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Stroke Side Effects: Understanding the Aftermath
- Published on July 14, 2020
Every stroke is different and, as a result, every patient will experience side effects differently.
To make the recovery process even more complex, some patients develop side effects months after discharge from the hospital. This means it’s a good idea to understand other potential side effects, so that you’re able to catch signs early.
This page contains a comprehensive list of the most common stoke side effects. Before we dig in, though, it’s important to understand why these side effects occur.
What Causes Stroke Side Effects?
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 side 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 side effects: the size and location of the stroke.
The size of the stroke often correlates with the severity of the side effects. For example, patients that sustain mild strokes often experience no side effects while massive stroke survivors usually sustain significant aftermath, such as paralysis.
The area of the brain affected by stroke also influences the side 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 side 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 Stroke Side Effects
The most notable stroke side effects are the ones that affect physical movement.
We need to be able to move to accomplish the activities of daily living such as eating, dressing, and toileting. Therefore, the physical side effects of a stroke often get the most attention from occupational therapists.
Here are some of the most common physical after effects of stroke (click on the title to expand the section):
Hemiparesis
Many stroke patients sustain motor impairments that affect one side of the body, a condition known as hemiparesis. This occurs after the motor cortex is damaged and cannot send signals to the affected muscles. Treatment involves physical therapy to rewire the brain and restore movement.
Hemiplegia
Patients suffering severe stroke may develop paralysis on one side of the body. This chronic condition is best managed with physical therapy. Treatment should involve practicing passive paralysis exercises to help rewire the brain and improve mobility.
Spasticity
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 therapy to rewire the brain and loosen the muscles. Temporary management involves Botox and prescription medications.
Contractures
Contractures are an advanced stroke side effect that occur when spasticity is left unmanaged. Contractures are characterized by extreme stiffness in the muscles, joints, or connective tissue. Management involves splints and passive range of motion exercises.
Post-Stroke Fatigue / Excessive Sleeping
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, and it’s encouraged.
Balance Issues
The motor impairments that follow stroke may result in poor balance, putting stroke patients at risk of falling. Rehabilitation exercises, particularly for the legs and feet, can help restore movement in the body and improve balance.
Dysphagia (Swallowing)
If you have difficulty swallowing after stroke, it could be a sign that you have a stroke side 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.
Shoulder Complications
Because the shoulder socket is particularly vulnerable to injury, many stroke patients experience shoulder pain. Treatment involves physical therapy shoulder exercises and pain medication. If left untreated, it may develop into more serious conditions like shoulder subluxation (where the shoulder become partially dislocated) and frozen shoulder (where the ligaments then become inflamed).
Foot Drop
When patients have difficulty lifting the front part of the foot, they are dealing with a stroke side effect called foot drop. Management involves wearing an AFO brace to prop the foot up and improve safety. Treatment involves rehabilitation exercise and physical therapy.
Curled Toes
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.
Learned Nonuse
If stroke patients fail to move their muscles (either through active exercise or passive range of motion), they may suffer a side effect called learned nonuse. This condition causes your brain to completely forget about the affected muscles. 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 Stroke Side Effects
Next you’ll discover the potential cognitive side 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 stroke side effects:
Aphasia (Language)
Aphasia is a common language difficulty that can occur after a stroke, especially left hemisphere strokes. Not all languages 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.
Impaired Cognitive Function
The frontal lobe handles higher cognitive functions such as language and memory. When it sustains damage after stroke, it can make everyday cognitive functions, like remembering where you put your keys, more difficult. Fortunately, there are many studies showing that cognitive training helps improve cognitive function after stroke.
Poor Memory
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 exercises can help.
Vascular Dementia
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 side effects, 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 Stroke Side Effects
Next, we will discuss various sensory side effects that can occur after stroke.
Here are some of the most common sensory side effects after stroke:
Numbness
Post-stroke numbness is a common stroke side 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 some cases, sensory reeducation may be necessary to help stimulate the brain to improve sensation.
Tingling or Pins-and Needles Sensations
Another sensation-related stroke side effect 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 Post-Stroke Pain Syndrome
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.
Post-Stroke Pain
Not all pain after stroke is chronic. Sometimes localized pain can occur after a stroke, usually stemming from other side effects like spasticity or contractures. This type of pain is best treated by addressing the underlying condition.
Left Neglect
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.
Visual Disturbances
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 resoration therapy and/or specialized glasses.
These side effects are more likely to occur if the stroke affected the areas of the brain that process sensory information or spatial awareness, such as thalamic stroke or parietal lobe stroke.
A stroke in these areas are more likely to cause sensory side effects, however, it’s not guaranteed. Any type of stroke can create various side 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) and others are secondary complications (resulting from other stroke side effects).
Here are some of the most common medical complications after stroke:
Bedsores
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 and pressure ulcers by re-positioning the body every couple hours.
Incontinence
Stroke can affect your ability to control your bladder and/or bowel movements, which is a condition known as incontinence.
Seizures
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.
Pneumonia
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
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 venous thrombosis, doctors may prescribe blood-thinning medication.
Headaches
Headaches are a common and worrisome stroke side effect. If you experience severe or mild headaches that last for longer than a few hours, seek medical attention immediately because it signify further medical complications.
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 side 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:
Pseudobulbar Affect
Random ourbursts of laughter and/or crying may stem from a post stroke side effect known as emotional lability or pseudobulbar effect. Treatment includes medication or psychotherapeutic intervention.
Personality Changes
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.
Depression and Anxiety
Unfortunately, depression and anxiety are common stroke side effects 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 side effects after stroke, we hope this guide provided you with the answers you need for recovery.
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See how Susan is recovering from post-stroke paralysis
“I had a stroke five years ago causing paralysis on my left side which remains today.
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At first it was difficult for me to be successful with a few of the exercises but the more I use it, the better my scores become.
I have recently had some movement in my left arm that I did not have before.
I don’t know if I can directly relate this to the use of the FitMi but I am not having occupational therapy so I conclude that it must be benefiting me.
The therapy modality motivates me to use it daily and challenges me to compete against my earlier scores.
I heartily recommend it!” -Susan, stroke survivor
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