Stroke

Stroke is a brain injury caused when blood flow is to the brain is suddenly interrupted due to a clot or a ruptured blood vessel. The interrupted blood flow causes damage to the brain. Stroke can happen at any age and may result in the loss of the ability to move, to communicate, to process information, to swallow, to cope with stress, and more. Its after-effects often include extreme fatigue, depression, anxiety, deficits with memory, attention and vision, and the inability to sense self-movement and body position. Deficits depend on where and how much damage has occurred in the brain.

That is why, at the first signs of stroke (listed below), it is essential to call 9-1-1 and seek immediate medical attention to limit or, in some cases, reverse damage.

Topics in this section include:


Types of stroke leading to brain injury

About 85 per cent of strokes are ischemic, caused by a clot that blocks blood flow to the brain, and the remainder are hemorrhagic, caused when a weakened blood vessel bursts. A brain scan at the hospital will quickly determine the type and location of the stroke and the emergency treatment required.

Both kinds of stroke have similar symptoms, including drooping face, slurred speech, weakness, numbness, dizziness, confusion, and sudden severe headache. (See FAST, below)

Acute treatments are different, depending on the type and location of the stroke, which is why calling 9-1-1 and seeking immediate medical attention is critical. For both types of strokes, the patient will have a rehabilitation and treatment plan to follow when they leave the hospital.

People can also have a fleeting stroke called a Transient Ischemic Attack, or TIA. It is sometimes called a mini-stroke. TIA symptoms may only last for a few minutes, and usually less than a hour, and normally result in no lasting injury to the brain. However, a TIA is a warning sign that a more serious stroke may occur soon and medical care is required right away by calling 9-1-1.

Identifying a stroke using FAST

The key to minimizing the damage a stroke can do to the brain is getting medical attention as quickly as possible. The Heart and Stroke Foundation advocates using the FAST method to identify strokes in others (or in some cases, yourself). FAST stands for Face, Arms, Speech, and Time.

  • Face – is it drooping?
  • Arms – can both be raised?
  • Speech – is it slurred
  • Time – call 9-1-1 immediately

These are the main symptoms of stroke. Additional symptoms can include confusion, loss of consciousness, sudden and severe headaches, and nausea/vomiting.

Effects of stroke

A stroke causes damage to the brain, which can result in a variety of physical, emotional and cognitive effects that change the ability to move, communicate and process information. These effects can include:

  • Attention and memory deficits
  • Balance challenges
  • Bowel and bladder problems
  • Emotional challenges, like depression
  • Low energy
  • Muscle weakness
  • Paralysis – this can be localized (face, arm, or leg)
    • Hemiplegia (paralysis on one side of the body)
    • Quadriplegia (paralysis of all four limbs and trunk)
  • Sensation changes
  • Speech problems
  • Swallowing problems (dysphagia) 
  • Vision problems

These changes can make it difficult to prepare food, drive, work, or complete leisure activities.

Stroke and brain injury rehabilitation

In the first few days, doctors will be trying to stabilize you and make a medical diagnosis. Then recovery begins. The first stages of recovery can take different lengths of time for different people. You may feel tired and experience weakness. The medical team will work with you until you’re able to move to rehabilitation and be discharged from the acute care or stroke ward of the hospital.

Rehabilitation will vary depending on your needs, but the goals remain the same: to recover or adapt your abilities as best as possible. It will include physical, mental and cognitive exercises. It may also include working with a speech language pathologist (SLP) on speaking and swallowing. Occupational therapists (OT) can help with activities of daily living (ADLs), motor skills and home environments, and physical therapists (PT) can assist with muscle strengthening and range of motion (ROM) exercises. Rehabilitation takes a lot of time, practice and patience but it will help you regain independence by relearning or adapting your abilities.

Risk factors for a stroke

There are several lifestyle and conditional factors that can increase a person’s risk of stroke.

Lifestyle changes can improve your overall health while reducing risk of stroke. Conditional factors such as blood pressure and diabetes can be addressed with doctors, medications, and in some cases lifestyle adjustments.

Resources & Research


See sources

Recovery

A person with a first-time concussion typically recovers fully within a few days to weeks after the injury. No two concussions are the same. This means that recovery is different for everyone.

The Ontario Neurotrauma Foundation guidelines for Concussion/ mTBI and Persistent Symptoms was developed to improve patient care by creating a framework that can be implemented by healthcare professionals to effectively identify and treat individuals with persistent symptoms following a concussion/mTBI.

The patient version of the Guidelines for Concussion/mTBI and Persistent Symptoms is for adults over the age of 18. These were developed to make communication between healthcare provider and patient easier. Starting in 2019 these guidelines will become living guidelines to ensure that the most current research literature is incorporated into the recommendations.

Topics in this section include:


Concussion recovery tips

The symptoms you experience can be difficult to manage and have an impact on your daily life. Some symptoms may come and go, and your recovery may take longer than expected. It can be frustrating, debilitating, and scary. You’re not alone – recovery can be challenging for many people. With the right education and support, you’ll be able to face those challenges and make positive progress.

Here are some ways you can proactively assist your concussion recovery. You should make sure to listen to your doctor if they have more specifics steps for your recovery plan.

Appropriate rest and activity
The concussion guidelines say you should slowly become more active after 24 – 48 hours of rest. This is a change from ‘cocoon therapy’ – the practice of long periods of rest in low lighting with little to no activity.  Recent research indicates that long periods of rest may do more harm than good [1].

