Stroke Symptoms Worsening: What's The Reason Behind It?

Experiencing worsening stroke symptoms can be frightening, and it's essential to act quickly. While stroke recovery is often non-linear, with ups and downs, sudden and dramatic worsening of symptoms warrants immediate medical attention. Here are some reasons why stroke symptoms may get worse:

1. Regression as part of the recovery process: Stroke recovery is a complex journey with twists and turns. It's normal to experience setbacks and plateaus along the way. This can be influenced by factors such as changes in routine, activity levels, and new medications.

2. Medical complications: Conditions such as urinary tract infections, respiratory issues like pneumonia, and febrile illnesses can lead to increased brain ischemia and worsen stroke symptoms.

3. Brain edema: This complication, more common in large strokes and hemorrhages, can cause a delayed but significant worsening of symptoms, including headache and decreased alertness.

4. Gradual or stepwise increases in focal deficits: This category, which often begins during the first day of hospital admission, involves the gradual worsening of neurological deficits.

5. Reduced blood flow to the brain: Ischemic strokes, the most common type, occur when blood clots or narrowed blood vessels reduce blood flow. Hemorrhagic strokes involve burst blood vessels, leading to bleeding in or around the brain.

6. Emotional and psychological factors: Post-stroke depression and anxiety are common and can impact a person's motivation, energy levels, and emotional state, potentially contributing to worsening symptoms.

7. Stopping rehabilitation: Discontinuing rehabilitation can lead to deterioration in functional abilities and worsening symptoms.

It's crucial to monitor your symptoms closely and seek medical advice if you experience any sudden or significant changes. Stroke recovery is a challenging process, and working closely with your medical team is essential to managing and improving your symptoms.

Emotional and personality changes after a stroke

Emotional and personality changes are common after a stroke and can be very challenging for the survivor and their loved ones. These changes can get better with time and treatment.

Emotional Lability

Emotional lability, or pseudobulbar affect (PBA), is common after a stroke. This is when emotional responses seem irrational or are out of proportion. For example, a survivor may cry or laugh uncontrollably, or their responses may seem out of character or context. PBA is caused by damage to the parts of the brain that control emotional responses, particularly the cerebellum, which helps monitor the expression of emotions.

Depression and Anxiety

Depression and anxiety are common at any stage after a stroke, with up to 33% of survivors experiencing post-stroke depression. Depression can be caused by physical limitations, health worries, brain changes, and delays in treatment. Anxiety may be caused by changes in the brain and can lead to social avoidance.

Apathy

Apathy, or a lack of motivation, can occur after a stroke. This can lead to a loss of interest in seeing friends and family and a lack of interest in previously enjoyable activities. It can be caused by post-stroke depression, a decline in cognitive abilities, a loss of responsibility, and structural and functional changes in the brain.

Aggression

Some stroke survivors may behave in aggressive or irritable ways. This is often a result of the emotional impact of the stroke and the stroke-induced brain injury. Aggression is particularly noticeable in survivors who have had a large stroke or who have vascular dementia.

Lack of Empathy

A stroke survivor may become less empathetic, which can result in self-centred behaviour and damaged relationships. This is caused by damage to the regions of the right side of the brain, which affects their perception of other people's emotions and facial expressions.

Loss of Sense of Humour

A stroke can diminish a survivor's sense of humour, as humour requires insight and quick thinking. This is caused by a loss of cognitive skills and damage to the frontal and temporal lobes.

Loss of Social Inhibitions

Some stroke survivors may behave in socially inappropriate ways, such as insulting people or undressing in public. This is often associated with a stroke of the frontal lobe, which usually allows people to adjust their behaviour.

Strategies for Coping with Emotional and Personality Changes

• Be aware of triggers, such as fatigue, stress, anxiety, and overcrowded environments.
• Ignore the emotional response and continue with the conversation or task.
• Tell people about your stroke and what works best for you.
• Take a break and try relaxation and breathing exercises.
• Make changes to your routine, such as one-to-one activities in a quiet environment.
• Seek treatment, such as cognitive behavioural therapy, medication, or support from a psychologist or doctor.

Physical changes after a stroke

• Difficulty with gripping or holding things: This can be caused by muscle weakness or changes in sensation, thinking, and memory.
• Fatigue or tiredness: Post-stroke fatigue is common and can be caused by physical changes, medication side effects, mood changes, depression, anxiety, or sleep disturbances.
• Incontinence: Different types of incontinence can occur due to medication, muscle weakness, or changes in sensations, thinking, and memory.
• Pain: Pain after a stroke can be nociceptive (caused by actual or potential tissue damage) or neuropathic (caused by nerve damage that sends incorrect messages to the brain).
• Restricted ability to perform physical activities or exercise: A stroke can result in reduced mobility and difficulty with movement, requiring adaptations to the home environment.
• Weakness or paralysis of limbs, usually on one side of the body: This is a common disability after a stroke and can impact daily activities, including self-care tasks.

It is important to note that early treatment and rehabilitation can improve recovery, and many individuals regain significant function over time. The recovery process is often complex and non-linear, with ups and downs along the way. It is crucial to work closely with a healthcare team, which may include doctors, physiotherapists, occupational therapists, speech therapists, and counsellors, to address these physical changes and maximize recovery.

