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.
A stroke, 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 a focal cerebral ischemia that most often results in neurological and medical complications with long-term implications with regards 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 the 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.
About complications in the elderly
Nearly 75 percent of all strokes are seen in the 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 stoke sufferers suffer from some complication post stroke and at least 24 percent of stroke patients suffer from a serous medical complication.
A serious complication can be defined as one, which is prolonged, life threatening, or that which results in hospitalization or death.
Such serious medical complications, which are more common in the 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.
Common complications that can occur after an ischemic and hemorrhage stroke and common to all ages include:
Falls and accidents
Falls and accidents due to a stroke are a common fallout 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.
Increased intracranial pressure
Increased pressure in the brain can occur due to a hemorrhagic stroke particularly 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 a recurrent stroke.
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 blood supply to the vital areas causing 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.
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 ischemic stroke. They are also seen 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 the elderly people, stroke is the most common cause of seizures.
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 pneumonia.
Approximately 55% of patients who suffer from an acute stroke present with dysphagia.
A stroke patient can aspirate recurrently and could suffer from pneumonia on and off.
This can cause chronic infection of the lungs, which then get weakened. The lungs fail to provide enough oxygen to the lungs. This is can lead to sepsis or a lung abscess.
Recurrent pneumonia of this type does not have a good prognosis. Mortality rate is high especially in elderly people above the age of 75 years.
Urinary tract infections (UTI) and bladder control
A stroke patient who has lost control over his bladder needs to have a Foley’s catheter inserted into the bladder so that the urine can be collected in the urine bag to maintain hygiene.
Chronic use of the Foley’s catheter can cause recurrent hospital-acquired urinary tract infection with poorer outcomes.
The increase of UTI in stroke patients is possibly due to immunosuppression, increased bladder dysfunction, and increased and recurrent use of having a bladder catheter. This complication is seen in patients with both ischemic and hemorrhagic stroke.
Depression is a common fallout resulting from both the ischemic stroke and 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 National Institutes of Health, post-stroke depression is under diagnosed. Elderly people are more prone to this secondary complication of emotional and behavioral change.
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 the types of strokes, 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 therapists 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
- pain in the affected part of the body
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 the 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.
Other secondary complications
Other ensuing or secondary complications that occur as a result of the above direct effects include:
- Bedsores occur usually on the lower back due to 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 muscles of the limbs.
- Deep venous thrombosis (DVT) — blood clots form in veins of the legs because of immobility due to stroke. These clots can travel through the blood stream and get lodged in the lungs. This is a dangerous condition and can result in pulmonary embolism and death.