According to the
University of Medicine and Dentistry of New Jersey, only 10 percent of stroke
victims recover without any side effects. This means of all the 700,000 stroke patients
in the US – even if they survive the stroke – there is a 90% chance that the
difficult times are not over. It is the leading cause of long-term disability. Blood
loss in the brain can cause severe brain damage resulting in a plethora of
various symptoms depending on the area of the brain that lacked blood.
Often when referring to
brain damage we think of those with cognitive damage. Memory, thought,
judgment, and organization are all cognitive functions that can decline after a
stroke in many cognitive areas of the brain, mostly in the temporal lobe or
frontal lobe. This decline is called vascular dementia. Although there is no
cure, it is often treated with anti-platelet drugs or anticoagulants to reduce
risk of future damage, or antidepressants, which has been shown to increase
mental functionality.
One of the most common
side effects of stroke is incontinence. If the patient had a stroke in the
frontal lobe, it can cause confusion about when the correct time to go to the
bathroom is. If the patient suffered a stroke in the motor cortex, it can cause
inability to regulate muscles, in this case certain sphincters. A stroke in the
sensory cortex can cause loss of sensation in the bladder. Patients never
realize that their bladders are overloaded. The common treatment for this is
regular assisted trips to the bathroom every few hours and adult diapers for
when trips are missed.
More than a quarter of
stroke victims will develop aphasia, a language impairment. There are many
types of aphasia but the two most common are Broca’s and Wernicke’s aphasia.
Broca’s, due to damage in the Broca’s area of the brain, is characterized by a
block to the person’s vocabulary. They often get only a few words out at a time
and the formation of new words is difficult. Reading and comprehension come
fine, but writing is an issue. The inability to make words connect is why Broca’s
is called “non-fluent” aphasia. Wernicke’s aphasia, due to damage in the
Wernicke’s area of the brain, the comprehension of words is lacking. The mouth
receives the signal to say the sentence, but the brain cannot process the
thoughts that the patient wants to say. What comes out is a slur of words, most
of which do not relate to the thought process. Reading and writing are severely
impaired here. Currently lots of research is being put into both drug and
speech therapy for aphasia victims.
Parkinson's
disease is a neurological disorder due defective dopamine receptors. Vascular Parkinsonism
is a collection of the same neurological symptoms, but it is due to damage from
a stroke affecting the basal ganglia in the motor cortex of the brain. Unlike
Parkinson’s disease, vascular Parkinsonism is more likely to affect the legs
and the gait of the patient than to cause tremor in the upper extremities.
Treatment normally includes physical therapy.
Other long term effects
of stroke can also include Dejerine-Roussy Syndrome, heightened sensation of
pain due to damage in the sensory cortex; dysphagia, an inability to swallow
caused from damage near the brain stem; Balint Syndrome, a series of vision impairments
after damage to the optic nerve; Anton Syndrome, an unusual form of blindness
after an occipital stroke; seizures, common after intracerebral hemorrhaging; and
prosopanosia, an inability to identify faces after a stroke in the border of
the temporal and occipital lobes of the brain. Although there are a lot of areas
potential problems that can arise from a stroke, just remember that early
diagnosis is the key. Staying ahead of the problem makes it manageable.
Alagiakrishnan, Kannayiram, MD, et al. “Stroke-Related
Dementia.” eMedicineHealth. http://www.emedicinehealth.com/stroke-related_dementia/article_em.htm
“Aphasia Facts.” The
National Aphasia Association, 2010. www.aphasia.com
“Effects of a Stroke.”
About.com, 2012. http://stroke.about.com/od/unwantedeffectsofstroke/Learn_About_The_Conditions_by_Which_Stroke_Changes_Peoples_Lives.htm
Jankovic, Joseph, M.D.
"Vascular Parkinsonism.” Parkinson's Disease Center and Movement Disorders
Clinic, Department of Neurology, Baylor College of Medicine, 2011. https://www.bcm.edu/neurology/parkinsons/?pmid=14200
“Stroke Statistics.” The
University Hospital, University of Medicine and Dentistry of New Jersey. http://www.theuniversityhospital.com/stroke/stats.htm
A stroke depending on the area affected can cause various neurological issues in an individual. I was surprised to find that a stroke can cause Vascular Parkinsonism were individual will exhibit similar neurological symptoms. Parkinson is a disease due to the death of a region of the brain was the dopamine producing cells are located. Other than treating the conditions with pharmaceuticals such as dopamine agonists, it has been shown that many of the symptoms can be treated with exercise and physical training. It is thought that this can be a practical method of improving the quality of life of these individuals due the idea of neuroplasticity which is that the brain can from new connections with proper stimulation. I found this article were a retired physician diagnosed with Parkinsons’s significantly improved his condition and now organizes exercise classes to help others with similar conditions. (http://www.gazettetimes.com/news/local/active-healing-exercise-class-serves-parkinson-s-patients/article_ad3e28ca-e6bb-11e1-9e77-001a4bcf887a.html) It would be interesting to find if such treatments would be equally beneficial for other neurological symptoms caused by a strokes.
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ReplyDeleteA lot of the pharmacology for neurological disorders, including Parkinson's, schizophrenia, and drug addiction, revolve around the dopamine theory. Dopamine has not only be implicated in the "reward system" associated with addiction, but it's lack or excess is associated with Parkinson's or schizophrenia.
ReplyDeleteI concur with Dan's idea of utilizing physical activity as the major form of rehabilitation, as it has shown to offset the symptoms of Parkinson's. It has also been used for strokes to help regain most if not complete use of the post-CVA deficit.
The use of dopamine in strokes has been debated. One study has shown that in ischemic states, there is actually more dopamine in the brain. (http://stroke.ahajournals.org/content/19/12/1540.abstract).
It has been proven that rehabilitation is needed for stroke patients to be able to function again. A study published in the journal Neurology in 2011 reported that individuals who remain depressed three months after a stroke are more likely to have decreased functional capabilities in comparison to those whose depression was successfully treated. I think it is important that stroke patients are screened for depression by their physicians or physical therapists in order to insure that they are able to regain as much lost function as possible after a stroke.
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