Coping With Stroke

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If you have suffered a stroke, the long-term effects may endure after your first stroke symptoms stabilize and even after you receive appropriate treatment. Long-term stroke complications are, in many ways, similar to initial stroke symptoms. What the immediate and long-standing effects of a stroke have in common is that they generally involve the same part of the body or the same cognitive function.

For example, your arm may be weak, your face may be lopsided, speech might be garbled, or vision may be blurry. This is because the initial symptoms of a stroke correspond to the area of the brain that is injured by the stroke, as do the enduring residual effects.

However, some effects of stroke can take months, or even years, to develop.

Physical

Weakness

Most of the time, weakness caused by a stroke affects one side of the body. This is called hemiparesis, while complete paralysis of one side of the body is called hemiplegia.

Hemiparesis or hemiplegia after a stroke can affect the face, arm, or leg or a combination of the three. Generally, a stroke survivor suffers long-term weakness that is less severe than the initial weakness that he or she experienced while the stroke was in its early stages, especially if stroke treatment was initiated promptly.

Hemiparesis and hemiplegia result from a stroke that damages one side of the brain in one or more of the regions that control motor function. A cortical stroke, a subcortical stroke, or a brainstem stroke can cause hemiplegia or hemiparesis.

Balance

The majority of stroke survivors continue to feel a bit off-balance, even during and after stroke recovery. These sensations can manifest in many different ways, and they can come and go, but dizziness typically stabilizes about six months after a stroke and does not normally continue to worsen in severity.

Some stroke survivors truly are off-balance, some feel dizzy, some experience light-headedness, and still others have a sensation that the room is spinning.

A stroke in any region of the brain can cause a sense of feeling off-balance, but a stroke involving the brainstem or the cerebellum is more likely to result in persistent dizziness and trouble maintaining balance and coordination.

Physical therapy is the most effective way to combat balance impairment after a stroke, and there are a number of safe, at-home balance exercises that you can do on your own to maximize your sense of balance and reduce your dizziness.

Vision Changes

There are a variety of vision changes that may result from a stroke, including double vision (diplopia), visual field loss (hemianopsia), jerking of the eyes (nystagmus), and loss of vision.

These are the most common visual changes after a stroke, although some stroke survivors lose vision in the center of the visual field, while other stroke survivors lose the ability to see color.

Disruptions in vision after a stroke can be a serious handicap, interfering with driving and even safety at home.

Communication Problems

These are among the most well-known results of a stroke—and, to many, they're among the most impactful.

Aphasia

Aphasia describes trouble speaking or understanding words due to a disease or an injury of the brain. When a stroke involves the dominant side of the cerebral cortex (usually the left side), a stroke survivor may have trouble forming words (Broca's aphasia) or trouble understanding words and language (Wernicke's aphasia).

Usually, a stroke survivor has one or the other and only rarely experiences both, though this can occur if the stroke is very large.

Dysarthria

Dysarthria is a problem in which a stroke survivor cannot speak clearly. Most stroke survivors who have dysarthria can understand speech and use the correct words, but they have trouble making their words understandable due to muscle weakness or diminished coordination of face and mouth muscles.

Stroke survivors who have dysarthria do not necessarily have aphasia, as these are two completely different types of speech problems.

Cognitive Deficits

Cognitive changes after a stroke include memory glitches, trouble solving problems, and difficulty understanding concepts.

The severity of cognitive changes after a stroke varies tremendously from one stroke survivor to another. In general, a larger stroke results in more severe cognitive deficits than a smaller stroke.

Another factor that influences the degree of cognitive deficit after a stroke is whether a stroke survivor had any cognitive problems prior to the stroke. A person who had early dementia or was cognitively impaired for any reason prior to a stroke is at a higher risk of suffering from a worse cognitive deficit after a stroke.

Some stroke survivors experience severe dementia-like symptoms after a stroke, but that is typically the consequence of the buildup of damage from several strokes, rather than only one stroke.

Hemispatial Neglect

The neglect of one side of the environment and the diminished ability to notice one side of the body is called hemispatial neglect. This results from a stroke of the right cerebral cortex.

Often, stroke survivors who have hemispatial neglect are completely unaware that they had a stroke.

