Vision Problems After Stroke: What Patients See

Stroke is a medical emergency and a leading cause of disability and death in the US. It occurs when there is a blockage in the blood vessels supplying the brain or when a blood vessel in the brain ruptures. The effects of a stroke depend on where in the brain it occurs and how much brain tissue is affected. The faster a stroke is treated, the more likely the patient is to survive and avoid disability. Stroke symptoms include face drooping, arm weakness, speech difficulty, confusion, trouble seeing, and loss of balance or coordination.

Stroke symptoms: balance, vision, face, arms, speech

Balance

A stroke can affect your balance by changing the way your brain controls it. You may feel unsteady or uncoordinated, and experience weakness on one side of your body. This can make it difficult to sit up or stand, and you may find yourself walking with a dragging foot, known as foot drop. You may also experience a loss of sensation in your affected side, particularly your legs, which can make it difficult to move around.

Vision

Vision problems are common after a stroke. These can include difficulty focusing, double vision, and eye movement problems. You may also experience visual field loss, where you lose part or whole sections of your visual field, and visual processing problems, where you struggle to recognise objects and people or experience visual hallucinations.

Face

A stroke can cause sudden numbness or weakness in the face, especially on one side.

Arms

As with the face, a stroke can cause sudden numbness or weakness in the arms, usually on one side of the body.

Speech

Speech and language problems are common after a stroke. You may experience sudden confusion, have trouble speaking or understanding speech, or be unable to make sense of text.

Stroke diagnosis: neurological exam, imaging, tests

Stroke diagnosis is a complex process that involves a range of tests and examinations to confirm the condition and determine the best course of treatment. Here is an overview of the key components of stroke diagnosis:

Neurological Exam

The neurological exam plays a crucial role in evaluating a patient with a suspected stroke. This exam typically includes:

• Mental status evaluation: Checking orientation to person, place, time, and alertness.
• Cranial nerve function assessment: Testing functions such as smell, vision, eye movement, sensation, strength, and coordination.
• Motor exam: Evaluating muscle strength and coordination in the upper and lower extremities.

Imaging

Neuroimaging is essential for stroke diagnosis and management. The choice of imaging technique depends on the patient's condition and the suspected type of stroke. Common imaging modalities include:

• Computed Tomography (CT) Scan: This is often the first imaging technique used to detect intracranial haemorrhage and identify calcification, which is vital for lesion detection.
• CT Angiography (CTA): This technique is used to visualise blood vessels and detect thrombosis, occlusions, vascular malformations, and aneurysms.
• CT Perfusion (CTP): CTP measures cerebral blood flow, volume, and transit time, helping to identify core infarction and areas at risk.
• Magnetic Resonance Imaging (MRI): MRI provides higher soft-tissue contrast than CT and is superior for detecting acute ischemic stroke, especially in the hyperacute and acute phases.
• MRI Angiography (MRA): Similar to CTA, MRA evaluates large vessel occlusions and atherosclerotic lesions, offering an alternative for patients with allergies or renal impairment.

Additional Tests

In addition to the neurological exam and imaging, other tests are crucial for stroke diagnosis:

• Blood tests: Evaluating blood glucose levels, renal function, and clotting status.
• Telemetry: Monitoring heart rhythm and electrical activity.
• Physical exam: Assessing overall patient status, including vital signs, cardiac and respiratory function, and evidence of infection.

Stroke treatment: medication, surgery, rehabilitation

A stroke is a medical emergency that occurs when blood flow to the brain is interrupted, causing brain cells to die and resulting in a loss of brain function. The effects of a stroke vary depending on the part of the brain affected, but can include impaired movement, speech, memory, emotional control, and essential bodily functions like bowel control.

There are two main types of strokes: ischemic strokes and hemorrhagic strokes. Ischemic strokes are caused by a blood clot or plaque deposit blocking a blood vessel in the brain, while hemorrhagic strokes are caused by a burst blood vessel that spills blood into the surrounding tissues.

Medication

The treatment for a stroke depends on the type of stroke and may include medication, surgery, and rehabilitation. Drug therapy is the most common treatment for ischemic strokes, which are caused by blood clots. The two most common drug therapies are:

• Antithrombotics: These drugs prevent the formation of new blood clots that can become stuck in an artery of the brain and cause strokes. Antithrombotics include antiplatelet and anticoagulant drugs, also called blood thinners. They help stop cells and other factors in the blood from sticking together and forming blood clots.
• Thrombolytics: These drugs treat the stroke by dissolving the blood clot that is blocking blood flow to the brain. The most commonly used drug for thrombolytic therapy is called tissue plasminogen activator (tPA), which must be administered within three to four hours of the onset of symptoms.

People with hemorrhagic strokes cannot be treated with thrombolytics as this makes the condition worse. Instead, medication is used to lower blood pressure and prevent additional bleeding.

