Clinical features
- Introduction
- Paralysis
- Cognitive deficits
- Visual disturbances
- Speech and language problems
- Fatigue
- Emotional difficulties
- Pain
Introduction
Following a stroke the resulting functional restrictions can vary greatly. The effects of a stroke depend upon the part of the brain affected and the extent of the damage. A large stroke may result in death. A small stroke may result in minor difficulties, which may go away completely over time.
In general 1/3 of survivors have a severe disability, 1/3 return to independent functioning and 1/3 die in the first month following their stroke.
Although stroke is a disease of the brain, the entire body can be affected. Functional restrictions resulting from a stroke include:
- Paralysis,
- Cognitive deficits,
- Visual disturbances,
- Speech problems,
- Disturbances of gait and mobility,
- Spasticity of muscles,
- Loss of co-ordination,
- Emotional difficulties and,
- Pain.
Paralysis
A common effect of a stroke is paralysis on one side of the body. This is called hemi-plegia (another term is hemi-paresis). This paralysis may be complete (or dense) or may be partial, resulting in various degrees of weakness. Paralysis may affect only the face, an arm or a leg, or one entire side of the body. Some people experience difficulty with eating or swallowing (dysphagia). Damage to a part of the brain called the cerebellum may result in vertigo (a spinning sensation) and problems with balance and co-ordination (ataxia). Fine rapid movements of the eyes (nystagmus) may occur.
Cognitive deficits
Stroke may interfere with thinking, awareness, attention, learning, judgement and memory. If the cognitive problems are severe the person may develop an inability to recognise that one side of the body exists. This is called spatial neglect or agnosia. In the context of stroke, neglect means that the person has no knowledge of one side of the body or one side of the visual field (homonymous hemianopia) and is unaware of the deficit.
Following a stroke, a person may be unaware of his or her surroundings, or may have mental deficits and be unaware that these exist.
Personality changes may occur. These may include irritability, apathy, lability of mood, and occasionally aggressive behaviour. Inflexibility in coping with problems is common and, if severe, may result in a catastrophic reaction. Such changes are more likely to be associated with widespread cerebro-vascular disease than a single stroke but may continue to worsen despite improvement in the physical aspects of the stroke.
Visual disturbances
A stroke patient may have visual impairment. The type of visual impairment is determined by which part of the brain has been affected by the stroke. For example, stroke affecting:
- the temporal lobe may result in an upper homonymous quadrantanopia,
- the parietal lobe may result in a lower homonymous quadrantanopia,
- the occipital cortex may result in a homonymous hemianopia or cortical blindness (the patient cannot see but lacks insight into the degree of visual loss and may even deny it),
- the brainstem may result in weakness of eye movements and double vision or nystagmus which may affect vision.
To consider H/R Mobility Severely Visually Impaired (SVI) criteria, click on the link H/R Mobility Severely Visually Impaired (SVI) deeming provisions.
Speech and language problems
Stroke patients often have problems understanding or forming speech. A difficulty or inability to understand or express language is called Dysarthria or aphasia. Physical difficulty in speaking is called Dysarthria.
Fatigue
Fatigue is a very important ill-effect following a stroke, and should be borne in mind when considering rehabilitation programmes.
Emotional difficulties
A stroke can lead to emotional problems. Following a stroke, some people may have difficulty controlling their emotions, or may express inappropriate emotions in certain situations such as inappropriate laughing or crying. Depression is common after a stroke and this may be more than a general sadness and sense of loss of a previous active life. It may hamper recovery and may be suicidal in some cases. Post stroke depression is treated in the same way as any other clinical depression.
Mood disorders are common after a stroke and include depression, anxiety and less commonly mania.
Vascular dementia may result from successive strokes.
Pain
Following stroke, some people may experience pain, strange sensations or numbness, in some cases this may be difficult to treat.
Amended April 2011
