Recognizing Stroke Symptoms: Understanding The Time Sensitivity

A stroke is a life-threatening medical emergency that requires immediate attention. The recovery process can be lengthy and differs from person to person, depending on factors such as the severity of the stroke, age, and prior health status. The first three to four months after a stroke are crucial for recovery, with most improvements occurring during this period. However, it's important to note that gains can continue well into the first and second year. Rehabilitation plays a vital role in helping individuals regain their independence and improving their quality of life.

The first few minutes

Face Drooping: Check for face drooping by asking the person to smile. If one side of their face droops or appears numb, it could be a sign of a stroke.

Arm Weakness: Ask the person to raise both arms. If one arm drifts downward, it could indicate a stroke. This is a sign of sudden numbness or weakness on one side of the body.

Speech Difficulty: Pay attention to their speech. Is it slurred or strange? Are they having trouble speaking or understanding speech? These are additional indicators of a potential stroke.

Time to Act: If you observe any of these signs, it's time to act fast. Call 911 immediately and note the time when the symptoms first appeared. This information is crucial for helping healthcare providers determine the best treatment.

Other early signs and symptoms of a stroke include sudden confusion, trouble seeing in one or both eyes, dizziness, loss of balance, and a severe headache with no apparent cause. It's important to remain vigilant and take immediate action if you suspect someone is having a stroke.

Remember, stroke treatments that work best are typically only available if the stroke is recognised and diagnosed within 3 hours of the first symptoms. Therefore, it's crucial to act swiftly and seek emergency medical assistance.

Immediate treatment

A stroke is a life-threatening medical emergency, and immediate action is required to prevent permanent damage or death. Here are the steps to take for immediate treatment:

Recognise the Signs

The faster you receive treatment for a stroke, the better. Strokes are not always easy to recognise, but there are some key signs to look out for. Remember the acronym FAST:

• Face: Ask the person to smile and observe if one side of the face droops.
• Arms: Ask the person to raise both arms. If they have muscle weakness on one side, one arm will drop.
• Speech: Check for slurred speech or difficulty choosing the right words.
• Time: Act quickly and call emergency services.

Call Emergency Services

If you or someone around you is showing signs of a stroke, call 911 or your local emergency number immediately. Time is critical, and quick treatment can reduce the risk of death or long-term disability.

First Aid

While waiting for emergency services to arrive, you can perform first aid. Put the person in a safe and comfortable position, lying on their side with their head slightly raised in case they vomit. Check if they are breathing and perform CPR if necessary. If they are bleeding, apply pressure to the wound. Observe their condition carefully and be prepared to inform the emergency operator of any changes, including if the person fell or hit their head.

Medical Treatment

Once the person is in the care of medical professionals, they will be taken to the emergency department to stabilise their condition and determine the type of stroke. If it is an ischemic stroke caused by a blood clot, clot-busting medication can be administered to reduce long-term effects. Alteplase IV r-tPA, also known as tissue plasminogen activator, is the first and only FDA-approved drug treatment for ischemic strokes. It dissolves the clot and improves blood flow when administered within three hours, and in certain cases, up to four and a half hours.

In some cases, an endovascular procedure may be performed to remove the clot by sending a catheter to the site of the blocked blood vessel. This procedure may involve administering tPA directly into the blood clot to dissolve the blockage.

The first few weeks

The rehabilitation team will include physiatrists, neurologists, physical and occupational therapists, speech-language pathologists and nurses. They will meet daily to discuss the patient's condition, and therapy will be delivered as often as every hour during the first day or two. Therapy sessions will be conducted up to six times a day while the patient is in the hospital.

The rehabilitation will focus on activities of daily living (ADL), such as bathing and preparing food. The patient and their care team should also discuss activities important to the patient, such as work-related skills or hobbies, to help set recovery goals.

The patient may experience a range of symptoms in the first few weeks after a stroke, including:

• Cognitive symptoms like memory problems and trouble speaking
• Physical symptoms such as weakness, paralysis, and difficulty swallowing
• Emotional symptoms like depression and impulsivity
• Heavy fatigue and trouble sleeping

It's important to be aware that recovery times vary for everyone. While some people may recover in a matter of days or weeks, for others, it can take months or years and may require significant life changes.

Rehabilitation

The road to recovery after a stroke is different for everyone. For some, it may take days or weeks to recover with little impact on their lives. For others, it can take months or years and may require significant life changes. Rehabilitation focuses on overcoming post-stroke side effects and symptoms.

The Rehabilitation Team

The rehabilitation team typically includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They meet daily to discuss the patient's condition, and some form of therapy is delivered as often as every hour during the first day or two.

The Rehabilitation Plan

The rehabilitation plan may include:

• Physiotherapy and exercises to help with movement and problems such as numbness down one side of the body.
• Cognitive behavioural therapy (CBT) to help with anxiety, depression, and tiredness.
• Activities to improve memory, concentration, thinking, and mood (cognitive rehabilitation).
• Exercises to help improve problems with speech, swallowing, and vision.
• Advice, exercises, and medications to help with bowel or bladder problems.

Therapy Types

There are several types of therapy that can aid in stroke rehabilitation:

• Speech therapy: This helps improve communication, speech, and swallowing.
• Physical therapy: This assists with movement, physical function, and coordination skills, such as walking and balance.
• Occupational therapy: This helps regain skills needed for daily living, such as eating, drinking, dressing, bathing, reading, and writing.
• Recreational therapy: This aids in regaining social skills.
• Psychotherapy: This addresses post-stroke depression or other mental health challenges.

Recovery Timeline

The first three to four months after a stroke are typically when the most rapid recovery takes place. During this time, most patients will enter and complete an inpatient rehabilitation program or make significant progress in their outpatient therapy sessions. After six months, improvements are still possible but will be much slower. Some stroke survivors can continue to improve for up to 18 months post-stroke, depending on the rehabilitation they receive.

Factors Affecting Recovery

Several factors influence the recovery process:

• The location and extent of the stroke in the brain.
• The survivor's motivation.
• The availability of caregiver support.
• The quantity and quality of rehabilitation.
• The survivor's health before the stroke.

Long-term effects

The long-term effects of a stroke depend on its severity and the area of the brain affected. The more severe the stroke, the worse the damage. The faster you get medical attention for stroke symptoms, the better your chances that the effects are temporary or less severe.

Cognitive Symptoms

People who have had a stroke may experience memory problems, trouble speaking, and difficulties with thinking and reasoning. Cognitive therapy can help with memory issues and problems with focus and concentration.

Physical Symptoms

Physical symptoms can include weakness, paralysis, and difficulty swallowing. Physical therapy can help improve or regain the ability to use hands, arms, feet, and legs, as well as address balance issues and muscle weakness.

Emotional Symptoms

Emotional symptoms can include depression, impulsivity, and anxiety. Rehabilitation psychologists and neuropsychologists can help screen for these issues and create a plan to improve emotional functioning.

Fatigue and Sleep Disturbances

Stroke survivors often experience heavy fatigue and trouble sleeping.

Sensory Changes

Sensory changes can occur on one side of the body, such as loss of sensation or altered sensation.

Vision Problems

If the stroke occurs toward the back of the brain, it is likely to result in some form of disability involving vision.

Behavioral Changes

A stroke can result in behavioral changes such as a slow, cautious behavioral style or a quick, inquisitive behavioral style.

It is important to note that the recovery process after a stroke is unique to each individual and can be slow and uncertain. Rehabilitation plays a crucial role in helping stroke survivors regain function and adapt to any lasting changes.

Frequently asked questions