Surgery

Surgery may be required to treat a stroke or to prevent a future stroke. In the case of ischemic strokes, the goal is to restore blood flow as quickly as possible. This can be achieved through the following procedures:

• Intra-arterial thrombolysis: A catheter is inserted into an artery and guided to the blockage to deliver clot-busting medication.
• Mechanical thrombectomy: A catheter with a special wire cage at the end is used to grab the clot and pull it out.
• Carotid endarterectomy: A surgical procedure to open a partly blocked artery by removing fatty deposits.
• Carotid angioplasty: A small tube called a catheter is inserted into an artery in the leg or arm and guided to the blocked carotid artery, where a tiny balloon is inflated to make the artery wider.

In the case of hemorrhagic strokes, surgery is often required to stop the bleeding and relieve any pressure on the brain caused by the excess fluid. The following procedures may be used:

• Coil embolization: A catheter with a tiny coil at the end is threaded to the spot where the artery ruptured, causing a blood clot to form and seal off the break.
• Aneurysm clipping: A clip is placed at the base of an aneurysm (a weak spot in the artery wall that has bulged out) to close it and prevent further damage.
• Arteriovenous malformation (AVM) repair: Surgery is performed to stop blood flow to an abnormal growth of blood vessels or to remove it.

Rehabilitation

Rehabilitation therapy is an important part of stroke recovery and can lead to improved function over time. The sooner rehabilitation begins, the better the chances are for the person to regain function. Rehabilitation may include:

• Physical therapy: Helps the person relearn simple motor activities such as walking, sitting, standing, and lying down.
• Occupational therapy: Assists the person in relearning everyday activities, such as eating, drinking, bathing, dressing, cooking, reading, writing, and using the toilet.
• Speech therapy: Focuses on helping the person relearn language and speaking skills or learn other forms of communication.

Stroke recovery: physical, occupational, speech therapy

A stroke is a serious medical condition that occurs when there's a change in how blood flows through the brain. This can be due to a blood clot, the narrowing of a blood vessel, or a burst blood vessel, resulting in reduced blood flow and oxygen supply to the brain. The effects of a stroke depend on which part of the brain is affected, and can cause a range of issues, including problems with vision, speech, movement, and memory.

Physical Therapy

Physical therapy is an important aspect of stroke recovery, helping individuals to relearn simple motor activities such as walking, sitting, standing, and lying down. It also assists in improving balance and coordination to prevent falls, which are common after a stroke. The sooner physical therapy begins, the better the chances of regaining function and independence.

Occupational Therapy

Occupational therapy (OT) focuses on helping individuals regain the ability to perform everyday activities, such as eating, drinking, bathing, dressing, cooking, and using the toilet. OT helps improve independence and can be started in the hospital, continuing at home or in an outpatient therapy centre. OT may involve the use of specific equipment, such as shower chairs and grabbers, to make daily tasks easier.

Speech Therapy

Speech therapy is crucial for individuals who have experienced language and communication difficulties after a stroke. Speech therapists provide personalized exercises to help individuals recover their speech production skills, including tongue and facial exercises, as well as reading and writing activities. Speech therapy can also address difficulties with swallowing, which is common after a stroke.

Stroke prevention: diet, exercise, medication

A stroke occurs when there's a change in how blood flows through the brain, which can be life-threatening and cause serious adult disability. While some factors that increase the risk of stroke are uncontrollable, such as age, race, ethnicity, and family history, there are several preventative measures that can be taken to reduce the likelihood of experiencing a stroke. These include maintaining a healthy diet, regular exercise, and taking medication.

Diet

Eating a healthy, balanced diet rich in nutrients, vitamins, and minerals can help to lower your risk of having a stroke. Consuming four to five servings of fruits and vegetables daily is recommended, as they are naturally low in fat and calories and rich in fiber, potassium, folate, vitamin A, and vitamin C. Foods high in potassium, such as sweet potatoes, bananas, tomatoes, and soybeans, are particularly beneficial for maintaining healthy blood pressure, which is the leading risk factor for strokes. Additionally, magnesium-rich foods like spinach are linked to a reduced risk of stroke.

Including fish in your diet is also beneficial. Salmon, albacore tuna, trout, and mackerel are high in omega-3 fatty acids, which help regulate blood pressure and cholesterol levels. Researchers have found that eating fish regularly is associated with a lower risk of stroke.

Whole grains are another important component of a stroke-preventative diet. Opting for whole grain bread, cereal, oatmeal, and brown rice provides your body with fiber, B vitamins, magnesium, and iron, all of which contribute to heart health and, in turn, stroke prevention.

When it comes to dairy, choose low-fat or non-fat milk, yogurt, and cheese products. These provide calcium, protein, vitamin D, and potassium without the high levels of saturated fat and cholesterol found in their full-fat counterparts, which could otherwise increase the risk of heart disease and stroke.

Exercise

Incorporating regular physical activity into your routine is essential for stroke prevention. Aim to make exercise a part of your everyday life by engaging in activities you enjoy, such as walking, cycling, or swimming. Consult with your healthcare provider if you need guidance or have specific concerns or conditions that may impact your ability to exercise.

Medication

For those with existing health conditions, medication can play a crucial role in stroke prevention. Controlling high blood pressure, high cholesterol, and diabetes through proper medication and medical advice is essential. Additionally, managing blood thinners is important, as too much aspirin or anticoagulants can lead to bleeding. Always consult with your doctor to ensure your medication dosage is correct.

Frequently asked questions