A stroke is a cerebrovascular accident and its complications are the result of the ischemic after-effects on the brain. The possible dangers just cannot be ignored. Again, these effects can give rise to further secondary complications.

The complications can make your life miserable. They can cause disability and quite commonly death. Stroke is the third largest medical cause of death worldwide.

Therefore, if you experience any of its warning signs, diagnosing the stroke and its type becomes most vital because it is the immediate and prompt emergency treatment that is critical to prevent complications and possibly death.

A stroke, due to any causes, whether ischemic or hemorrhagic, invariably gives rise to disabilities, which can be temporary (short term) or permanent (long term) depending on how long the ischemia (lack of blood supply) lasted and which part of the brain was involved.

Stroke is focal cerebral ischemia that most often results in neurological and medical complications with long-term implications with regard to the quality of life, morbidity, and mortality.

Achieving cerebral reperfusion within the first 90 minutes significantly reduces the risk of these post-stroke complications.

A transient ischemic stroke (TIA), often referred to as a mini-stroke, has no complications, only symptoms, which often last only for about five minutes to a few hours and then disappear leaving no lasting effects.

A worry that bothers the attending physician is that the complications that can occur soon after an acute stroke, are life-threatening, and preventing them from setting in is the primary focus of the treatment.

Common complications of a stroke

Complications that can occur in men and women after an ischemic and hemorrhage stroke and are common to all ages include:

1. Falls and accidents

Falls and accidents due to a stroke are common fallouts as an after-effect of a stroke. This occurs due to muscle and bone weakness, impairment of sensory function, incoordination, loss of balance, and visual problems.

According to a study, 14% and 65% of stroke survivors experience falls while in hospital and up to 73% of stroke survivors experience a fall in the first 6 months at home after discharge. Fractures and wounds are common.

2. Increased intracranial pressure

Increased pressure in the brain can occur due to a hemorrhagic stroke particularly a hemorrhage in the subarachnoid space. Due to the bleeding, there is an increase in pressure in the brain.

Intracranial pressure can rise rapidly and press on the vital areas of the brain and the spinal cord causing damage. This is a medical emergency that can cause death.

Possible complications include death, neurological problems that can be reversible or permanent, seizures, and recurrent stroke.

3. Brain edema

Brain edema, also called swelling of the brain, can occur due to both ischemic and hemorrhagic stroke.

As the brain swells, it presses on the blood vessels and affects the blood supply to the vital areas causing the death of the brain cells in the affected part. Most deaths due to stroke that occur in the first week are due to brain edema.

4. Seizures

Seizures are a sign of brain injury and are due to sudden abnormal electrical activity in the brain. During a seizure, the person may go into spasms or convulsions

Seizures are a little more likely to occur in cases of a severe hemorrhagic stroke rather than an ischemic stroke. They are also seen as more likely to occur in a stroke involving the cerebral cortex.

The risk of the patient suffering from seizures is most during the first thirty days after the stroke. About 5% of such patients suffer from seizures during these few initial weeks. And, the risk increases further after the patient suffers a second stroke.

In elderly people, stroke is the most common cause of seizures.

5. Aspiration pneumonia

Damage to the cortex or brain stem due to stroke can lead to impairment of the swallowing reflex or the gag reflex (dysphagia).

In such a situation, when you swallow, particles of food and drinks can go down the bronchus (windpipe) into the lungs. This is called aspiration.

These inhaled substances can carry bacteria and can cause infection in the lungs and subsequent aspiration pneumonia.

Approximately 55% of patients who suffer from an acute stroke present with dysphagia (difficulty in swallowing).

A stroke patient can aspirate recurrently and could suffer from pneumonia on and off. This can cause chronic infection of the lungs, which then become weakened. This is can lead to sepsis or a lung abscess.

Recurrent pneumonia of this type does not have a good prognosis. The mortality rate is high, especially in elderly people above the age of 75 years.

6. Urinary tract infections (UTI) and bladder control

A stroke patient who has lost control over his bladder needs to have a Foley catheter inserted into the bladder so that the urine can be collected in the urine bag to maintain hygiene.

Chronic use of the Foley catheter can cause recurrent hospital-acquired urinary tract infections (UTIs) with poorer outcomes.

