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Stroke: Its Impact on Mind, Movement & Lifestyle

February 22, 2012 8:30 AM with Dr. Jim Castle

Stroke—otherwise known as a “brain attack” is the fourth leading cause of death in the United States. Join Jim Castle, MD, neurologist at Northshore as he answers you questions about stroke symptoms, risk factors, prevention techniques and recovery. Learn more about the effects stroke can have on cognitive abilities, balance and movement. Early questions are welcomed.

Angela (Moderator) - 8:20 AM:
Welcome! Today’s chat: Stroke – Its Impact on Mind, Movement and Lifestyle will begin shortly. Please start submitting your questions and Jim Castle, MD, neurologist will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to read our recent blog post, Stroke: A Brain Attack Requiring Immediate Action. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

  Nancy (Chicago, IL) - 8:30 AM:
I had a hemorrhagic stroke on Feb. 7, 2010. I have made many improvements since then. What are things that can be done? Evanston Hospital is a great place for stroke patients!
Dr. Jim Castle (NorthShore)
The first thing to consider is what caused the stroke. Most hemorrhagic strokes are caused by high blood pressure, but other causes include abnormal blood vessels such as arterivenous malformations, aneurysms, and cavernous malformations. I would make sure that the underlying cause has been identified and is being treated appropriately. Beyond that, the most important thing to do is keep a positive attitude and continue rehab. Even 2 years after a stroke I hear stories of people who make considerable improvement with rehab. Even if it means exercising on your own, try to make the effort to continue to improve. Good luck!

  Josh (Elmhurst, IL) - 8:33 AM:
My father suffered a stroke nearly a month ago. What should my family and I consider to improve his outcomes and ensure he is being properly cared for?
Dr. Jim Castle (NorthShore)
First, best to make sure that the underlying cause of the stroke has been identified. I assume from the question that this was an "ischemic" stroke - the most common kind. If so, the two most common reasons that would occur is if he had a clot come from his heart or from one of his arteries. I would make sure that he is taking his medications as prescribed to prevent another occurrence. Depending on his physical status, it would also be in his best interest to do all the right things with his lifestyle - in other words, healthy eating, exercise, no smoking. Beyond that, to get him better the most important things are a good attitude and aggressive rehabilitation. Make sure that he is working everyday on trying to improve whatever was lost because of the stroke, and that he is not having any depression (which can be treated) as a result of the stroke.

  Karen (Evanston, IL) - 8:37 AM:
I’ve heard that you should never drive yourself to the hospital if you think you are having a stroke. Why is so important to be evaluated quickly?
Dr. Jim Castle (NorthShore)
You are right. It is critical to call 911 for several reasons. First, if an ambulance takes you to the hospital, you are typically put in the "front of the line" so to speak in the Emergency Room, and are immediately given a bed and treated as an acutely ill patient. If you drive yourself in, you frequently have to sit in a waiting room before getting attention. Coming via ambulance sets a series of events into motion which speed up your treatment. Second, often times a stroke will render you unsafe to drive. You may not even realize that you are unsafe to drive, and can get into car accidents.

  lori (porterville ca) - 8:40 AM:
I care for a 95 yr. old female who has had prior stroke. This morning her blood pressure was high, she had glossy eyes, less movement on her left side than usual, and was also having trouble bearing weight on the left side. She took time to respond to questions. What could this be?
Dr. Jim Castle (NorthShore)
If that ever happens, you should call 911. She could be having another stroke, or having a seizure. Even if she returns to normal after a few minutes, I would definitely call her doctor and have her evaluated soon. Patients with strokes in the past are very prone to having small seizures which make them confused, can raise their blood pressure, and bring back their old stroke symptoms. These need to be treated appropriately so that they do not get worse.

  Gary (Chicago, IL) - 8:43 AM:
My wife had a stroke about three months ago. She has been very emotional since her stroke and also has been having trouble sleeping. Are these common symptoms? What can we do to increase her energy and improve her mood?
Dr. Jim Castle (NorthShore)
It is very common for patients to develop depression or personality changes after a stroke. There are several treatment options available for these issues, and the treatments are usually tailored for the specific problem. Three issues that come to mind are: 1) depression, 2) "pseudobulbar affect", 3) personality change from brain damage. Depending on which one of these she has, considerations could be given for anti-depressants, mood stabilizers, energy medications (such as Nuvigil), or Psychiatric/Psychological counseling. It is important to have this checked out right away so that she can continue with her rehabilitation properly.

