Signs of Stroke Recurrence: Fever and Weakness in Patients

Stroke patients have recently experienced fever and weakness?

Hello, doctor.
My mother has had a stroke for over ten years, resulting in paralysis on her left side.
She has also experienced two strokes on her right side.
While she can move her right hand, it is weaker and she cannot grip tightly.
Her speech is also affected.
In the past two days, she seems to have less energy, her sitting posture is slumped, and she has intermittent fever (close to 38 degrees Celsius) with sweating.
Her time spent in bed has increased, but she does not exhibit other cold symptoms like a runny nose or cough.
She can clearly state her name and mine.
She is able to perform actions like raising her hand, shaking hands, or lifting her head.
She can still eat and drink, although she has had ongoing issues with chewing and swallowing.
When asked if she has any other discomfort, she is unable to articulate anything.
Could this indicate a possible recurrent stroke? Should she be taken to the hospital for examination?

JOJU, 40~49 year old female. Ask Date: 2021/07/30

Dr. Jiang Junyi reply Neurology

Dear Ms.
JOJU,
I hope this message finds you well.
I would like to inquire about your mother's cerebral blood vessels.
If there is already significant stenosis, dehydration caused by fever may lead to insufficient cerebral blood flow, resulting in neurological deficits.
This condition could potentially lead to new infarctions.
Typically, once the infection is controlled, consciousness gradually improves.
The brain cells that are damaged due to a stroke do not regenerate; therefore, it is essential to engage in intensive rehabilitation to connect the surviving brain cells.
The effectiveness of rehabilitation is greatest during the first month, and progress tends to plateau after three months, which is considered the golden period for rehabilitation.
It is generally encouraged for family members to invest more effort during this time.
Currently, the pandemic situation is relatively stable, and I recommend accompanying your mother to the emergency department to identify the source of the infection and manage it effectively, thereby preventing further damage to the brain due to inadequate cerebral circulation.
Caring for a stroke patient can be quite challenging, and it is important to implement self-protection measures, maintain cleanliness and disinfection, and adhere to new preventive health practices before and after medical visits.
Thank you for your inquiry, and please feel free to discuss any related questions.
Wishing you and your mother good health, safety, and joy.
Sincerely,
Dr.
Jiang Junyi
桃醫神內

Reply Date: 2021/07/30

More Info

In assessing the situation of your mother, who has a history of stroke and is currently exhibiting symptoms such as fever, weakness, and leaning while sitting, it is crucial to consider several factors that could indicate a potential recurrence of stroke or other underlying medical issues.

Firstly, the symptoms you describe—such as increased weakness, fever, and increased drowsiness—can indeed be concerning. While these symptoms may not directly indicate a new stroke, they could suggest a range of complications that require immediate medical attention. In patients with a history of stroke, especially those who have experienced multiple strokes, any sudden change in condition should be taken seriously.

Fever in a stroke patient can be indicative of an infection, which is common in individuals who have had strokes due to factors like immobility and difficulty swallowing. Infections, particularly pneumonia or urinary tract infections, can lead to systemic inflammation and may exacerbate neurological symptoms. The presence of fever (especially if it is persistent and around 38 degrees Celsius) alongside increased drowsiness and weakness could suggest that your mother is fighting an infection, which may be affecting her overall condition and possibly her neurological status.

Moreover, the fact that she is experiencing increased drowsiness and has a history of difficulty with swallowing raises concerns about her ability to maintain adequate hydration and nutrition. Dehydration can lead to confusion and weakness, and in the context of her previous strokes, it could potentially lead to further neurological compromise.

It is also important to note that while she is still able to respond to questions and perform some physical tasks, the combination of her symptoms warrants a thorough evaluation. The ability to respond to questions does not rule out the possibility of a new stroke or other neurological issues, especially if there are changes in her baseline level of consciousness or cognitive function.

Given these considerations, it is advisable to seek medical attention promptly. A healthcare provider can perform a comprehensive assessment, including a neurological examination, and may recommend imaging studies such as a CT scan or MRI to rule out any new strokes or other acute changes in the brain. Blood tests can also help identify any underlying infections or metabolic imbalances that may be contributing to her symptoms.

In summary, while the symptoms you describe may not definitively indicate a new stroke, they do suggest that your mother is experiencing a significant change in her health status that requires immediate medical evaluation. It is better to err on the side of caution, especially given her medical history. Early intervention can be crucial in managing potential complications and ensuring the best possible outcomes for her health.

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