Coughing And Strokes: What's The Connection?

Coughing can cause a stroke, although it is rare. Forceful coughing can increase the pressure inside the brain, causing a hemorrhagic stroke. In some cases, violent coughing can tear the lining of an artery, triggering a life-threatening health crisis. For instance, a 49-year-old man suffered a severe stroke that was likely caused by a violent cough, which tore an artery in his neck. In another case, a doctor suffered a rare type of stroke after years of chronic coughing tore the lining of an artery in her neck.

Coughing can tear an artery in the neck

Coughing can sometimes lead to strokes, which can be life-threatening. A stroke is caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). A tear in the artery can cause blood to pool and pinch the artery closed, blocking blood flow to the brain. This is what happened to Dr. Shaiba Ansari-Ali, a rheumatologist at Northwestern Medicine Delnor Hospital in Geneva, Illinois. She suffered a rare and deadly type of stroke, called a basilar artery stroke, which left her with locked-in syndrome, where she was aware of what was happening but appeared unconscious to others.

Forceful coughing, violent coughing, or coughing fits can cause tears in the arteries in the neck, which can lead to a stroke. This is especially true for those with high blood pressure or a cerebral aneurysm (a weakened blood vessel in the brain that could rupture under pressure). In addition, coughing can increase pressure in the chest and stomach, which may then lead to increased pressure in the brain. This increased pressure can cause a hemorrhagic stroke.

Coughing can also cause a rare phenomenon called a cough-induced hemispheric transient ischemic attack (TIA). A TIA is a temporary disruption of blood flow to the brain that doesn't usually cause lasting symptoms. However, in some cases, it may require treatment with surgery.

It is important to recognize the signs of a stroke, which can include numbness or weakness in the face, arm, or leg; confusion or trouble speaking or understanding speech; trouble seeing in one or both eyes; dizziness, or problems with balance; and severe headaches. If you experience any of these symptoms, it is crucial to seek medical help immediately.

This can block blood flow to the brain

Coughing can lead to a tear in the artery, which can trigger a stroke. A stroke is caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). In the case of Dr. Shaiba Ansari-Ali, a rheumatologist at Northwestern Medicine Delnor Hospital in Geneva, Illinois, her chronic cough led to a vertebral artery dissection, which caused her stroke. The violent coughing she experienced tore the lining of an artery that goes to the brain along the back of the neck, blocking blood flow to the brain and triggering a life-threatening crisis.

Janette Church, a 38-year-old mother of two, also suffered a stroke caused by a coughing fit. She experienced a small tear in her artery, located in her neck, which allowed blood to pool and then pinch the artery closed, blocking blood flow to her brain. This type of stroke can occur when there is a sudden increase in pressure inside the brain.

For patients with high blood pressure or those who have been diagnosed with a cerebral aneurysm, forceful coughing, sneezing, or blowing one's nose could cause a hemorrhagic stroke. This is because these actions can increase the pressure inside the brain, causing blood vessels that go to the brain to burst or become blocked.

Cough-induced hemispheric transient ischemic attacks (TIAs) are a rarely described phenomenon where coughing leads to a temporary disruption of blood flow to the brain. While TIAs do not cause lasting symptoms, they are a warning sign of a potential future stroke.

It can increase pressure inside the brain

Coughing can lead to a stroke, as evidenced by several cases. One such incident involved a 49-year-old man, Paul Park, who suffered a severe stroke potentially triggered by a violent cough from a nasty cold. Another case was that of Dr. Shaiba Ansari-Ali, a rheumatologist, who experienced a rare and deadly type of stroke brought on by a chronic cough. These instances highlight the potential danger of coughing and its ability to increase pressure inside the brain, leading to life-threatening situations.

The mechanism by which coughing can induce a stroke involves the sudden increase in pressure inside the brain. Forceful coughing, particularly in individuals with high blood pressure or a cerebral aneurysm, can cause a rapid surge in intracranial pressure. This pressure increase can lead to a hemorrhagic stroke, which is a type of stroke caused by a leaking or bursting blood vessel. The increased pressure can also cause a transient ischemic attack (TIA), a temporary disruption of blood flow to the brain that can have serious consequences.

