Hemorrhagic Stroke Symptoms and Recovery in Elderly Patients

Q: Hemorrhagic Stroke Symptoms and Recovery in Elderly Patients

Hello： Based on your description, Grandpa has suffered a hemorrhagic stroke in the right hemisphere of the brain, complicated by an infection and fever, and the volume of bleeding from the stroke may not be insignificant. <br>After leaving the intensive care unit, Grandpa's consc

Hemorrhagic Stroke Issues

Hello doctor, I would like to ask about the symptoms of a stroke.
My grandfather suddenly felt dizzy and experienced weakness in his left hand and left leg while in the bathroom over two weeks ago.
His speech became increasingly slurred, and he was taken to the hospital.
The doctors assessed that he had a significant hemorrhagic stroke that affected the retina but did not compress the brainstem.
However, due to his advanced age of 86, the doctors advised against surgery.
He spent over a week in the intensive care unit but has been experiencing persistent fever, with temperatures around 38°C (100.4°F), which the doctors attributed to a lung infection.
After the fever was brought under control, he was cleared to transfer to a regular ward.
Although he remained somewhat lethargic in the ICU, he showed slight awareness during the first few days, occasionally responding to questions.
After moving to the regular ward, my grandfather seems to have improved slightly; he opens his eyes and looks around, and his temperature has stabilized below 37.5°C (99.5°F).
However, he has become less talkative.
I am unsure if this is due to a lack of desire to speak or if his condition has worsened.
I have been there to support and encourage him, and occasionally, he responds when I ask him who I am, but mostly he just looks at me without speaking.
I would like to ask the doctor, does this situation indicate a lack of spontaneous awareness?

Zhou, 20~29 year old female. Ask Date: 2016/08/10

Dr. Hong Weibin reply Neurology

Hello: Based on your description, Grandpa has suffered a hemorrhagic stroke in the right hemisphere of the brain, complicated by an infection and fever, and the volume of bleeding from the stroke may not be insignificant.
After leaving the intensive care unit, Grandpa's consciousness level, as assessed by the Glasgow Coma Scale (GCS), may be around E4V4M5-6, indicating a state of increased drowsiness.
The maximum score on the GCS for a normal person is 15.
Due to the severity of the stroke, in addition to affecting the strength of his limbs, it can also impair cognitive function and consciousness.
Therefore, Grandpa's level of awareness may fluctuate, being more alert at times and more drowsy at others.
However, as the acute phase of the stroke passes (which typically lasts from 7 to 14 days from the onset of the hemorrhagic stroke), these fluctuations in consciousness should gradually stabilize.
Grandpa still has some level of awareness, but due to structural damage from the brain hemorrhage, his consciousness may not be as clear as it was before.
A person's level of consciousness can vary significantly due to brain damage, electrolyte imbalances, infections, and other factors.

In terms of care, it is recommended that family members spend more time with Grandpa, engage him in conversation to encourage him, and provide gentle local massages to his limbs.
Additionally, it is important to frequently reposition him and gently pat his back, taking care to avoid choking, which can help prevent aspiration pneumonia and pressure sores.
Grandpa may be receiving nutrition through a nasogastric tube, so it is advisable to administer feedings slowly and avoid giving too much at once to prevent vomiting.
If there are signs of respiratory secretions, please remember to ask the nurse for assistance with suctioning.
Grandpa's rehabilitation journey will be long, requiring patience and love from the family.

Reply Date: 2016/08/10

More Info

Understanding the symptoms and recovery process of hemorrhagic stroke, especially in elderly patients, is crucial for both caregivers and family members. Hemorrhagic strokes occur when a blood vessel in the brain ruptures, leading to bleeding in or around the brain. This can result in various neurological deficits, depending on the location and extent of the bleeding.

In your grandfather's case, the initial symptoms he experienced—dizziness, weakness in the left arm and leg, and gradually slurred speech—are classic signs of a stroke. The fact that he was 86 years old and had a significant amount of bleeding likely influenced the medical team's decision against surgical intervention. Instead, he was treated conservatively, which is often the case in elderly patients where the risks of surgery may outweigh the potential benefits.

After a hemorrhagic stroke, patients may experience a range of symptoms, including cognitive impairments, motor deficits, and changes in consciousness. Your grandfather's fluctuating levels of consciousness, where he sometimes responds to questions but is often in a state of drowsiness, indicate that he is still recovering from the acute effects of the stroke. The Glasgow Coma Scale (GCS) is often used to assess a patient's level of consciousness, and it sounds like your grandfather's GCS may have been in the moderate range, reflecting his mixed responsiveness.

The presence of a fever and subsequent lung infection complicates recovery. Infections can exacerbate confusion and lethargy, making it difficult to assess the patient's neurological status accurately. Once the infection is controlled, you may notice improvements in his alertness and responsiveness.

Regarding your concern about whether your grandfather has "no self-awareness," it is essential to understand that his current state does not necessarily mean he lacks consciousness or awareness entirely. Patients recovering from strokes can exhibit varying degrees of awareness and responsiveness. The fact that he occasionally recognizes you and can respond to simple questions suggests that he retains some level of cognitive function, even if it is diminished.

As for recovery, it is a gradual process that can take weeks to months, and sometimes even longer, especially in elderly patients. Rehabilitation is crucial, and engaging him in physical and cognitive therapies can significantly aid in his recovery. Family support plays a vital role in this process. Encouraging him to communicate, even if he is reluctant, can help stimulate his cognitive functions. Simple activities, such as gentle conversation, reading to him, or playing familiar music, can also be beneficial.

In terms of expectations, while some patients may regain significant function, others may experience lasting deficits. The extent of recovery often depends on various factors, including the size and location of the hemorrhage, the patient's overall health, and the timeliness of rehabilitation efforts. It is also important to maintain realistic expectations and to celebrate small improvements along the way.

In summary, your grandfather's situation is not uncommon for someone who has suffered a hemorrhagic stroke, especially at his age. His recovery will likely be slow and may require ongoing support and rehabilitation. It is crucial to remain patient and optimistic, as improvements can occur over time, even if they are gradual. Engaging with healthcare professionals about his rehabilitation plan and any concerns you have will also be beneficial in navigating this challenging journey.

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