Follow-up after a stroke

What a stroke is and why follow-up matters

A stroke occurs when part of the brain loses its blood supply. An ischemic stroke (about 85% of cases) is caused by blockage of an artery, by a clot that forms there (thrombosis) or one that comes from afar, usually from the heart (embolism), and by atherosclerosis of large or small vessels. A hemorrhagic stroke (about 15%) is caused by rupture of a vessel inside the brain or in the spaces around it; the most common cause is uncontrolled hypertension.

Acute treatment, within the first hours, includes dissolving the clot (thrombolysis) or removing it with a catheter (thrombectomy) in ischemic cases, and stopping the bleeding and lowering pressure on the injured brain in hemorrhagic ones. After leaving hospital begins an equally important phase: functional recovery and prevention of a second stroke. The risk of a new stroke is highest in the first months and remains raised for years, so long-term follow-up is part of treatment.

What is assessed after leaving hospital

The check-up covers strength, gait, balance, speech, swallowing and the ability to carry out daily activities. Memory and concentration, mood, fatigue and pain are also assessed. Bring the discharge summary, the list of medicines, imaging reports and earlier tests. New problems should not automatically be explained by the old damage: a new change may be a new stroke or another illness.

Common consequences that need attention: weakness and spasticity (muscle stiffness), shoulder pain on the paralyzed side, speech (aphasia) or articulation (dysarthria) disorders, swallowing disorders (dysphagia), which risk aspiration pneumonia, depression (in about a third of patients), marked fatigue, cognitive disorders, late epileptic seizures and falls.

How rehabilitation is organized

Rehabilitation is adapted to the patient’s needs and concrete goals. It may include physiotherapy (strength, balance, walking), speech and swallowing therapy, occupational therapy (daily activities) and measures for independence at home, with the relevant team. The brain can adapt (neuroplasticity): recovery is fastest in the first three months, but improvement can continue for months and years with repeated, purposeful exercise. Recovery differs from person to person; there is no deadline or guaranteed outcome for everyone.

Cognitive-behavioral therapy and cognitive stimulation can help with anxiety, depression, fatigue and memory. Family members need guidance and support, not just a list of medicines.

How the risk of recurrence is lowered

Prevention of a second stroke rests on treating the cause and the risk factors:

• Blood pressure is the most important factor. After the acute phase, the target for most patients is below 130/80 mmHg (tension 13 over 8), reached gradually and individually (see arterial hypertension).
• Cholesterol: after an atherosclerotic ischemic stroke, statins and an LDL-cholesterol target below 70 mg/dL (1.8 mmol/L) are recommended; see dyslipidemia.
• Antiplatelet drugs (acetylsalicylic acid, clopidogrel) prevent platelet clotting; anticoagulants are used when the cause is atrial fibrillation (see atrial fibrillation) or another cardioembolic source. They are not interchangeable and are not needed in every patient; the choice depends on the type of stroke.
• Diabetes (see type 2 diabetes), smoking, alcohol, excess weight, physical inactivity and sleep apnea should be treated.
• Carotid arteries: significant narrowing (usually ≥70%) on the side of the stroke may need prompt intervention (see carotid atherosclerosis).

As appropriate, cardiology assessment is needed for an embolic cause: a cardiology visit, ECG, Holter ECG for intermittent atrial fibrillation and echocardiography. Further brain imaging is recommended when indicated.

What needs care at home

If there is coughing or choking while eating, ask for a swallowing assessment. Prevent falls (lighting, removing obstacles, grab rails), follow the exercise and medication plan, and take your medicines every day without interruption. Use a weekly pill box. Home blood pressure monitoring helps a great deal. Report changes in mood, pressure sores from prolonged sitting or lying, or difficulty with daily care. Regular neurology and cardiology check-ups, every 6 months to a year or sooner when the doctor considers it reasonable, follow the course, the medicines and the risk factors.

Care at Tirana Polyclinic: we offer neurology consultation, physiotherapy and coordination with cardiology as needed. We interpret tests and imaging performed at other clinics.