if administered in time. Doctors can resolve this with clot-busting drugs like aspirin or tPA (when early intervention is possible). When drugs are not sufficient, doctors may use surgery to remove the clot in the brain.

If the bilateral stroke is caused by a burst artery (hemorrhagic stroke), surgery is more rare and attempts to repair the ruptured artery and relieve swelling in the brain. Hemorrhagic strokes are not treated with clot-busting drugs because they would make the bleeding in the brain worse.

After the stroke has been treated and blood flow is restored to the brain, the brain damage is irreversible, and the brain cells that died cannot be brought back. However, the brain is resilient, and other neurons can adapt and make new connections to take over the functions of the lost cells. This process is called neuroplasticity.

Rehabilitation focuses on restoring the survivor's abilities that were compromised by the stroke. For example, if speech was impaired by the stroke, rehabilitation focuses on improving the survivor's ability to communicate. Rehabilitation can take many forms, including:

• Speech therapy: This can help the patient regain language and speaking abilities and improve their ability to control muscles that help them breathe, eat, drink and swallow.
• Physical therapy: This can help the patient improve or regain the ability to use their hands, arms, feet and legs. This can also help with balance issues, muscle weakness and more.
• Occupational therapy: This can help retrain the patient's brain so they can go about their daily activities. This therapy is especially helpful in improving precise hand movements and muscle control.
• Cognitive therapy: This can be helpful if the patient is having memory problems. It can also help if they have difficulty with activities that require focus or concentration.

Long-term treatments

There are also long-term treatments for stroke, which happen in the days and months after emergency treatment. These include:

• Thrombolytic drugs (within three to four and a half hours).
• Blood pressure management.
• Thrombectomy (within 24 hours if there’s no significant brain damage).
• Reversal of any medication that might increase bleeding.
• Use of medications or surgery to reduce pressure inside the skull.

What is the recovery process?

The Recovery Process

The recovery process for a bilateral stroke will depend on the severity of the stroke, the area of the brain affected, and how quickly treatment is provided. However, there are some general steps that can be outlined.

Initial Treatment

If you experience a bilateral stroke, you will likely be admitted to an emergency department to stabilize your condition and determine the type of stroke. If it is caused by a blood clot (ischemic stroke), clot-busting medication can be administered to help reduce long-term effects if given in time. The faster you receive treatment, the better your chances of recovery. During this initial stage, you may need to spend time in intensive or acute care.

Rehabilitation

Rehabilitation should start as soon as possible after the initial treatment, ideally within 24 hours. The rehabilitation team includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They work together to evaluate the effects of the stroke and create a rehabilitation plan. The typical length of a hospital stay after a stroke is five to seven days, during which therapy sessions are conducted up to six times a day to help evaluate the damage and jump-start the recovery process.

The focus of rehabilitation is on restoring the patient's abilities that were compromised by the stroke. This includes physical abilities, such as walking and sitting, as well as cognitive and emotional functions. Physical therapy helps improve balance and coordination, while occupational therapy focuses on relearning skills needed for activities of daily living, such as dressing, bathing, and eating. Speech therapy is crucial for patients who have trouble swallowing or speaking due to the stroke.

Long-Term Recovery

The first three months after a stroke are the most critical for recovery, with most improvements occurring during this period. However, gains can continue to be made for up to a year, and even beyond. It is important to continue following up with your care team, including your primary care physician, rehabilitation physician, physical and occupational therapists, a neurologist, and a rehabilitation psychologist. They can help manage any ongoing health concerns and support your long-term recovery.

Even with good care, a severe bilateral stroke may result in serious disabilities or ongoing impairments, known as chronic stroke disease. In some cases, a stroke can cause immediate death or lead to death days, weeks, or months later.

What are the risks of another stroke?

After any stroke, the chance of a second stroke is much higher, and if the brain has already suffered damage, a second stroke can cause further harm. The medical team works hard to reduce the risk of a second stroke by treating risk factors like blood clotting, high blood pressure, and heart problems. However, it is important to be aware of the risks and take steps to prevent another stroke. Here are some key points to consider:

• High blood pressure is a significant risk factor for both ischemic and hemorrhagic strokes. It is crucial to manage blood pressure through medication, lifestyle changes, and regular monitoring.
• Heart disease and atrial fibrillation are also common risk factors. It is important to address any heart-related issues and maintain a healthy cardiovascular system.
• Diabetes can increase the risk of ischemic strokes, so managing blood sugar levels is essential.
• Smoking is another modifiable risk factor. Quitting smoking can significantly reduce the chances of having another stroke.
• Blood clotting is a critical factor in ischemic strokes. Anticoagulants and other treatments may be prescribed to prevent blood clots from forming or breaking loose and travelling to the brain.
• Advanced carotid stenosis or clogging of the neck arteries on both sides is a risk factor for bilateral watershed strokes, which can lead to severe disability.
• Traumatic head injuries can increase the risk of hemorrhagic strokes, so it is important to take precautions to protect the head, especially if the person is at risk of falls or participates in contact sports.
• Arteriovenous malformations and ruptured brain aneurysms are also risk factors for hemorrhagic strokes. These conditions may require surgical intervention or other treatments to reduce the risk of a stroke.
• High cholesterol is linked to an increased risk of stroke. A healthy diet and, if necessary, medication can help manage cholesterol levels.
• Alcohol use disorder and drug misuse are also risk factors for stroke. It is important to seek professional help if struggling with substance abuse.
• Migraines are associated with an increased risk of stroke, especially migraines with auras. Managing migraines and addressing any underlying causes can be a crucial part of stroke prevention.

While these are some of the key risks associated with another stroke, it is important to work closely with a medical team to identify and address specific risk factors. Each person's situation is unique, and a personalized treatment plan is essential for effective stroke prevention. Additionally, participating in rigorous therapy and making recommended lifestyle changes can help reduce the risk of another stroke and improve overall health and well-being.

Frequently asked questions