The impact of coughing on intracranial pressure is significant, especially for those with underlying health conditions. For individuals with high blood pressure, the force of coughing can further elevate their blood pressure, increasing the risk of a stroke. Additionally, for those with a cerebral aneurysm, or a weakened blood vessel in the brain, the sudden increase in pressure from coughing can lead to a rupture, resulting in a stroke. This is why it is crucial for people with these conditions to be cautious and seek medical advice if they experience severe coughing.

Furthermore, the physical act of coughing can exert stress and strain on the neck and blood vessels, particularly the arteries leading to the brain. In the case of Dr. Shaiba Ansari-Ali, her chronic cough put her neck under constant stress, eventually leading to a vertebral artery dissection. This condition involves the tearing of the lining of the artery, causing a blockage that restricts blood flow to the brain and triggers a stroke. The force of coughing can also lead to a subarachnoid haemorrhage, a type of brain bleed that occurs during physical exertion or straining.

Understanding the link between coughing and increased intracranial pressure is crucial for recognizing the potential dangers of even a common ailment like a cold or cough. While not everyone who coughs will suffer a stroke, it is important to be aware of the potential risks, especially for those with pre-existing health conditions. Recognizing the warning signs of a stroke, such as numbness, speech difficulty, and vision problems, is vital, and prompt medical attention can save lives.

This can lead to a rare condition called locked-in syndrome

A violent or chronic cough can lead to a tear in the artery, triggering a severe stroke. This can lead to a rare condition called locked-in syndrome (LIS), where the patient is aware but unable to move or communicate verbally. This is due to the complete paralysis of nearly all voluntary muscles in their body, except for vertical eye movements and blinking.

LIS is usually caused by damage to the lower brain and brainstem, specifically the pons, and is often the result of a stroke or brain haemorrhage. The pons is a broad horseshoe-shaped mass of nerve fibres that connects the medulla oblongata (the lowest portion of the brainstem) with the cerebellum, which plays a vital role in physical movement and coordination. Damage to the pons results in the interruption of all the nerves running from the brain, through the spinal cord, and to the body's muscles, resulting in paralysis.

People with LIS are conscious, alert, and have their normal cognitive abilities, but they are unable to show facial expressions or speak. They may be able to communicate through coded messages using eye movements or blinking, as these functions are often not affected by the paralysis. In some cases, individuals with LIS may retain some movement in certain facial muscles.

The diagnosis of LIS can be challenging, as patients may initially appear unconscious or in a coma following a stroke. It is also difficult to measure responsiveness in patients with LIS, as they lack typical motor responses to pain or other stimuli. Brain imaging and electroencephalography (EEG) tests can aid in the diagnosis by providing clues about brain function and sleep-wake patterns.

There is currently no cure or specific treatment for LIS. However, individuals with LIS may benefit from supportive therapy, communication training, and assistive technologies to help them interact with their environment.

People with high blood pressure are at greater risk

It is possible for a violent coughing fit to cause a tear in an artery, leading to a severe stroke. While this is a rare occurrence, people with high blood pressure are at greater risk of this happening.

High blood pressure, or hypertension, is a condition where the force of blood against the walls of your arteries is too high. This force can weaken the arteries, making them more susceptible to tears. When a person with high blood pressure coughs forcefully, the increased pressure in the brain caused by the action of coughing can lead to a hemorrhagic stroke. This is because the forceful coughing may cause a sudden increase in pressure inside the skull, which can then result in a tear in the blood vessels of the brain.

In addition, people with high blood pressure are already at an increased risk of experiencing a stroke. This is because high blood pressure can cause damage to the blood vessels and the heart, increasing the likelihood of a blood clot forming and blocking an artery, or of a blood vessel leaking or bursting. Therefore, the combination of high blood pressure and violent coughing can be particularly dangerous.

It is important to note that not everyone who experiences a violent coughing fit will suffer a stroke, even if they have high blood pressure. However, it is crucial to be aware of the potential risk and to seek medical attention if you are experiencing any unusual symptoms, such as numbness or weakness in the face, arm, or leg, confusion or trouble speaking, sudden loss of eyesight, or severe headaches. These could be warning signs of a stroke, and early intervention can significantly improve outcomes.

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