Regaining alertness/consciousness after an acute ischemic stroke

[mamino]

My 75 year-old mother had an acute ischemic stroke a week ago today.  She had a frontal parietal infarct that damaged a third of her left hemisphere.  She hasn't really regained any level of alertness, though has shown marked improvement every day.  Yesterday was the first time she was able to really open her eyes and look at things, though she closes them again after a few seconds.  She can hear and move all her extremeties, though the movement is much more limited on her right side.

I'd like to know if there's any way to predict when or whether she'll regain an alertness level.  She also still has brain swelling -- is that directly related, and how long does it take for brain swelling to subside?

[vja]

Hi
My mother 87 had a severe ischmic stroke also.  Brain swelling is a result. I do not know how long it takes to subside, but I would imagine it is like any other type of swelling.  The fact that she can move all her extremities, even though weak on the right side is great news!!  Stroke patients have to sleep a LOT after the stroke...she will become more alert as time goes on but right now she needs a lot of sleep.  I only know this from my experience and what I have been told.  The brain heals while she is sleeping, so don't try to keep her awake all the time. Hope this helps.

[caregiver222]

Don't be afraid to sit next to her and hold her hand/wrist or put your arms around her while she is sleeping. This is very reassuring.

[mamino]

Update 10 days after the stroke: My mom opens her eyes for very short periods and is focusing on people, but recognition isn't apparent.  She's also able to open and close her mouth, and seems to be regaining a little movement of her tongue.  She was also able to swallow during a speech therapy session.  So she's still slowly improving, and she seems to be responding to commands like "open your mouth" at times, but it's not obvious enough to be 100% definitive.

Thanks for the responses!  I've shown them to the rest of my family and they definitely provide some comfort!  We're still hoping and   praying for some quicker and obvious progress, especially on the cognition level, but we also know that she's still healing and it's still early (though it's the longest 10 days I can remember)...

[caregiver222]

Take heart! My little 101 year old sweety-pie is now talking sentences, feeding herself, can walk a little with assistance and laughs continually every day. A very ineractive happy person with a high quality of life. After her strokes she was expressionless and lifting her hand would result in a limp hand falling down. No response or facial expression whatsoever. She could not talk or feed herself. It is heard to believe she is the same person. She has extremely happy days filled with lauighter and enjoys every meal. So the life-force works in magical ways and you should never give up hope.

[dmt0923]

I am so happy to have found this site. My Uncle Jerry who is 64 years young had an acute ischemic stroke on Christmas Eve. What a shock to the family and what a long two weeks this has been. He was driving from KC to Illinois when it occurred, but managed to get to his destination.

Jerry has been moved from an Illinois Hospital to its adjoining convalescent center. He was in the hospital a week and he has been in the convalescent center 10 days. I am visiting every Tuesday and Saturday.

I am trying to read and learn as much as I can to help my Aunt who is lost without him. (they have no children)Jerry has right side paralysis and cannot speak, but tries to grunt. His progress seems very slow, but showing some slow improvement with recognition and left side dexterity. They are now doing twice daily therapy and I just found out the speech therapist has been on vacation, but he should start speech therapy this week. Jerry cant swallow yet and they have him on a feeding tube!

What I am most shocked about is that they assigned him a doctor, but she has not even been to see him in ten days. He has had 3 C/T scans and I will have a copy of the latest one tommorrow. I have sent for his health care directive which fortunately list me along with my aunt and his sister.

My question to the forum is there any recommendations you can give me on what I should be asking of the staff and the physician. Is it common not to have followup from a physician after you leave the hospital?

Any advice to help me help my Uncle would be forever appreciated.

[vja]

Hello
So I dont' repeat myself you might want to read some of the posts I wrote to Amber212.  My mother had a large stroke at the age of 87, also ischemic. She is right side paralyzed and cannot speak.  As for your question re the physicians...it seems to me that they keep the vital signs stable and that is about it.  The first task is to get your uncle eating which they will try to accomplish in the nursing home he will go to after the hospital..then don't expect much from the physicians..they leave almost all recovery up to the physical, occupational and speech therapists.  All the Dr's do is keep the patient alive and try to prevent another stroke.  Hope this helps. They will tell you "all strokes are different" and you cannot tell who will recover and who will not.

[mamino]

My mom was discharged from the hospital and is now in a skilled nursing facility, where they're doing pretty aggressive therapy even though she's still not alert for very long periods.