  Chris (Chicago) - 8:46 AM:
Are you ever able to regain your memory and comprehension after a stroke? If so, what can you do to encourage this recovery?
Dr. Jim Castle (NorthShore)
As with all strokes, there should be improvement after the initial event. Most of the improvement comes in the first 6 weeks, but can continue for years later. Given these specific symptoms you describe, a few ideas come to mind. First, ask your doctor for a referral to a "Speech Therapist". These therapists often work at the hospital, and will help with word finding, reading, comprehension, etc. They often give the patient exercises to do at home as well. That would be the main thing. Beyond that, I would strongly recommend keeping the mind exercising by reading, doing crossword puzzles, and gentle physical exercise. The worst thing to do is sit on a couch and watch TV.

  Pierce (Skokie) - 8:49 AM:
How do you know if you are suffering from a stroke? Do some of the signs and symptoms differ depending on if you are male or female?
Dr. Jim Castle (NorthShore)
The signs should not differ based on whether you are a man or a woman. I like the saying "STRoke" for determining the typical signs and symptoms. S stands for "Smile" - is the smile drooping on one side? T stands for "Talk" - is the voice slurry or are the words not making sense? R stands for "Raise your arms" - is one arm drifting downward and weak? If any of those symptoms are occuring, there is a good chance that you are having a stroke and should call 911 immediately. Another sign of stroke would be sudden visual loss.

  Bernard (Chicago, IL) - 8:52 AM:
How many different types of strokes are there? I’ve heard one type is causes more by heart problems and the other is brain-based. Is this true? Do the causes differ for each type?
Dr. Jim Castle (NorthShore)
The vast majority of strokes are caused by blood clots either from the heart or from the arteries that supply the brain. In the case of clots arising from the heart, these are usually due to an irregular heart rhythm called "atrial fibrillation". It can also be caused by an old heart attack that makes some of the walls of the heart beat less vigorously than they should. Strokes of this type are usually treated with medications called "anticoagulants". The other, more common source of clots are from the arteries themselves. This is usually due to high cholesterol, high blood pressure, diabetes, and smoking. These strokes are usually treated with "anti-platelet" medications, blood pressure control, and cholesterol medication.

  Fran (Rockford, IL) - 8:56 AM:
Do strokes cause permanent brain damage? Since his stroke my husband has very limited cognitive abilities as compared to how he was beforehand. He also continues to struggle with balance. What can I do to help?
Dr. Jim Castle (NorthShore)
The answer to your first question is, "yes". Strokes often cause permanent brain damage. In your husband's situation, I think the most important thing would be to get him rehabilitation from a specialist. It sounds like he could use the assistance of a "Speech Therapist" and a "Physical Therapist". They can work aggressively with him to get his cognitive abilities improved and his walking more stable. The Physical Therapist can also provide safety tools as needed to prevent falling, such as a cane or walker.

  Allie (Highland Park, IL) - 8:59 AM:
I am curious to learn about the different treatment options that exist for strokes. Are some more readily accepted than others?
Dr. Jim Castle (NorthShore)
This is somewhat complicated. There are acute treatments and chronic treatments. Assuming we are talking about "ischemic" strokes - the most common form, then I'll give you a basic outline here: For acute strokes, the only 2 accepted therapies are 1) Intravenous TPA medication if given to appropriate patients within 3 hours if they are older than 80 year of age, or within 4.5 hours if they are 80 or under. This medicine carries a 3% chance of causing sudden death, so it is not to be given without careful thought. 2) "Permissive Hypertension" - a term which means allowing the blood pressure to run high and therbey get as much blood as possible to the site of the stroke. For chronic stroke prevention, if the stroke was caused by a clot from the heart, the typical therapy would be to give an "anti-coagulant". If the stroke was caused by a clot from an artery, the typical treatment would be to give an "anti-platelet", a blood pressure medication and choleterol medication.

  Thomas (Chicago) - 9:05 AM:
Is it normal to not regain full movement of just one side of the body after a stroke? Why is this?
Dr. Jim Castle (NorthShore)
It is certainly a possibility. The reason that one side of the body is effected, and not the other, is that each side of the brain controls the opposite side of the body, and is supplied by two completely different sets of arteries. Therefore, it is standard for a stroke to effect only the left or right side of the body. Hopefully, with time the strength improves, but in some unfortunate people, they remain paralyzed on one side.