The increase in UTI among stroke patients is possibly due to immunosuppression, increased bladder dysfunction, and increased and recurrent use of a bladder catheter. This complication is seen in patients with both ischemic and hemorrhagic strokes.

7. Clinical depression

Depression is a common fallout resulting from both an ischemic stroke and a hemorrhagic stroke. It can set in weeks, months, or even years after your stroke.

Depression sets in as a secondary complication, which results from the primary neurological and medical effects.

This comes about due to the permanent loss of lifestyle the patient once enjoyed and the restrictions, which now have to be followed.

Emotional reactions to such physical liabilities are common. It is a mixture of anger, frustration, anxiety, sadness, fear, and hopelessness in varying degrees.

Emotional health is as important as physical health for post-stroke recovery. Depression can significantly slow down your recovery.

Almost one-third of stroke patients suffer from depression and yet, according to the National Institutes of Health, post-stroke depression is often underdiagnosed. Elderly people are more prone to this secondary complication of emotional and behavioral change.

8. Hemiparesis and hemiplegia

The right side of the brain controls the motor function of the left side of the body. The left side of the brain controls the motor function of the right side of the body.

Thus, when one side of the brain is damaged, the opposite side of the body gets affected. Hemiparesis and hemiplegia can occur with both types of strokes (ischemic and hemorrhagic), which occur in the left or right hemisphere of the cerebrum.

Hemiparesis is weakness and/or slight paralysis of one side of the body (unilateral). You can still move the affected side of your body, but with reduced muscular strength. Recovery from hemiparesis is mainly with physical and occupational therapists.

Hemiplegia is a more severe form and involves complete paralysis of one side of the body.

According to the National Stroke Association, as many as “9 out of 10 stroke survivors have some degree of paralysis immediately following a stroke.”

This condition is caused by disruption of blood supply to the parts of the brain that control movements of the limbs, trunk, face, etc.

Rehabilitation and physiotherapy therapy can help stroke survivors recover and gain voluntary movement even years after their stroke.

Hemiplegia often causes

  • muscle spasticity (muscle weakness in the affected part of the body)
  • muscle atrophy
  • seizures
  • pain in the affected part of the body

9. Foot drop

Foot drop is a commonly found stroke complication and is the inability to lift the front part of the foot after a stroke. So, when you walk, your toes drag along the ground. One, therefore, tends to lift that one knee higher to avoid the toes dragging along the ground.

Foot drop may affect one foot or both feet; it may be short-term or long-term.

Rehabilitation therapy can help in partial or total recovery.

The nerves supplying the affected foot are damaged due to the stroke and the concerned muscles become weak due to disuse.

10. Other secondary complications

Other ensuing or secondary complications that develop include:

  • Bedsores occur usually on the lower back due to the immobility of the stroke patient and the pressure on the affected areas due to long-standing immobility.
  • Limb contractures occur due to reduced or total immobility of the limb due to hemiplegia caused by stroke. Certain muscles, tendons, or scar tissues go into a chronic state of contraction, which can permanently shorten them. Fibrosis of connective tissue can result in decreased mobility. It also produces deformity or distortion of the muscles of the limbs.
  • Deep venous thrombosis (DVT) — blood clots form in the veins of the legs because of immobility due to stroke. These clots can travel through the bloodstream and get lodged in the lungs. This is a dangerous condition and can result in pulmonary embolism and death.

Complications of stroke in the elderly

Nearly 75 percent of all strokes are seen in elderly people above the age of 65 years and the risk of suffering from a stroke doubles each decade after the age of 55.

Almost 95 percent of stroke sufferers develop some complication post-stroke and at least 24 percent of stroke patients suffer from a serious medical complication.

A serious complication can be defined as one, which is prolonged, life-threatening, or results in hospitalization or death.

Such serious medical complications, which are more common in elderly people include pneumonia (5 percent), gastrointestinal bleeding (3 percent), congestive heart failure (3 percent), and cardiac arrest (2 percent).

Some more specific stroke complications in the elderly include confusion, mouth care, swallowing, and lack of nutrition.

With increasing age, the risk of death becomes more prevalent.