I'm still confused about how long brain swelling can really persist, though.  One neurologist told me that it's mostly gone about 10 days after the stroke, and another said that it can take 4-6 weeks!  I'm hoping the latter, since it would help to explain the fact that my mom still doesn't/can't open her eyes for much longer than 10-15 seconds...Does anyone have any first-hand knowledge of this?

[vja]

Re keeping her eyes open more than 10-15 seconds.  I only know what I was told...that after a stroke, the brain needs a lot of healing, this healing takes place while the patient is asleep and they need lots of sleep and are very tired after a stroke..her sleeping is probably what her body is telling her to do.  My mother also slept 24/7 after her stroke.  We only got her up for food, bathroom, sitting up for a couple hours and back to bed.  She slept while sitting up also.

[mamino]

Thank you for the information -- Can you recall how long it took before she really regained longer periods of alertness?  Our family is resigned to the whole recovery/rehab process being a really long one, but the rehab can't really even begin until my mom regains a much higher level of alertness for longer periods...

[lahinva]

My dad also had a stroke approx. 8 months ago.  In the beginning he was not able to do much therapy because he couldn't stay away.  We researched his chart and found that he was getting vicodin and ativan 2 - 3 times a day.  This had been going on for a few weeks before we found it.  Once we got him off of those two drugs, he became much more alert and was able to do the therapy.  The only problem was that the insurance denied him for more therapy because they said he had plateaued.  We had to fight for 2 months to get him back into therapy, which we finally did... He is now at home with my mom along with some aids helping him.  He still can't really walk, but he can transfer and get to the bathroom.  We are amazed he has made it this far, most of the therapists in the rehab center he was, never thought he would be able to do any of this.  He still goes to outpatient therapy twice a week.  It is a long hard process, but you will see improvements, just remember some times its two steps forward and one step back....Good luck and I wish you the best....

[vja]

To Mamino, I think it took about 3-4 mos. before my Mom could stay awake very long.  She still WANTS to sleep all the time, but we try to keep her active during the morning, ADL's etcand breakfast...then a nap...then afternoon out and about, dinner and...early to bed.  It is not only the stroke, but my mother does not have any initiative. I feel that is part of the stroke.

To Lahivna..it was good you got him off Ativan..they use that in nursing homes to calm people down..two of those and my Mom would be "face down in the soupbowl."  Ativan and Vicodin would really knock somebody out.  It is good you fought for PT with the insurance.  I had to do the same thing.  My Mom came down with pneumonia in the nursing home.  The Dr. was NEVER around.  We had to DEMAND a chest x-ray which showed she had pneumonia which was why she could NOT do the PT...we also fought and they put her back on PT for a while, but not very long.  It seems they are not willing to try with elderly stroke patients at all.  We had to hire our own at $90/hr.  She helped Mom start to walk a little, but it is hard to find a PTherapist that will work with a 90 year old stroke patient..it is really sad..it is like they consider it hopeless.  We did find one where we live now who is willing to work with her...just getting her to stand and sit and stand again is a lot..we need that so she can transfer.  Anyway I wanted you to know you were not the only one that had to fight the insurance to get PT...don't listen to the plateau ****...who sets the standards anyway??--the Physical Therapist..he/she can make those standards impossible or attainable.  Hope this helps.  Vicki

[caregiver222]

One thing you should keep on top of are the "certificates of necessity" the physicians sign to enable you to obtain equipment from medicare/medicaid or the insurance companies. You often have a great number of options available they don't tell you about. As an example you can often select the mattress, but if you go into "default mode" you may get a plastic-coated very hard mattress. They push "electric beds", but they are very dangerous. The arms of the patient can be easily broken while caught in the rails, and the attendents do not always pay attention when they use them. You should do all the reading you can about strokes in order to make informed decisions.

[ANS66]

Mamino, my grandmother had a stroke and her symptoms are very similar to the ones that you spoke about.  I was wondering if you could update me on the current status of stroke recovery.  Again my grandmother's symptoms are almost identical (no alertness/consciousness, can move all limbs, etc...).  I'm hoping you get this.

[NurSinGSTU]

Acute cerebral edema (swelling) reaches its peak in about 72 hours and will generally subside within 2 weeks.

[t6643]

my father had a stroke 13 days ago is some what alert he  sits up in a wheelchair twice a day but he has pulled his ng tube out so many times
that the dr cannot put it back in. He cannot swallow does any one have any experenice on how long it takes for this funtion to return.

t6643

[PamRam228]

It took my husband about 4 weeks to be able to swallow, but he could only eat pureed food.  It took about 2 months for him to be able to eat real food and drink liquid without a thickener.