Daily activities of living should be re-introduced gradually. Overtime as symptoms decrease, the more active you can become [2]. You should always consult with your doctor before resuming activity that includes a significant risk of injury. If your symptoms get worse when you’re active, try scaling back. Every person has a threshold for activity, and it may take awhile to find yours.

There is no set timeline for when you’re supposed to be able to return to regular activity. The important thing is that you take your time and consult with your doctor.

Return to work gradually
Like with physical activity, your return to work should be gradual, building up over time. Depending on the severity of your concussion, your return to work could begin a few days to a few weeks after your injury. You should make sure to talk with your employer about your concussion, any symptoms you’re still experiencing, and how best to transition back to your full responsibilities [3].

Keep a journal of how you’re feeling both at and after work. This will help track your symptoms and whether you’re ready to take a step forward and increase your workload. While working, you should take frequent breaks to give your brain time to rest. You should also plan for additional time to finish tasks and try to find a quiet environment to complete your work.

If you’re ready to return to work, but need a little help getting the process started, visit the return to work section for tips and resources.

Ask for help
If you are having trouble with household tasks like cooking or cleaning, ask a family member or friend for assistance. Return to activities gradually according to doctor recommendations.
Bring someone with you to appointments
When you experience a concussion, symptoms can make it difficult for you to keep track of information or get to appointments. Bringing a friend or family member with you to appointments can be helpful. They can write down information and communicate with your medical team.

Risk factors

There are several risk factors that are taken into consideration when doctors are mapping out your recovery.

Medical
  • History of previous brain injury
  • Previous neurological or psychiatric problems
  • Effects of other health issues like medications, bodily injuries, etc.
  • Anxiety
  • Depression
  • Insomnia
  • The number of symptoms you are experiencing
Personal or environmental factors that may negatively affect recovery
  • Mechanism of injury (e.g. motor vehicle accident, assault)
  • Significant delays or not returning to work following the injury
  • Being a student
  • Life stressors
  • Older age
  • Lack of social support
  • Female gender
  • Lower resilience
  • Returning to a contact sport too early
Multiple concussions and second impact syndrome
Getting another concussion while still recovering from a previous one may increase the risk for long-term problems. Second impact syndrome is an extremely rare event where a second concussion in close succession to a previous, not yet healed concussion leads to uncontrolled brain swelling. Most reported cases have been in teenagers and young adults. In a few cases worldwide, it has even been linked to death [4].

It’s important to fully heal from a first concussion before returning to any sport or activity that could put you at high risk of getting another. When you do return to a sport or activity, you should speak with your coach/leadership team about safety precautions.

What if my symptoms aren’t going away?

All these factors will impact how quickly you recover from your concussion [5].

If you still have symptoms 1 month after your initial injury, these are called persistent symptoms (sometimes referred to as prolonged symptoms or post-concussion syndrome). Every person’s recovery is different, so don’t be alarmed if you do have some symptoms after the 1-month period. Talk to your doctor about what symptoms you are experiencing.

Persistent symptoms include:

  • Headaches
  • Fatigue or difficulty with sleep
  • Unsteadiness or decreased balance
  • Memory or concentration difficulties

If you’re experiencing seizures, slurred speech, or numbness you should consult with your doctor prior to the 1-month mark.

Prolonged symptoms can affect your daily life and make it difficult for you to perform regular activities. Your doctor may want to do more tests and check in with you more often if it turns out you have persistent symptoms. Their tests and medical investigations will tell them how best to manage your symptoms. Check the ONF guide for more information on managing prolonged symptoms.

What is Chronic Traumatic Encephalopathy (CTE)?

CTE is a neurodegenerative disease that has been found posthumously in a small number of athletes and veterans with a history of multiple head injuries. Not much is know about CTE, but more research is currently being conducted.

Private concussion clinics

There are many private concussion clinics across Canada offering a wide variety of concussion recovery methods and therapies. These private clinics have no federal or provincial oversight or regulations and there are no assurances of the services they provide. When figuring out whether a private clinic is right for you, ask the following questions [6]:

  • Does the clinic have a medical doctor?
  • Does the clinic have a team of licensed health care professionals?
  • Does the clinic follow the most up-to-date standards of care for managing a concussion?
  • What tools, tests and recommendations is the clinic using?

Disclaimer: There is no shortage of web-based online medical diagnostic tools, self-help or support groups, or sites that make unsubstantiated claims around diagnosis, treatment and recovery. Please note these sources may not be evidence-based, regulated or moderated properly and it is encouraged individuals seek advice and recommendations regarding diagnosis, treatment and symptom management from a regulated healthcare professional such as a physician or nurse practitioner. Individuals should be cautioned about sites that make any of the following statements or claims that:

  • The product or service promises a quick fix
  • Sound too good to be true
  • Are dramatic or sweeping and are not supported by reputable medical and scientific organizations.
  • Use of terminology such as “research is currently underway” or “preliminary research results” which indicate there is no current research.
  • The results or recommendations of product or treatment are based on a single or small number of case studies and has not been peer-reviewed by external experts
  • Use of testimonials from celebrities or previous clients/patients that are anecdotal and not evidence-based 

Always proceed with caution and with the advice of your medical team. 


See sources