Stroke or cerebral ischemia is a cerebrovascular accident that is equivalent to a myocardial infarction but in the brain. Stroke is the leading cause of death in women and the second in men, but in addition to mortality, it is fearsome due to the consequences it causes, which can be both physical consequences (pain, muscular, visual problems, swallowing problems …), and psychic (cognitive disorders, memory, depression …).
To learn about the consequences of a stroke, we have spoken with Dr. José Miguel Pons Amate, Stroke Unit Coordinator of the Neurology Service of the General University Hospital Valencia. We have distinguished the consequences according to the type of stroke, whether it is ischemic - when a clot or other reason causes an area of the brain to not receive blood supply - or hemorrhagic - due to the rupture of a cerebral vessel -, depending on whether it affects the right hemisphere or left and depending on the part of the brain affected.
What sequelae does the stroke leave depending on whether it is ischemic or hemorrhagic?
Hemorrhagic stroke usually presents more serious symptoms "at the beginning, but when the inflammation associated with bleeding subsides, in general the recovery can be somewhat faster and more pronounced than in the ischemic one." However, during "the first days it can be more serious and has a higher mortality rate than ischemic".
What are the sequelae depending on whether it has affected the right or left hemisphere?
As Dr. Pons Amate explains, “the brain is divided into two interconnected parts and, in a very schematic way, we can say that each part of the brain is in charge of the opposite part of the body.
- If the stroke has affected the left hemisphere, they generally affect language and mobility on the right side of the body. Sometimes also to the visual field of the right side.
- If the stroke has affected the right hemisphere, they generally produce alterations on the left side. They do not affect language unless the patient is left-handed. However, "they frequently produce visual-spatial, graph-motor alterations in the organization and sequencing of activities." Another serious consequence is “a phenomenon called hemineglect, whereby the patient does not pay attention to their left side, so they may not be aware of stimuli on that side, and they may trip over objects or even the doorframe. In severe cases they may not become aware of the deficit or even not recognize their own arm or leg ”.
What are the sequelae according to the affected brain region (frontal, parietal, etc.)?
The different areas of the brain affected by a stroke can give different symptoms and leave different sequelae. Dr. Pons Amate states that "it is difficult to generalize and simplify in a few words what are the symptoms that occur in each of the areas of the brain." In a very schematic way it can be said that:
- If the stroke affects the frontal region. It can leave motor sequelae, both in mobility and in the expression of language. It is also associated with dehinibition and neuropsychological changes.
- If it affects the parietal lobe. It produces sensitive alterations, it can affect the understanding of language, alterations in orientation and in relation to objects, which are called praxis.
- If it has affected the occipital region. The most important consequences are in vision.
- In the temporal region. It can cause vision, hearing and language problems.
How are the aftermath of stroke
- Problems that affect movement. Sometimes a stroke paralyzes an area of the body and it is impossible to move it. It may also be that she is not paralyzed, but loses strength and prevents normal movement. It can also affect coordination and balance, so there is an increased risk of a fall.
- Contraction of certain muscles. This contraction is permanent and painful, as it leads to contractures, stiffness and, of course, poses a problem for the mobility of the person.
- Visual problems. The person who has suffered a stroke may lose part of his visual field, but if he is aware of the problem he can compensate for it by moving his head to focus where he has no vision.
- Trouble speaking The affected person cannot make sounds or articulate words intelligibly to make themselves understood.
- Changes in sensation. They can be noticed from tingling to losing the sensitivity of touch in certain areas of the body.
- Pain. It can be a pain similar to a burning, which intensifies if someone touches the affected patient or something touches him, even if it is water when washing.
- Difficulty eating. It is common that after a stroke there may be difficulties in swallowing food, so at the beginning of suffering the patient is fed with a tube, but this is not usually needed for a long time. However, it is very useful for the affected person to be well nourished and also to prevent the passage of liquids or food to the lung.
- Difficulty controlling the sphincters. It is another of the sequelae of stroke that also requires rehabilitation, with Kegel or hypopressive exercises or other measures that the doctor may advise.
- Psychological problems. One of the most frequent is depression and the inability of the patient to accept the consequences of her illness, which can manifest itself in the form of apathy, irritability, etc.
- Cognitive problems. The affected person may have impaired memory, suffer problems concentrating, orienting himself, etc.
How does the type of stroke suffered or the affected area influence rehabilitation?
“The rehabilitation of a sequel depends to a great extent on the age of the patient, and the beginning of the recovery of the symptoms. The younger the age and the early onset of recovery, the better the functional prognosis and being able to remain without sequelae. People of very old age have a lesser capacity for their brain to adapt to the injury and therefore have less capacity for recovery ”, explains Dr. Pons Amate.
The sooner rehabilitation begins, the better. The specialist remarks that “the start of rehabilitation must be early, already during admission and as soon as the stroke is stabilized. If the symptoms persist without improving for days or weeks, it implies that the damage produced is severe, regardless of whether the size of the infarct is not very large, and therefore the chances of recovering the functional deficit are reduced ”.
What to do to rehabilitate from the aftermath of a stroke
Depending on the sequelae and their severity, rehabilitation can have different treatments, from speech therapy for language problems, to physical therapy and exercises for mobility problems or to control sphincters, etc.
There are other sequelae that must be treated with medication , such as pain or permanent muscle contraction.
On the other hand and always depending on the severity of the consequences, it may be necessary to adapt the house so that the person can move in it without problems. For example, when there are mobility problems, it is necessary to adapt the bathroom, remove rugs to prevent falls, etc.
The importance of genetics in recovering from a stroke
A study coordinated by researchers from the Hospital del Mar Institute for Medical Research (IMIM) and doctors from the Hospital del Mar in Barcelona has identified specific variants in the PATJ gene that predispose to a worse recovery from an ischemic stroke. The importance of this study, published in Circulation Research, lies in the fact that in the future the identification of these genetic variants can be used as a biomarker at the time of stroke and, thus, be able to personalize the treatment to be followed.
To avoid sequelae, activate the Ictus Code
When a person suffers a stroke, the speed with which they receive medical assistance will be decisive both for their survival and to minimize the consequences that they may suffer. If you suspect that someone is having a stroke, do these three tests:
- Smile. If people are having a stroke, it can be difficult because their mouth tends to twist and it can be difficult to make a smile.
- Raise your arms. When suffering the stroke, one of the two arms can be paralyzed or with the feeling that it is heavy.
- Repeat a phrase. Ask him to repeat a short and very easy phrase, for example: "Today it is sunny." If he is suffering from cerebral ischemia, the affected person may have trouble understanding what is being said or articulating words and making himself understood.
If you think it is a stroke, call 112 to be seen urgently.
And, as always, the important thing is to influence prevention.
