Stroke—Its Cause

“THE brain is the most delicate organ of the body,” states neurologist Dr. Vladimir Hachinski, of the University of Western Ontario in London, Canada. At only 2 percent of the body’s total weight, the brain contains more than ten billion nerve cells, which are in constant communication to produce our every thought, movement, and sensation. Dependent on oxygen and glucose for energy, the brain receives a steady supply via an intricate system of arteries.

However, when any limited part of the brain is deprived of oxygen for even a few seconds, delicate neuron functions are impaired. If this persists for longer than a few minutes, brain damage results, as brain cells begin to die along with the functions they control. This condition is called ischemia, a lack of oxygen mainly caused by artery blockage. Further damage is inflicted on brain tissue as oxygen starvation triggers a deadly cascade of chemical reactions. The result is a stroke. A stroke also occurs when blood vessels rupture, flooding the brain with blood, which cuts off connecting pathways. This disrupts chemical and electrical flows to the muscles and causes injury to brain tissue.

Its Effects

Every stroke is different, and strokes can affect individuals in ways that are almost limitless. Although no one suffers from every possible consequence of a stroke, the effects may range from mild and barely observable to severe and painfully obvious. The area of the brain in which a stroke occurs determines which bodily functions are impaired.

A common affliction is weakness or paralysis of the upper and lower limbs. Generally, this is limited to one side of the body, the side that is opposite the side of the brain where the stroke occurs. Thus, right-brain damage results in left-sided paralysis, and left-brain damage, in right-sided paralysis. Some individuals may retain the use of their arms and legs, only to find that their muscles shake to such an extent that their limbs seem to go off each in its own direction. The victim looks like a novice skater trying to keep his balance. Dr. David Levine, of New York University Medical Center, says: “They have lost the kind of sensation that tells them whether or not their limb is moving and where it is in space.”

Upwards of 15 percent of survivors experience seizures, resulting in episodes of uncontrolled movements and, commonly, in periods of unconsciousness. Also, feeling pain as well as changes in sensations is common. A stroke survivor who experiences constant numbness in his hands and feet says: “There are nights when something touches my legs and I wake up because it seems as if I am receiving electric shocks.”

Stroke outcome may include double vision and problems with swallowing. If the sensory centers of the mouth and the throat are damaged, further indignities can be suffered by stroke victims, such as drooling. Any of the five senses can be affected, causing disturbances in sight, hearing, smell, taste, and touch.

Communication Problems

Picture yourself being followed down a dimly lit street by two huge strangers. Glancing back, you see them rushing toward you. You try to scream for help, but nothing will come out! Can you imagine the utter frustration you would feel in such a situation? That is what many stroke victims experience when they suddenly lose their ability to speak.

Being unable to communicate thoughts, feelings, hopes, and fears—figuratively being isolated from friends and family—is one of the most devastating consequences of stroke. One stroke survivor described it this way: “Every time I tried to express myself nothing came out. I was forced to remain silent and could not follow either verbal or written commands. Words sounded . . . as though the people around me spoke a foreign tongue. I could neither comprehend nor use language.”

Charles, though, understood everything being spoken to him. But about making a reply, he writes: “I would frame the words I wanted to say, but they came out scrambled and garbled. At that point I felt I was trapped inside myself.” In his book Stroke: An Owner’s Manual, Arthur Josephs explains: “Over one hundred different muscles are controlled and coordinated during speech and each of those muscles is controlled by an average of over one hundred motor units. . . . An astounding 140,000 neuromuscular events [are] required for each second of speech. Is it any wonder an injury to a portion of the brain controlling these muscles may result in garbled speech?”

Many baffling phenomena in the speech area are produced by a stroke. For example, an individual who cannot speak may be able to sing. Another may say words on impulse but not on command or may, on the other hand, talk incessantly. Others repeat words or phrases over and over or use words inappropriately, saying yes when they mean to say no and vice versa. Some know the words they want to use, but the brain cannot prompt the mouth, lips, and tongue to say them. Or they may experience slurred speech because of muscle weakness. Some may punctuate their words with explosive outbursts.

Other stroke damage may be impairment of the portion of the brain that controls emotional tone. The result can be speech that sounds flat. Or there may be difficulty in comprehending the emotional tone of others. Communication barriers like these and those described above can drive a wedge between family members, such as husband and wife. Georg explains: “Because stroke affects facial expressions and gestures, indeed the whole personality, we suddenly did not get on with each other as before. It seemed to me as if I had a totally different wife, someone I had to get to know all over again.”

Emotional and Personality Changes

Inappropriate mood swings, outbursts of tears or laughter, extreme anger, unaccustomed feelings of suspicion, and overwhelming sadness are just part of the bewildering emotional and personality disturbances stroke survivors and their families may have to deal with.