Pain

As many as 60 percent to 70 percent of stroke survivors experience new-onset pain after a stroke. Post-stroke pain can include muscle pain, facial pain, headaches, low back pain, and neck pain.

The treatment for post-stroke pain includes rest, physical therapy, and medication. Post-stroke headaches require special attention from your doctor, but they can improve with the right treatment.

Fatigue and Sleeping Problems

Most stroke survivors experience some degree of fatigue. This can manifest as excess sleeping or as tiredness with the inability to get enough rest.

On a related note, sleep disturbances such as waking in the middle of the night, having trouble falling asleep, trouble staying asleep, and sleeping sporadically throughout the day are very common after a stroke. These problems typically add to the overall fatigue people experience.

Unlike many other post-stroke effects, sleep disturbances do not have a tendency to improve on their own. If you experience sleep problems after a stroke, you should discuss your symptoms with your doctor.

Swallowing Difficulties

About half of stroke survivors experience some problems with chewing and swallowing food.

A speech and swallow evaluation can identify swallowing problems after a stroke. While it might not seem to be a major issue, swallowing problems are, in fact, quite dangerous. The choking that results from stroke-induced muscle weakness may cause serious illness, such as aspiration pneumonia or even life-threatening breathing obstruction problems.

Trouble With Urination

After a stroke, many stroke survivors experience incontinence, which is urinating when you do not want to. Some stroke survivors also experience bladder retention, which is the inability to urinate on demand. Both of these problems are inconvenient and potentially embarrassing, but they can be managed with medical treatment.

Muscle Atrophy

After a stroke, the weakened muscles may be so weak that you cannot use them at all. When muscles are unused for a prolonged time, they can literally shrink, becoming smaller, and losing actual muscle bulk and tone. Unfortunately, muscle atrophy results in worsening muscle weakness.

It is difficult to recover from muscle atrophy, but rehabilitation techniques can help improve the situation and slowly rebuild muscle. It is better to prevent muscle atrophy through pre-emptive post-stroke rehabilitation methods that engage weakened muscles before they shrink.

Muscle Spasticity

Sometimes weakened muscles become stiff and rigid after a stroke, possibly even jerking on their own. Muscle spasticity is often painful, with pain centered around the spastic muscles and involving nearby muscles as well. Spasticity and rigidity result in diminished motor control of the already weakened muscles.

Muscle spasticity can be prevented with active post-stroke rehabilitation. If muscle spasticity develops after a stroke, there are a number of effective medical treatments that can be used to control the symptoms, but the medications do not completely reverse this.

Seizures

When the cerebral cortex becomes injured after a cortical stroke, this region of the brain may start to produce erratic electrical activity, resulting in a seizure. After a cortical stroke, as many as 30 percent to 50 percent of stroke survivors experience this.

Sometimes, seizure prevention is a part of the post-stroke care program if there is a high risk of post-stroke seizures. Some stroke survivors develop seizures years after a cortical stroke in the context of a serious medical event, such as surgery or a major infection. Post-stroke seizures can be managed with medication.

Emotional

Many people experience sadness and depression after a stroke. This is a result of resulting physical changes in the brain.

But there are other emotional changes that arise in response to the new circumstances that a stroke survivor must face, such as sadness and angst regarding the difficulties that a stroke can cause.

While depression is the most common mood after a stroke, some stroke survivors also experience anxiety, anger, or frustration.

Behavioral Changes

After a stroke, new behaviors can include a lack of inhibition, which means that people may behave inappropriately or childlike. Other changes in behavior include a lack of empathy, loss of sense of humor, irrational jealousy, and anger.

Social

Life after a stroke can be challenging for both patients and their caregivers. Many people find joining a support group can help them to better deal with the challenges ahead.

For a list of support groups in your area, check the National Stroke Foundation's website at www.stroke.org/we-can-help/caregivers-and-family/support-groups. You can also check with your local hospital and rehabilitation centers.

Online support is available through the Stroke Network at www.strokenetwork.org.

A Word From Verywell

The long-term effects of a stroke are wide-ranging. It is important to recognize that, while some stroke effects such as hemiplegia and vision loss are expected, other issues such as pain, dizziness, and trouble urinating also deserve your attention to help you live your best life possible as you recover from your stroke.

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