Ischemic stroke natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Natural History
Complications
| Duration | Complications |
|---|---|
| Early complications
( <7 days ) |
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| Late complications
( >7 days ) |
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Prognosis
Prognosis of stroke depends on factors such as
- Age of the patient
- Location of infarct
- Size and volume of infarct
- Extent of neurological damage
- Time to seek medical help
- Comorbid conditions such as
- Intevention such as thrombolysis
- Quality of rehabilition care
- Complications
Good Prognostic factors
Bad prognostic factors
Infarct size and location
- Large size of infarct
- Severe neurological deficit
- Advanced age
- Large volume of infarct (supratentorial infarcts)
- Infarct location and vascular supply
- Cervical internal carotid artery
- Anterior choroidal artery
- Insular branch of middle cerebral artery
- Basilar artery
- Large intracranial artery
Presence of clinical complications
- Cerebral edema
- Fever
- Hyperglycemia >200mg/dl
Presence of other co morbid conditions
- Anemia
- Myocardial infarction
- Diabetes mellitus
- Atrial fibrillation
- Malnutrition
- Renal dysfunction
- Heart failure
- Cancer
- Coronary artery disease
- Low socioeconomic status
Disability affects 75% of stroke survivors enough to decrease their employability.[2] Stroke can affect patients physically, mentally, emotionally, or a combination of the three. The results of stroke vary widely depending on size and location of the lesion.[3] Dysfunctions correspond to areas in the brain that have been damaged.
- Some of the physical disabilities that can result from stroke include paralysis, numbness, pressure sores, pneumonia, incontinence, apraxia (inability to perform learned movements), difficulties carrying out daily activities, appetite loss, vision loss, and pain. If the stroke is severe enough, or in a certain location such as parts of the brainstem, coma or death can result.
- Emotional problems resulting from stroke can result from direct damage to emotional centers in the brain or from frustration and difficulty adapting to new limitations. Post-stroke emotional difficulties include anxiety, panic attacks, flat affect (failure to express emotions), mania, apathy, and psychosis.
- 30 to 50% of stroke survivors suffer post stroke depression, which is characterized by lethargy, irritability, sleep disturbances, lowered self esteem, and withdrawal.[1] Depression can reduce motivation and worsen outcome, but can be treated with antidepressants.
- Emotional lability, another consequence of stroke, causes the patient to switch quickly between emotional highs and lows and to express emotions inappropriately, for instance with an excess of laughing or crying with little or no provocation. While these expressions of emotion usually correspond to the patient's actual emotions, a more severe form of emotional lability causes patients to laugh and cry pathologically, without regard to context or emotion.[2] Some patients show the opposite of what they feel, for example crying when they are happy.[4] Emotional lability occurs in about 20% of stroke patients.
- Cognitive deficits resulting from stroke include perceptual disorders, speech problems, dementia, and problems with attention and memory. A stroke sufferer may be unaware of his or her own disabilities, a condition called anosognosia. In a condition called hemispatial neglect, a patient is unable to attend to anything on the side of space opposite to the damaged hemisphere.
- Up to 10% of all stroke patients develop seizures, most commonly in the week subsequent to the event; the severity of the stroke increases the likelihood of a seizure.[5][6]
References
- ↑ 1.0 1.1 Senelick Richard C., Rossi, Peter W., Dougherty, Karla (1994). Living with Stroke: A Guide For Families. Contemporary Books, Chicago.
- ↑ 2.0 2.1 Coffey C. Edward, Cummings Jeffrey L, Starkstein Sergio, Robinson Robert (2000). Stroke - The American Psychiatric Press Textbook of Geriatric Neuropsychiatry (Second Edition ed.). Washington DC: American Psychiatric Press. pp. 601–617.
- ↑ Stanford Hospital & Clinics. "Cardiovascular Diseases: Effects of Stroke". Unknown parameter
|accessyear=ignored (|access-date=suggested) (help) - ↑ Villarosa, Linda, Ed., Singleton, LaFayette, MD, Johnson, Kirk A. (1993). Black Health Library Guide to Stroke. Henry Holt and Company, New York.
- ↑ Reith J, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Seizures in acute stroke: predictors and prognostic significance. The Copenhagen Stroke Study. Stroke 1997;28:1585–9. PMID 9259753.
- ↑ Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Epileptic seizures after a first stroke: the Oxfordshire Community Stroke Project. BMJ 1997;315:1582–7. PMID 9437276.