Stroke & other brain injuries

Most strokes, about 87%, happen when blood flow to the brain is blocked. Others are caused by bleeding in the brain.

See “Stroke: the basics” below.

Brain cells are very sensitive to low oxygen and can start to die within minutes. Causes include cardiac arrest, drowning, choking, smoke or carbon monoxide, and very low blood pressure.

Brain tumors can cause headaches, seizures, problems with vision, hearing and speech, balance and sleep problems, and changes in personality or mood.

Encephalitis is inflammation and swelling of the brain, usually caused by a virus. It’s rare. Some cases are mild, while severe cases can cause lasting problems.

• B, Balance: Do they feel off-balance or dizzy?
• E, Eyes: Do they have trouble seeing?
• F, Face: Ask them to smile. Does one side droop?
• A, Arms: Ask them to raise both arms. Does one drift down?
• S, Speech: Ask them to repeat a simple phrase. Is it slurred or strange?
• T, Time: If you see any of these, call 911 right away

Note when symptoms started. Don’t drive yourself; an ambulance team can start care on the way.

Rehab often begins in the hospital within a day or two. Recovery can take weeks, months or years. Some people recover fully, while others live with lasting changes.

Rehab can include

• Mental health support and support groups
• Occupational therapy for daily tasks like dressing and eating
• Physical therapy for movement and coordination
• Speech therapy for talking and understanding

• Changes in emotional control
• Depression
• Speech or language problems
• Thinking, memory, attention or judgment problems
• Weakness or paralysis, often on one side

About 1 in 4 stroke survivors has another stroke within 5 years. Working with your care team on prevention can protect your future.

• Counseling or talk therapy
• Reaching out to friends and family
• Regular exercise, as your care team allows
• Stress reduction
• Stroke support groups

Talk with your clinical provider about which mix of supports fits you. See “Depression: understanding it” for more.

Because about 1 in 4 strokes happen to people who’ve had one before, worry about another one makes sense. Knowing the BE FAST signs and having a prevention plan with your care team can turn worry into action.

Family and friends can help ease fear and anxiety during recovery.

A stroke can change work, driving, hobbies and roles at home overnight. Feeling grief, anger or frustration about that is a natural reaction, not a weakness.

The “Living with chronic illness” guide has more on adjusting to a new normal.

In some kinds of aphasia, speech flows but may not make sense, and understanding is hard. In others, speech is short and takes effort, while understanding is often better. Aphasia can follow a stroke, head injury, brain surgery, brain tumor or brain infection.

• Accept gestures, pointing or drawing
• Allow plenty of time to respond
• Avoid correcting their speech
• Include them in conversations
• Turn down background noise
• Use short, simple sentences

Many people improve a great deal in the first few months. Some difficulties may last, but skills can keep improving for years. Speech-language therapy helps at every stage.

Milder effects can include trouble paying attention, poor judgment, speech problems and clumsy movement. More serious injuries can cause coma or lasting changes.

Cardiac arrest survivors often struggle with attention, multitasking and memory. Anxiety, depression and post-traumatic stress can follow, too. The American Heart Association calls for long-term care that looks after body, mind and emotions.

Families, bystanders who helped, and others who watched a resuscitation may also struggle with anxiety, depression and post-traumatic stress. Their feelings deserve support as well.

The “PTSD” guide explains stress reactions after frightening events.

A brain or spine tumor, and the diagnosis itself, can bring distress, anxiety and sadness. Signs can include feeling fearful, angry or helpless, and changes in sleep, eating or social life.

What can help

• A daily routine with relaxation, like slow breathing, music or prayer
• Bringing a support person to appointments
• Keeping a mood and symptom journal
• Noting three good things each day
• Asking about counseling or therapy if distress lasts

See “Cancer & mental health” for more on coping with a cancer diagnosis.

Brain tumors can make it harder to understand others or express yourself, and loved ones may not know how to help.

Ideas that help

• Ask for specific help: meals, rides, errands
• Choose one person to share updates
• Keep some time together about normal life, not just illness
• Split responsibilities and check in regularly

Encephalitis can cause irritability, poor temper control and confusion. Severe cases may cause memory loss, flat mood or loss of interest in daily life.

The most serious stage usually lasts 1 to 2 weeks, but full recovery can take months. Some people need physical or speech therapy.

Caregivers of people with brain injuries often feel sad, anxious, angry, guilty and frustrated. Long-term stress can affect patience, focus and mood.

Small ways to recharge

• A daily walk
• Asking clearly for help
• Humor and small rewards
• Support groups

See “Family caregivers” for more.

A free line for stroke survivors, families and caregivers, for support, information, or someone to listen. Many of the team are stroke survivors or caregivers themselves. It’s open weekdays and is not a crisis line.

The National Brain Injury Information Center helps people find rehab, support and other services. It’s open weekdays, 9 a.m. to 5 p.m. Eastern Time. It is for information only, not a crisis line.

• A ride to therapy
• A meal or an errand
• A quiet visit or a phone call
• An hour so a caregiver can rest