Every stroke is different and, as a result, every patient will experience secondary effects differently.
To make the recovery process even more complex, some patients develop secondary effects months after discharge from the hospital. This means it’s a good idea to understand other potential effects, so that you’re able to catch signs early.
This page contains a comprehensive list of the most common effects of a stroke. Before we dig in, though, it’s important to understand why these effects occur.
What Causes the Effects of a Stroke?
A stroke is caused when the supply of blood in the brain is compromised. This deprives the local brain tissue of oxygen-rich blood, causing brain cells to die.
Once the stroke has been treated, normal blood flow is restored. This puts an end to the stroke, but the damage left behind can lead to secondary effects. This is why timely stroke treatment is vital to both save a life and minimize disability.
When disability after stroke occurs, two factors influence the effects: the size and location of the stroke.
The size of the stroke often correlates with the severity of the secondary effects. For example, patients that sustain mild strokes often experience no effects while massive stroke survivors usually sustain significant aftermath, such as paralysis.
The area of the brain affected by stroke also influences the effects sustained. For example, a stroke in the left hemisphere is likely to lead to language issues because that’s where the language center of the brain usually resides.
Nothing is guaranteed, though. Every stroke is different and every brain is wired a bit differently. The good news is that, by understanding some of the most common secondary effects, you can prepare yourself for the road to recovery ahead.
Now that you understand why stroke side effects occur, let’s dig into the list of the most common ones.
Part 1: Physical Effects of a Stroke
The most notable effects of a stroke are the ones that impact physical movement.
We need to be able to move to accomplish the activities of daily living such as eating, dressing, and toileting, as well as walking. Therefore, the physical effects of a stroke often get the most attention from occupational and physical therapists.
Here are some of the most common physical after effects of stroke (click on the title to expand the section):
Many stroke patients sustain motor impairments that affect one side of the body (the side opposite to where the stroke was), a condition known as hemiparesis. This occurs after the motor cortex is damaged and cannot send signals to the affected muscles. Treatment involves physical and occupational therapy to rewire the brain and restore movement.
Patients suffering severe stroke may develop paralysis on one side of the body. This chronic condition is best managed with physical and occupational therapy. Treatment should begin with practicing passive exercises to help rewire the brain and improve mobility. Education from therapists regarding safe positioning of your immobile body parts is also very important.
When affected muscles become stiff and tight, it’s due to a condition called spasticity. This can limit a stroke patient’s range of motion. Treatment involves physical and occupational therapy to rewire the brain and stretch/loosen the muscles. Sometimes in severe cases, temporary management involves Botox injections and prescription medications, so consider talking to your doctor about this.
Contractures are an advanced secondary effect of a stroke that occur when spasticity is left unmanaged. Contractures are characterized by extreme stiffness caused by a shortening of the muscles or connective tissue that span one or more joints. The stiffness is so severe to the point where movement in the area becomes nonexistent.
Management involves splints or casts, passive and prolonged stretching exercises, or potentially surgery. If any of your muscles become contracted, there are also assistive devices that can help you with improving function, and your occupational therapist would be able to tell you about them.
Fatigue is common after a stroke as the brain is trying to heal itself, which may drain the patient’s energy. Everyday tasks may take more energy to complete, resulting in daytime sleepiness or fatigue. As a result, excessive sleeping is common in stroke patients.
While excessive sleeping early on in recovery is encouraged and beneficial, if this continues later in recovery it may impede rehabilitation and be a sign of other underlying issues. Speak to your doctor if this is the case for you.
The motor impairments that follow stroke may result in poor balance, putting stroke patients at risk of falling. Rehabilitation exercises, particularly for the legs, feet, and core, can help restore strength and movement in the body and improve balance.
If you have difficulty swallowing after stroke, it could be a sign that you have a secondary effect known as dysphagia. Patients work with Speech Language Pathologists (SLP) to retrain the brain to control the swallowing muscles. In some cases, a feeding tube may be required.
Because the shoulder socket is particularly vulnerable to injury, many stroke patients experience shoulder pain on their affected side when the shoulder becomes very weak. Treatment involves physical and occupational therapy shoulder exercises, maintaining proper positioning and support of your arm, and potentially pain medication.
If left untreated, it may develop into more serious conditions like shoulder subluxation (where the shoulder becomes partially dislocated) and frozen shoulder (where the ligaments then become inflamed).
When patients have difficulty lifting the front part of the foot (bringing their toes towards their shin), they are dealing with a condition called foot drop. Management involves wearing an AFO brace to prop the foot up and improve safety. Treatment involves rehabilitation exercise and physical therapy.
When the toes curl under, often in a painful manner, it’s the result of spasticity in the feet. This condition is known as curled toes. Treatment involves toe separators, AFOs, and of course, rehabilitation exercise.
If stroke patients fail to move their muscles (either through active exercise or passive range of motion), they may suffer a condition called learned nonuse. This condition causes your brain to have even more difficulty paying attention to the affected muscles, therefore making it harder to rehabilitate these muscles and over-relying on your non-affected side. This is where the phrase “use it or lose it!” comes from.
Inpatient and outpatient therapy typically focuses on restoring physical abilities. However, the cognitive effects of stroke can also impair the ability to perform activities of daily living, so those get attention too.
Part 2: Cognitive Effects of a Stroke
Next you’ll discover the potential cognitive effects of a stroke. These are more likely to occur after a frontal lobe stroke or a stroke that impairs the brain’s ability to think analytically or rationally.
Here are the most common cognitive effects of a stroke:
Aphasia is a common language difficulty that can occur after a stroke, especially left hemisphere strokes. Not all language problems are considered aphasia, but it’s an umbrella term that encompasses the majority of speech issues. Treatment involves speech therapy exercises. If the patient cannot talk at all after stroke, singing therapy may help.
