Effects of a stroke

A very severe stroke can cause a person to lose consciousness and go into a coma. Just after the stroke has occurred, there may also be fluctuations in consciousness. This depends, for example, on the time of day, the fatigue, the activities that took place just beforehand, and the pressure in the brain.

Many patients suffer from a hemiplegia as a result of a stroke. In addition to the inability or difficulty in moving an arm and/or leg, the torso muscles are also affected. This can make it difficult for a person to sit or stand without falling over. The paralysis also makes walking and moving more difficult. Shortly after a stroke the paralysis is loose, a few weeks after the stroke a high muscle tension (spasm) occurs.

Difficulties in understanding and expression may arise from the fact that the area of the brain that handles language is affected. Communication can therefore be very difficult or impossible. This is also referred to as aphasia. The seriousness and extent of the language problem depends, among other things, on the location and severity of the brain injury, the prior language ability, and your personality.
Some people with aphasia can still understand language well, but they have trouble finding the right words or constructing the sentences. Others talk a lot, but what they say is difficult or impossible for the other person to understand.

Due to problems with the strength and coordination of the muscles that control the voice, breathing, and speech, people can sometimes have difficulty speaking. This is called dysarthria. There are various forms of dysarthria: 

• Speech problems, where the speech speed is too high, too low, or variable.
• Sounds are omitted or replaced and speech may sound nasal or monotonous. It seems like somebody is speaking inarticulately.
• Problems with the voice, causing someone to sound hoarse or harsh, speaking too high, too low, too loud, or too soft. The voice can even be lost for a while.
• Respiratory problems: A person can only speak few words in one breath, breathe superficially or quickly, breathe audibly, or strain to breathe.

Swallowing is a complex interplay of different muscles in the mouth and throat. When swallowing, timing, coordination, feeling in the mouth/throat, and muscle strength play an important role. All these aspects can cause problems that make it impossible to chew or swallow, more difficult to swallow, or make it easy to choke. Choking means that liquid or food enters the trachea instead of the esophagus. This could cause pneumonia. Normally this is prevented by coughing, but due to a cerebral infarction it can happen that you do not cough or cannot do so properly.

This means that you lose part of the field of vision on one side of your eyes. Often both eyes are affected. It is also possible that a quarter of the field of vision is lost, in which case it is called quadrantanopia.
This disorder is caused by brain injury, not by an injury of the eyes.

This can lead to slower and uncoordinated movements, causing walking problems. These movements look like those of a drunk person. Problems with the coordination of the arm or hand can also arise.

If there are problems with sensation, you will experience it as a "numb" feeling or tingling in a body part. Touching body parts may feel different than usual. It is also possible that the temperature of, for example, water or pain on the skin is no longer (clearly) felt. It may also happen that a person no longer feels clearly whether their leg is bent or straight or does not feel where their arm or leg is when they are not looking at it.

Urinary incontinence may occur as a result of a stroke. This means you have no control over your bladder. Problems with the retention of urine for longer periods and the occurrence of unwanted urinary leakage are the result.
It may also be possible that you cannot urinate anymore or that you do not urinate properly. In order to empty the bladder, you should be catheterized regularly. This is the insertion of a tube into the bladder so that the bladder can be emptied artificially. The tube is removed when the bladder is empty.

Many people suffer from fatigue after a stroke, which may be severe. This usually occurs frequently and over a long period of time. It is not always clear where this fatigue comes from. Researchers think that fatigue is a direct result of the damage to the brain itself, but that it can also have to do with physical and mental exertion. Things that used to be easy now require an enormous amount of effort and energy. Fatigue affects your physical, emotional, and mental function.

In general, people who have suffered a stroke are able to remember the things they used to do, but they are not able to remember new information, or have difficulty in doing so. Fatigue and reduced attention and concentration can play an important role in this. If this affects you, it also has a negative impact on your memory.

A number of people are no longer as flexible as they were before the stroke. This manifests itself, for example, in difficulty finding another solution to a problem when they get stuck. They may also have trouble changing plans if something does not work out the way they had expected.

Everyone recognizes errors that we sometimes have with spatial perception: for example, we estimate the distance incorrectly, so that we place the cup right next to the table instead of on it. You may think there is going to be another step down the stairs yet you have already reached the floor. This type of situation regularly happens to a patient who has had a stroke and has damage to the right hemisphere. They confuse left and right or are unable to assess the distance to a particular object. This can have consequences for activities that require a good spatial assessment, such as getting dressed. 

Spatial neglect

As a result of a stroke, some people are no longer able to plan and organize life properly. This can have consequences for the organization of the day, household, and work. The result can be that someone loses track of the execution of complex actions, such as preparing a meal. Also, it is not always possible to plan in advance which things are needed for the activity. This manifests itself, for example, by going to the bathroom without taking the items needed to shower.