A stroke victim named Gilbert relates: “At times, I get emotional, either laughing or crying over the slightest thing. Once in a while, when I laugh, somebody will ask, ‘How come you’re laughing?’ and I really can’t tell them.” This, coupled with problems with balance and a slight limp, prompted Gilbert to say: “I feel as though I’m in some other body, as though I’m somebody else, not the same person I was before the stroke.”

Living with mind- and body-altering impairments, few people if any escape feeling a sense of emotional upheaval. Hiroyuki, whose stroke left him with impaired speech and partial paralysis, comments: “Even with time I just didn’t get better. Realizing I would not be able to continue my work as before, I fell into despair. I began blaming things and people and felt as if my emotions would explode. I did not act like a man.”

Fear and anxiety are common to stroke victims. Ellen comments: “I have feelings of insecurity when I experience pressure in my head that could warn of a future stroke. I become really fearful if I allow myself to think negatively.” Ron explains the anxiety he deals with: “To arrive at correct conclusions is almost impossible at times. Sorting out two or three small problems at once frustrates me. I forget things so quickly that I sometimes cannot remember a decision made a few minutes before. As a result, I make some awful mistakes, and it’s embarrassing to me and others. What will I be like in a few years? Will I be unable to converse intelligently or drive a car? Will I become a burden to my wife?”

Family Members Are Victims Too

It can be seen, then, that victims of stroke are not the only ones who must grapple with devastating consequences. Their families also do. In some cases they must cope with the terrible shock of seeing a once articulate, capable individual suddenly deteriorate before their eyes, reduced to a state like that of a dependent infant. Relationships can be disrupted as family members may have to take on unfamiliar roles.

Haruko relates the tragic effects this way: “My husband lost his memory of almost everything important. We suddenly had to get rid of the company he had run and let go of our house and our possessions. What hurt most was no longer being able to talk freely with my husband or turn to him for advice. Confused between night and day, he often removes protective diapers needed at night. Although we knew that the time would come when he would be reduced to this state, it is still hard for us to accept the reality of his condition. Our situation is completely reversed, in that now my daughter and I are my husband’s guardians.”

“Caring for someone with a stroke—no matter how much you love them—can be overpowering at times,” observes Elaine Fantle Shimberg in Strokes: What Families Should Know. “The pressure and responsibility don’t let up.” In some cases the high level of care some family members provide can take its toll on the caregiver’s health, emotions, and spirituality. Maria explains that her mother’s stroke had a terrific impact on her life: “I visit her every day and try to build her up spiritually, reading and praying with her, and then lavishing love, hugs, and kisses on her. When I come home, I’m drained emotionally—some days to the extent that I throw up.”

The most difficult thing for some caregivers to cope with is the change in behavior. Neuropsychologist Dr. Ronald Calvanio tells Awake!: “When you have a disease that affects higher cortical functions—that is, how a person thinks, conducts his life, his emotional reactions—we are dealing with the very essence of the person, so in certain ways the psychological impairments that occur really change the world of the family in a way that is quite dramatic.” Yoshiko relates: “My husband seemed to change completely after his illness, flaring up over the slightest thing. I get truly miserable at those times.”

Often, personality changes may not be recognized by those outside the family. Hence, some caregivers feel isolated and carry their burdens alone. Midori explains: “The strokes have left my husband with mental and emotional disabilities. Although he has a great need for encouragement, he will not talk about it with anyone and suffers by himself. So it is left up to me to handle his emotions. Watching my husband’s moods each day has made me uneasy and sometimes even afraid.”

How have many stroke survivors and their families coped with the changes a stroke brings in their lives? In what ways may each of us support those who suffer from the crippling effects of stroke? Our next article explains.

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Warning Signs

• Sudden weakness, numbness, or paralysis of face, arm, or leg, especially on one side of the body

• Sudden blurred or dimmed vision, especially in one eye; an episode of double vision

• Difficulty speaking or understanding even simple sentences

• Dizziness or loss of balance or coordination, especially when combined with another symptom

Less Common Symptoms

• Sudden, unexplained, and intense headache—often described as “the worst headache ever”

• Sudden nausea and fever—distinguished from a viral illness by the speed of onset (minutes or hours rather than several days)

• Brief loss of consciousness or a period of decreased awareness (fainting, confusion, convulsions, coma)

Do Not Ignore Symptoms

  Dr. David Levine urges that when symptoms appear, the patient “go as quickly as possible to a hospital emergency ward. There is evidence that if a stroke is treated in the first few hours, the damage can be minimized.”

  Sometimes symptoms may appear for a very short period of time and then disappear. These episodes are known as TIAs, or transient ischemic attacks. Do not ignore them, as they may indicate serious stroke risks, and a full stroke may follow. A doctor can treat the causes and help reduce the risk of a future stroke.

Adapted from guidelines provided by the National Stroke Association, Englewood, Colorado, U.S.A.