Post-Stroke Symptoms and Management in Patients

Conditions After a Stroke

Hello, Doctor: I would like to ask about my father, who is 58 years old and has high blood pressure.
His blood pressure usually ranges from 150 to 160, and he has experienced dizziness for over ten years.
In mid-March of this year, his blood pressure spiked significantly, and he felt very uncomfortable with a flushed face.
He took his antihypertensive medication in the afternoon, but it didn't help.
After taking it again in the evening, his blood pressure remained high at over 180, prompting a visit to the emergency room where he received IV fluids and felt better afterward.
He also experienced dizziness and muscle weakness, leading to a recommendation for hospitalization for further examination.
He was diagnosed with ischemic stroke, with a blockage occurring near the brainstem.
The doctor advised that medication would suffice and that rehabilitation was not necessary, prescribing medications for lowering blood pressure, cholesterol, and improving circulation.

Since starting the medication, my father has reported feeling very fatigued, experiencing insomnia, muscle soreness, and general weakness, which is a decline from his previous condition.
In mid-April, he mentioned that he originally had floaters in his right eye, but now both eyes are affected, with the left being worse than the right.
He has also started to catch colds easily, which take a long time to resolve.
By early May, he had a cough from a cold that lasted until the end of the month, and medications from the clinic did not help.
His bone soreness has not improved, and the dizziness that had subsided after taking medication has returned.

I would like to know if this is an individual case, a post-stroke symptom, or a precursor to another stroke, possibly due to insufficient immunity.
How can we improve his condition, and which specialist should we consult? Or will it resolve on its own? He sometimes expresses feelings of impending death, and I feel helpless.
Does he need to take antidepressants like Wellbutrin? At home, he monitors his blood pressure, which remains within normal limits, but when he visits hospitals, clinics, or pharmacies, his readings are often high, ranging from 130 to 150.
The clinic doctors question whether he has taken his medication, but he has, and he rests for 30 minutes before measuring.
The readings at home are around 110 to 120.
Is this a problem with the machine or the person measuring? He is very troubled and confused about this issue, as it happens every time.

eva, 20~29 year old female. Ask Date: 2016/05/29

Dr. Jiang Junyi reply Neurology

Hello, based on your description, I would like to know if your father has a history of diabetes or any other medical conditions besides hypertension.
The use of many medications can have related side effects, and if he has a unique constitution that makes him more sensitive to medications, I recommend that you accompany him to the doctor.
It would be beneficial to consolidate his medications at the same hospital to understand the reasons for prescribing various medications and the expected outcomes.
It is advisable to stabilize his medications before issuing a continuous prescription.
Wishing you and your father good health, peace, and happiness.
Sincerely, Dr.
Tao.

Reply Date: 2016/05/29

More Info

Understanding post-stroke symptoms and management is crucial for improving the quality of life for patients like your father, who has a history of hypertension and recently experienced an ischemic stroke. Given your father's situation, it is essential to address both the physical and psychological aspects of his recovery.

Post-Stroke Symptoms
After a stroke, patients can experience a range of symptoms, including:
1. Physical Weakness: This is common, especially if the stroke affected one side of the brain. Your father may feel weakness or fatigue, which can be exacerbated by medications or lack of physical activity.

2. Cognitive Changes: Issues such as confusion, difficulty concentrating, or memory problems can occur. Your father's feelings of despair and statements about feeling like he might die could be linked to these cognitive changes or depression.

3. Visual Disturbances: The increase in floaters in his vision could be related to changes in blood flow or pressure in the eyes, which can be common after a stroke.

4. Mood Changes: Depression and anxiety are prevalent among stroke survivors. It’s important to monitor his mental health and consider discussing these feelings with a healthcare provider.

5. Sleep Disturbances: Insomnia and fatigue can be side effects of both the stroke and the medications he is taking.

Management and Care Recommendations
1. Medication Management: Ensure that your father is taking his medications as prescribed. If he is experiencing side effects like muscle pain or fatigue, it is essential to discuss these with his doctor. Sometimes, adjustments in medication can alleviate these symptoms.

2. Regular Monitoring: Blood pressure can fluctuate due to various factors, including stress, medication timing, and even the method of measurement. It might be beneficial to use a validated home blood pressure monitor and keep a log of his readings to share with his healthcare provider.

3. Physical Rehabilitation: Although his doctor mentioned that rehabilitation might not be necessary, engaging in some form of physical therapy can be beneficial. Gentle exercises tailored to his abilities can help improve strength and mobility.

4. Nutritional Support: A balanced diet can aid in recovery and overall health. Consider consulting a nutritionist to ensure he is getting the necessary nutrients, especially if he has been ill and lost weight.

5. Psychological Support: Given his feelings of despair, it may be helpful to involve a mental health professional. Therapy or counseling can provide him with coping strategies and emotional support.

6. Follow-Up Care: Regular follow-ups with his neurologist or primary care physician are crucial. If his symptoms persist or worsen, seeking a second opinion or consulting a specialist in stroke recovery may be warranted.

7. Education and Support: Educate yourself and your family about stroke recovery. Support groups can also provide valuable resources and emotional support for both your father and your family.

Conclusion
Your father's symptoms could be a combination of post-stroke effects, medication side effects, and possibly underlying depression. It is essential to maintain open communication with his healthcare providers to address these issues comprehensively. Regular monitoring, appropriate medication management, and supportive care can significantly enhance his recovery journey. If his symptoms do not improve or worsen, do not hesitate to seek further medical advice or a second opinion.

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