Communication difficulties post-stroke

Communication problems are very common after a stroke. Around one-third of stroke survivors experience language problems, known as aphasia, which affects their ability to speak, read, write, and understand what other people say to them. A further two types of speech problems are dysarthria and apraxia of speech. These issues can make it difficult for stroke survivors to be understood by others.

Aphasia

Aphasia is a common problem after a stroke, affecting around a third of survivors. It impacts a person's ability to process language, both spoken and written. A person with aphasia may think clearly but struggle to use or understand language. There are many types of aphasia with different symptoms, and it affects people in different ways. Some people with aphasia can understand language but can't speak, while others can talk but don't make sense. Aphasia can also make it hard or impossible to read or write.

Dysarthria

Dysarthria is when a person can't control the muscles in their face, mouth and throat very well, so it's difficult to speak clearly. Speech may become slurred or slow, and the voice may sound quiet. This is often caused by weakness, slowness, or lack of coordination in the muscles of the mouth, face, voice, and lungs. Many stroke survivors have a mild form of dysarthria that sounds like mumbling or being a bit nasal because half of their face is paralysed.

Apraxia of speech

Apraxia of speech is when a person can't move the muscles in their face, mouth or throat in the right order to form words. Their tongue, lips, and/or jaw may not be able to make the correct movements, and they may speak slowly, with long pauses, and struggle with longer words and certain sounds.

Treatments

Communication problems can be treated using speech and language therapy. A speech and language therapist can help a person improve their speech, reading and writing, as well as learn other ways to communicate, such as gestures or electronic devices.

Recovery

Most communication problems do improve over time, but it's difficult to predict how much or how long it will take, as it varies from person to person. Problems tend to be worse in the first few weeks and will improve within the first three to six months. However, people continue to recover for months and even years after a stroke.

Impact on everyday life

A stroke can have a significant impact on a person's everyday life, and the effects can vary depending on the area of the brain affected and the severity of the stroke. Here are some ways in which a stroke can affect a person's daily life:

• Physical changes: These include difficulty with gripping or holding objects, fatigue or tiredness, incontinence, pain, restricted ability to perform physical activities, and weakness or paralysis on one side of the body.
• Emotional and personality changes: It is common to experience mood and personality changes after a stroke. Depression and anxiety are common, especially in people who have trouble with understanding, finding words, and communicating (aphasia). Other emotional changes may include irritability, aggressiveness, apathy, repetitive behaviour, disinhibition, and impulsiveness.
• Changes to thinking, memory, and perception: A stroke can impact cognitive skills such as the ability to learn new skills, problem-solving, attention, orientation, and short-term memory. Perception may also be altered, affecting how a person sees, hears, and feels the world.
• Communication: Strokes can affect the ability to speak, read, and write. Symptoms may include difficulty finding words or understanding speech (aphasia or dysphasia), weakness in speech muscles (dysarthria), and dysfunction of the nerve connection between the brain and mouth (dyspraxia).
• Everyday activities: A stroke may require changes to living arrangements, impact sexual function and relationships, impair the ability to drive or work, and reduce independence, requiring reliance on carers.
• Support: Many people may need support from healthcare professionals, including clinical psychologists, occupational therapists, rehabilitation nurses, and speech pathologists. Community services such as home help and respite care can also be beneficial, along with peer support groups and staying connected with family and friends.

It is important to note that early treatment and rehabilitation after a stroke can improve recovery, and many people are able to regain a significant amount of function. However, the impact of a stroke on everyday life can be significant, and tailored support is often needed to help individuals adjust and cope with the changes they are experiencing.

Treatment options

The treatment options for a stroke depend on the type of stroke and how soon the patient receives treatment. The two main types of strokes are ischemic and hemorrhagic. Ischemic strokes are caused by a blood clot or blockage in the brain, while hemorrhagic strokes are caused by a burst blood vessel that causes bleeding in or around the brain.

For ischemic strokes, the top priority is restoring blood circulation to the affected areas of the brain. This can be done through drug therapy, such as thrombolytics, or a catheterization procedure called a thrombectomy. Thrombolytics are most effective when administered within three to four and a half hours of the onset of symptoms. Thrombectomy procedures are also time-sensitive and are most effective within 24 hours of symptom onset.

For hemorrhagic strokes, the treatment depends on the location and severity of the bleeding. Reducing blood pressure is often a priority to limit bleeding and make it easier for clotting to seal the damaged blood vessel. Surgery may be necessary to relieve pressure on the brain from accumulated blood.

In addition to emergency treatments, patients may require long-term treatments to prevent future strokes and manage any lasting effects. This can include blood pressure management, blood thinners, antiplatelets, statins, and surgery to remove plaque from arteries.

Stroke rehabilitation is also an important part of treatment, helping patients recover or adapt to changes in their brain. This can include speech therapy, physical therapy, occupational therapy, and cognitive therapy. The sooner rehabilitation begins, the better the chances of regaining function.

Frequently asked questions