The frontal lobe handles higher cognitive functions such as memory and attention. When it sustains damage after stroke, it can make everyday cognitive functions, like remembering where you put your keys or paying attention to someone talking, more difficult.
Sometimes a stroke impairs the brain’s ability to retrieve old memories or create new ones. It can affect short-term memory, long-term memory, or both.
Sometimes memory improves on its own (spontaneous recovery). Other times, studies have shown that cognitive training helps improve cognitive function after stroke. This type of training is typically done with a speech therapist.
Post-stroke dementia refers to vascular dementia which can stem from the impact of the stroke. Vascular dementia can cause cognitive issues like impaired thinking and reasoning, memory loss, confusion, decreased attention span, and more. It’s important to work with a medical team for diagnosis and treatment.
With cognitive effects of a stroke, it’s best to work with a Speech Language Pathologist. SLPs are highly skilled in working with stroke patients with language difficulties and other cognitive issues.
Part 3: Sensory Effects of a Stroke
Next, we will discuss some of the most common sensory effects after stroke:
Post-stroke numbness is a common secondary effect that causes a total loss of sensation in the affected area. Fortunately, spontaneous recovery is possible where the numbness goes away on its own. In many cases, sensory reeducation may be necessary to help stimulate the brain to improve sensation.
Precautionary measures also need to be taken to ensure protection of the numb body parts, and this is something that your therapists should teach you more about.
Another sensory-related effect of a stroke includes tingling and pins-and-needles sensations. As with numbness, sometimes spontaneous recovery is possible; otherwise, sensory reeducation may help. It’s also important to note that sometimes pins-and-needles sensations occur before the onset of central pain syndrome, which we discuss next.
Central pain syndrome is a chronic pain condition that can affect stroke survivors. It often has a delayed onset, occurring months or even years after the stroke occurred. Usually, it starts with extreme sensitivity or pins-and-needles sensations, but progresses into chronic pain. There are ways to treat it, and your medical team should be consulted every step of the way.
Not all pain after stroke is chronic. Sometimes localized pain can occur after a stroke, usually stemming from other effects like spasticity or contractures. This type of pain is best treated by addressing the underlying conditions.
Image from Journal of Neurology
Hemineglect is a spatial awareness problem that prevents the stroke patient from noticing half of their environment and body — often the left side (informally known as left neglect). If someone with left neglect is asked to fill in the numbers on an empty clock, they may cram everything into the right side without realizing it. Hemineglect can affect the right side as well, but is typically not as severe as the left and is usually termed “right inattention.”
When a stroke affects the brain’s visual processing abilities, vision may be affected. Some patients develop double vision or sustain “field cuts” where half (or sometimes a quadrant) of the visual field is missing. Treatment includes vision restoration therapy and/or specialized glasses.
A stroke in these areas is more likely to cause sensory side effects, however, it’s not guaranteed. Any type of stroke can create various effects, because every brain is wired differently.
Part 4: Medical Complications After Stroke
Next you’ll learn about various medical complications from stroke. Some are primary complications (resulting directly from the stroke itself) and others are secondary complications (resulting from the effects of a stroke).
Here are some of the most common medical complications after stroke:
Bedsores are pressure ulcers that happen when there is prolonged pressure on areas of the body due to decreased mobility. They often happen during longer hospital stays, and they are unfortunately very common in stroke patients. You can help prevent bedsores by re-positioning the body every couple hours.
Stroke can affect your ability to control your bladder and/or bowel movements, which is a condition known as incontinence.
About 5% of stroke survivors will experience seizures after stroke. Seizures occur when there is sudden disorganized electrical activity in the brain, causing the body to convulse. They can be prevented and treated using medication or a vagus nerve stimulator.
Sometimes stroke patients with dysphagia (impaired swallowing) accidentally inhale food into the lungs. These occurrences are called aspirations, which can lead to pneumonia in stroke patients. Aspirations should be taken very seriously because they are the biggest cause of attributable mortality from medical complications after stroke.
Deep vein thrombosis is a medical condition where blood clots form in veins of the legs, often due to impaired mobility. Since many stroke patients struggle with mobility issues, this stroke risk factor increases during recovery. If you’re at risk of developing deep vein thrombosis, doctors may prescribe blood-thinning medication.
Medical complications often require medical attention for treatment. Be sure to keep your doctor and medical team informed if any new complications occur, and seek emergency medical attention if new symptoms are concerning.
Part 5: Emotional Complications After Stroke
Finally, a stroke can also lead to emotional effects. Some of these are primary complications that result directly from damage to the emotion center of the brain. Others are secondary complications, which stem from other dynamics of life after stroke.
Here are the most common emotional complications after stroke:
Random outbursts of laughter and/or crying when inappropriate to the context/situation may stem from a post-stroke condition known as emotional lability or pseudobulbar affect. Treatment includes medication or psychotherapeutic intervention.
Many stroke survivors feel like they’re a different person after stroke. This is likely caused by changes in abilities, thinking, and behavior after stroke.
Unfortunately, depression and anxiety are common effects of a stroke that many survivors experience and overcome. Sometimes it takes time for emotions to lift. Patients struggling with depression can also look for positive reading material, like our stroke recovery book Healing & Happiness After Stroke.
There are many uncertainties with the after effects of a stroke. The best thing caregivers and patients can do is stay informed and continue to pursue rehabilitation both with a therapist and at home.
If you or a loved one suffer from any of these effects after stroke, we hope this guide provided you with the answers you need for recovery.