  Peggy (Evanston) - 9:07 AM:
My dad was extremely active before suffering from a stroke 4 months ago. His movement and balance has improved greatly, but it’s not nearly the same as before. When can he begin more strenuous exercises? Will he ever be able to return to his past lifestyle?
Dr. Jim Castle (NorthShore)
I can't guarantee that he will be able to get back to his previous lifestyle. Unfortunately, most people with a stroke do not regain their full pre-stroke function. That said, I would encourage him to aggressively rehabilitate! That means working with a "Physical Therapist" and "Occupational Therapist" at his local hospital (his primary care doctor can refer him for that therapy), and be very aggressive about getting exercise and strength training. Since I have not met him, I can't tell you when it would be safe to re-start those things - you would need to check with the Physical and Occupational Therapists to decide when different activities are safe. However, even being bed-bound would not be an excuse to actively exercise. Anything he can do will help.

  Harry (Chicago) - 9:11 AM:
Can you drive after having a stroke?
Dr. Jim Castle (NorthShore)
This is a very tricky question. It depends entirely on how much improvement you have made after the stroke. If you are 100% back to normal, you should ask your doctor if it is ok. They will almost undoubtedly say "yes". However, if you have any lingering symptoms, they will often want you to check get a "Driving Evaluation". Most large hospitals offer such an evaluation through their Occupational Therapy office. I would recommend asking your regular doctor if you need such and evaluation, and if so, ask for a referral.

  Elaine (Evanston, IL) - 9:14 AM:
There is a history of high blood pressure, stroke and diabetes in my family. Does this put me a greater risk for having a stroke? What can I do now to reduce my risk?
Dr. Jim Castle (NorthShore)
This probably does put you at increased risk of stroke. I think it would be very important for you to have a yearly check up with your doctor and get monitored for blood pressure, cholesterol, and early diabetes. If any of these are an issue, treat them early! The sooner you start treatment for them, the better off your heart and arteries will be in the long term.

  Terrence (Skokie) - 9:17 AM:
If you think you are having a stroke how much time do you have to get to the hospital? Does a delay make things worse?
Dr. Jim Castle (NorthShore)
You need to get to the hospital immediately by calling 911. Although there is a treatment "window" of 3 to 4.5 hours for giving our most accepted acute stroke treatment (TPA medication), there is no question that the sooner you receive treatment the better off you will be. Receiving therapy at the end of that window is little better than not receiving it at all in most cases.

Angela (Moderator) - 9:17 AM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

  Jean (Chicago) - 9:19 AM:
Are there particular complications that may result from a stroke?
Dr. Jim Castle (NorthShore)
Two of the most common would be pneumonia and "DVT". Pneumonia is fairly common, and occurs because the swallowing mechanism is not working properly. Saliva and food can go down into the lung and cause an infection. This is typically prevented by having a Speech Therapist examine the patient and determine which foods they are safe to eat. A "DVT" means that a clot has formed in the veins of the legs. These clots form after prolonged inactivity (due to weakness from a stroke). They can travel to the lung and cause a fatal lung condition known as a "Pulmonary Embolus". This is typically prevented by starting the patient on blood thinners while they are lying in bed.

  Pablo (Chicago, IL) - 9:23 AM:
What does stroke rehabilitation entail? Can much of this be done from home?
Dr. Jim Castle (NorthShore)
You can think of stroke rehabilitation as similar to going to a gym and getting a personal trainer. The therapists work with you on strengthining what was weakened by the stroke. Physical Therapists often work with the legs and the larger muscles of the arms. Occupational Therapists often work with the fine muscles of the hands and arms. Speech Therapists often work with improving muscles of the mouth and with language ability. Typically, yes, it is better to go to their training center where they have all their equipment. For patients with less needs, they can often come to your house to exercise with you, or provide you with an exercise regimen that you can do on your own.

  Dean (Chicago, IL) - 9:25 AM:
Is there such a thing as a “silent stroke”? Are there long-terms affects of this even if no symptoms exist?
Dr. Jim Castle (NorthShore)
A "silent stroke", in my opinion, refers to one of two possibilities. The first is that you had a very small stroke in one of the tiny capillaries of the brain. These do not cause any notable symptoms, but if you have enough of them they can add up and over time lead to memory loss and weakness. The second type of "silent stroke" is a bigger stroke that would normally be expected to cause symptoms, but happened in a part of the brain that was not terribly important (think of an asteroid falling in a cornfield rather than downtown Chicago). It is a tip-off that you need to carefully control your stroke risk factors, but generally does not cause any long term cognitive or movement issues.

Angela (Moderator) - 9:29 AM:
Thank you for participating in our online chat today. An online transcript will be available shortly.

This chat has ended.

Thank you very much for your participation.