[tracey975]

please can someone help me, my poor 75 year old mother had a stroke 6 weeks ago, she had a bleed, she had a cat scan last week which showed the bleed is still there.She sleeps all day,totally paralysed down the left side and is not responding at all to therapy.She has never lost her speech,and was able to swallow.They put her on a soft diet and thickened fluids.But now after her getting de-hydrated she is being fed and all fluids through a tube in her nose.She is so desperatley ill,she is making no recovery.Has anyone eles been in the same position? we are going out of our minds.

[millertime78]

Tracey, I don't know what to say that will help you except to say that I will pray for your Mom, re hydration is vital if she is going to commence recovery. My Dad had a stroke on Jan 24th and although he's eating, drinking and walking about he still has limited recognition, cannot feed himself, speak or go to the bathroom on his own. Its tough but we're praying that his mental capacity will improve over time.

Keep the faith,

[tracey975]

Thankyou for your kind words xxxxxxxxxxxxxxx

[pat810]

Dear Tracey--My 90-year-old mother had a small ischemic stroke three weeks ago.  Her main symptom was speech difficulty--so-called "word salad", where she just said random words when she tried to communicate.  She was taken to the ER, and they did a CT scan, but nothing showed up.  The ER personnel diagnosed "advanced Alzheimer's" (which she does not have), and that diagnosis has followed her for the last three weeks.  After several days in the hospital, and three CT scans, the stroke showed up, but the diagnosis persisted.  The speech therapist in the hospital ordered pureed food (even though my mother did not have swallowing problems, and had a hamburger in the ER).  If your mom is able to speak and swallow, perhaps her diet can be improved, which may lift her motivation.  Check her medications, to be sure that she is not receiving unnecessary painkillers or sleep meds.  It was my experience that you have to be very proactive for your mom.  I became somewhat of a pest in the hospital and nursing home, but now my mom is back in her apartment and receiving home care and therapies.
   A stroke caused by a bleed can be very serious, but people do recover.  Ask for a meeting with the neurosurgeon to get a better idea of the prognosis.  You will be in my thoughts and prayers.  It is a very hard time.  Strength, Pat

[kg3]

Hi, my grandmother (82 year old) had an ischemic stroke on 3 May. The Dr said it was a massive stroke which affected her left hemisphere. She has just recently started opening her eyes but i dont think she sees us. Its almost been three weeks and there havent been many signs of improvement. She does however sqeeze our hands from time to time. Whenever the family is at the nursing home (they recently discharged her from hospital) we always try to chat with her and keep her awake, but after reading this thread I have realised that it is vital for her to get sleep.

I know that it varies from person to person but my questions are:
* What is the average time it takes for the brain swelling to subside?
* Do stroke victims always become more alert with time or is it possible for them to stay like this forever?

Thank you very much guys.

[millertime78]

Hi kg3,

I've kept a log of my Dad's stroke ( jan 24th 2008). You can track the improvements on the link below

http://www.medhelp.org/posts/show/429418

[Dr_Aparna]

Hi,
The swelling will begin to subside in 48-72 hours and will subside in a couple of weeks to a month.
How-ever after a stroke, control signals from the brain often cannot reach some muscles, typically in the hand or foot. Without these signals, the level of electrical activity in these muscles is too low for them to contract adequately on their own. This causes them to become increasingly weaker.
Most gains in a person's ability to function in the first 30 days after a stroke are due to spontaneous recovery.
For a stroke survivor, the rehabilitation goal is to be as independent and productive as possible. That may mean improving physical abilities. Often old skills have been lost and new ones are needed. It's also important to maintain and improve a person's physical condition when possible.
A person's family has a key role in rehabilitation. A caring and able spouse or partner can be one of the most important positive factors in rehabilitation.
ref:http://www.americanheart.org/presenter.jhtml?identifier=4713

[may45]

hi my mother had a heamorrhagic stroke about 7 weeks ago on the right side which paralized her left side, after two weeks in the hospital she came home four days later she had two isochemik strokes on the left side this left her unable to speak incontinent both bladder and bowels she has been sleeping for four weeks now opening her eyes briefly for a few seconds she eats with her eyes closed and does physio with her eyes closed what chance has she got for recovery