Life after stroke
This article aims to discuss the stroke causes and post-stroke symptoms. It underscores that stroke survivors are affected not only physically, but also cognitively, emotionally and behaviourally.
By Kiruba Nagaratnam, Consultant in Stroke and Geriatric Medicine, Circle Rehabilitation
Stroke is the major cause of disability both in the UK and in the world. It changes a person regardless of its severity and has a huge impact both at personal and societal levels. It is a great achievement that there are less people suffering from a new stroke in the UK now compared to 10 years ago. Still, however, one person suffers from a stroke every 5 minutes. More than two thirds of them leave the hospital with disability, and approximately one in every 50 people in the UK has survived a stroke.
Stroke is caused by damage to the nerve cells in the brain. This can happen due to lack of blood supply (ischaemic stroke) or as a result of bleeding (haemorrhagic stroke); the former accounts for nearly 80% of all strokes. By the nature of its name, it strikes without warning within a matter of minutes and it takes a long time to heal. The stroke recovery can take months to years, and with appropriate medical treatment and rehabilitation we can improve the chances of good recovery.
The brain has a remarkable ability to recover from an injury through adapting and learning. This ability is called neuroplasticity. The early part of the recovery period is spontaneous, during this time the brain hoovers up all the damaging chemicals and the swelling surrounding the injured brain resolves. The later part of the recovery is when the brain reorganises and forms new connections through learning and adapting. This process is helped by rehabilitation and can last for more than 6 months. However, only 3 out of 10 stroke survivors are reviewed at 6 months for assessment of their health and social care needs at present.
Many people believe strokes only affect a person physically. Therefore its cognitive, emotional and behavioural impacts are often overlooked or under recognised. One in four strokes affect people of working age, resulting in potential loss of work with financial implications. Post-stroke fatigue is very common after stroke, affecting more than two-thirds of stroke survivors. Nearly one-third of stroke survivors may experience anxiety or depression as a result of the stroke and post-stroke fatigue can also have an impact on mood. The stroke survivors are also likely to worry about having another stroke and can misinterpret the symptoms of fatigue, anxiety or depression as strokes.
Life after stroke can be challenging. However, with adequate support along with recognition and understanding of the long term effects of stroke, the lives of survivors can be transformed. As a result, they will be enabled to enjoy an active life without being hampered by disability.
Dr Kiruba Nagaratnam is a consultant in stroke and geriatric medicine at Circle Rehabilitation and the Royal Berkshire Hospital. He completed his specialty training and stroke fellowship in the Oxford Deanery and is practicing acute stroke and stroke rehabilitation. He has special interests in stroke prevention, life after stroke and in stroke rehabilitation. He is also experienced in the management of complex medical problems in older people.