Stroke

Stroke is usually due to blockage of blood vessel supplying specific area of brain. Sometimes it is due to leakage of blood from blood vessel.

Symptoms:

Common symptoms include:

  • Left or right side of body becomes paralyzed.
  • Difficulty in speaking
  • Difficulty in swallowing
  • Difficulty in balancing
  • Difficulty with vision
  • Difficulty with sensations

Recovery:

Recovery is usually slow and may be incomplete. Few patients get better with in weeks while majority may take months to years. The best thing that can help in early recovery is physiotherapy and it should be continued until affected arm and/or leg becomes fully functional. Speech therapist may help with difficulty speaking. Generally paralyzed leg gets better earlier then paralyzed arm.

Physiotherapy:

Physiotherapy plays major role in early recovery of function of affected limb. It should be done at all joints of affected leg and/or arm. Each joint should be gently stretched to the range of motion several times a day. It should be continued indefinitely until affected leg/arm becomes fully functional. Chest physiotherapy should be done in bed ridden patients.

Diet:

Patients with stroke usually have diabetes, hypertension and problems with blood cholesterol. They should observe all the precautions for the above conditions. For example they should avoid sugary, saltish and oily food. Overweight patient should lose weight to have better chances of recovery. Patients who are bed or wheel chair ridden need less calories than normal human and hence should not over-eat. Well balanced diet should be given containing right amounts of proteins, carbohydrates and fats. Water intake should be adequate especially in summers.

NG feed:

Some patients who have difficulty with swallowing are put on nasogastric (NG) tube. It is very important that attendants should not try to give food or drink through mouth when doctor has put patient on exclusive NG feed. Noncompliance with doctor’s advice can result in spillage of food/water into lungs and result in DEATH of patient. NG feed should be given as advised by doctor. Preferably patient should be made to sit before giving NG feed. Anything that can pass through NG tube and does not block it can be given like water, juices(if not diabetic), milk, soup, chicken broth, milk shake, tea/coffee, thin porridge, any dietary supplement (Ensure or Glucerna) mixed in water or milk. Patient should be kept sitting for at least 30 mins after NG feed. This will help proper food passage and will prevent reflux.

Diet Chart for Non-Diabetic Patients:

Frequently Asked Questions:

Does stroke recover fully?

You can hope full recovery but it can not be promised. Recovery depends on multiple factors like area and size of brain part damaged, existing diseases like hypertension, diabetes or heart disease and how compliant patient is with physiotherapy. Generally it takes months to years to recover fully and recovery may be incomplete. Leg tends to get better earlier than arm.

Can stroke occur again?

Yes it can occur. Since many patients who have stroke also have other risk factors like diabetes, hypertension, heart disease etc. , so it is not uncommon that many patients end up having multiple strokes. The key to minimize the risk is to take medicines properly and strictly advice dietary advice.

Can we give bath to stroke patient?

Yes, definitely. It is highly recommended to keep patient neat and clean. Patient may be given bath twice a week. Patient may be bathed daily if need arises. Patient should be adequately dried afterwards. Patient should be kept as clean as possible. Special care should be given to patients who are on diapers or having urinary catheters.  Cleanliness of perineal area should be ensured. Seepage of urine from catheter should be brought into notice of doctor/nurse when it occurs. Patient should be kept dry at all times especially after bath and after attending toilet needs. Patients should also brush their teeth at least once daily. They can also use hair oil, moisturizers and deodorants like healthy persons.

What should be bedding arrangements of paralyzed patients?

Patients who are bed ridden should have air mattress put over regular mattress. Air mattress should be turned on all the time while patient is on bed. Patient should be educated to change sides after every 30 minutes. If patient is unable to do so, family should help changing sides of patient. This will minimize the chances of developing bed sores. Back and hips of patient should be inspected regularly to see any signs of bed sores. If any redness of skin or skin break is noted, treating doctor should be informed at earliest. Head end of bed should be kept slightly higher than foot end. Bed sheets should be changed daily. Patient should be discouraged from lying in bed all times. They should only be on bed at night time or may be for couple of hours after lunch. Patients who have severe weakness and cannot stand unaided should be put in wheel chair or sofa or any other chair during day time. Legs should not hang down for prolonged period of time. For example, if patient has to sit for long time, another chair or table etc. should be kept under the legs of patient and legs should be extended at knees.

Does massage (Maalish) help the patient?

While massage with any oil or lubricant can help keeping the skin healthy but it does not help regain the strength in paralyzed limb. Physiotherapy should be done in preference to massage. Massage does NOT help in regaining muscle strength. Physiotherapy is MUST for all patients. Massage may be done if patient enjoys it.

How to manage toilet needs of patient?

If the patient can walk with help then he should be taken to toilet. If patient can sit, toilet chair should be used. Patient should be washed and dried adequately afterwards. If patient is not fully conscious or passes urine/stool without telling then diaper can be used but it should be used as last option. Diaper should be frequently changed. Patient on diapers are more prone to infections.

Does the wild pigeon yakhni/soup/broth help? Should we give yakhni/soup to patient?

Yakhni/soup/broth intake is always over emphasized in rural population. Yakhni/soup/broth of chicken, wild pigeon or mutton does NOT help in stroke. In fact, excessive use of salt in soup can be harmful to patient. If it has to be given, it should have less salt. It is advisable to give patient a well-balanced diet.

Can we take the patient to family gatherings etc.?

Stroke does not mean isolation. Patient should not be confined to just one room. Patient should be taken to TV room, terrace, lawn etc. Patient should also be taken on outings, dinners and family functions when possible. Patients who cannot walk independently should use walking aids or wheel chair. Patients should be taken regularly to parks so that they can enjoy sunshine and fresh air. It is very important for mental health and early recovery of patient.

Can stroke patient offer prayers and do fasting?

It depends on functional status of patient. If patient can keep himself clean then he can definitely offer prayers. Patient can also fast if patient can tolerate fasting easily. Patients with diabetes should discuss with their doctor regarding fasting.

What are general precautions regarding stroke patients?
  • Patients should take medicines regularly as advised by doctor. There are no exceptions to this. Missing the dose means putting patient at risk. Even if patient can not see doctor due to some reason, dose should not be missed.
  • Dietary advice should be followed strictly. There should be no leniency regarding this. In general patient should limit intake of salt, fats and sugar (if diabetic). Patients who are not ambulatory need less calories than normal persons. NG feed needs to be given very carefully. Overweight patients need to lose weight.
  • Physiotherapy is as important as is medication treatment. Physiotherapy needs to be continued indefinitely.
  • While mobilizing the stroke patients, extreme caution should be exercised to prevent any fall. Falls can result in fractures that may take months to heal. Over-weight patients are at particular risk.
  • Patients should regularly visit treating doctor as advised. In case doctor visit is missed, previous medicines should be continued until next visit.
How to take care of bedridden or wheelchair bound patient?

Please see section on “taking care of paralyzed patients

Disclaimer:
The information given here is intended for use of general public . It should not be taken as standard medical reference.

About the Author:

One of the most well known neurologists in Lahore, he is serving as Assistant Professor of Neurology at Lahore General Hospital. He is a graduate of King Edward Medical College and did residency in general medicine & neurology at Mayo Hospital Lahore. He did FCPS in neurology and moved to Lahore General Hospital, and has been working there since.

One Comment

  1. Sumera Haider June 16, 2020 at 11:21 am - Reply

    Very detailed information…everyone can benefit from it..great doctor Shahid Mukhtar.. A very dedicated and hard working professional..His treatments have always been very effective.. Excels in his profession..

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