Within a few days or weeks after a stroke some people develop "spasticity" in the part of the body whose mobility was affected by the stroke. But what does spasticity mean, and how does it affect people with stroke?

Spasticity can be described as the constant and unwanted contraction of one or more muscle groups as a result of damage (e.g., stroke) to the brain or the spinal cord. The net effect of spasticity is that the involuntarily contraction of certain muscle groups prevents the normal voluntary movement of the affected body part. For instance, in order to open your hand, your extensor hand muscles must become contracted at the same time that your flexor hand muscles become relaxed. Someone with hand spasticity may not be able to open his hand because its flexor muscles are involuntarily so strongly contracted, that the task becomes impossible.

In fact, hand flexor muscle spasticity might be so strong that it causes the finger nails to break into the skin of the palm! There are multiple treatments for spasticity including muscle relaxants, and botulinum toxin (botox) injections. Talk to your doctor about spasticity and find out what treatment is best for you.

Recommended reading:
Aphasia after stroke
Central pain after stroke
What is hemiparesis?

Many people who suffer depression symptoms after a stroke fail to tell their doctors about it. Most of them choose not to do so because they feel that depression is a "normal" aspect of life after such a potentially life-changing event. In a way, depression after stroke is normal, especially when one thinks of "normal" things as being the same as "common" things. After all, up to 40% of people who suffer a stroke develop symptoms of depression within a few months of their stroke.

But, regardless of how common depression is in stroke survivors, there is no reason why they shouldn't fight back. Modern medicine has brought us a myriad of very effective medications to fight this malady. More importantly, stroke patients who are treated for depression recover better than those who are not. Therefore, depression-stoics don't do better, they do worse. In other words, no matter how tough you are, your feelings of depression will get on the way of your recovery. The take home message here is that receiving treatment for depression can help you live a longer, mentally sharper, and more independent life after stroke. So tell your doctor about it. He/she can help you find the treatment that is right for you.

How do you know that you are depressed? Here are some common feelings reported by people with depression:

• Persistent sadness or flatness of mood
• Recurrent feelings of guilt, worthlessness, or helplessness
• Loss of interest in ordinary activities, including sex
• Decreased energy and constant fatigue
• Trouble with normal sleep patterns (waking up hours earlier or later than usual)
• Trouble with normal eating patterns (eating much less or more than usual)
• Difficulty with concentration and memory
• Thoughts of death or suicide

Recommended reading:
Depression after stroke
Sex life after stroke
Learning to speak again after a stroke

Some recent media noise was made about napping and the risk of stroke. Is it possible that an innocent nap here and there can increase your risk of stroke?
Not really. Logically, it only makes sense to associate napping and stroke if the napping is being done as a result of poor sleeping at night. This is what might increase the stroke risk, and not necessarily the napping itself.

Why is this? As it turns out, sleep is key to good heart-health and lack of it may independently increase a person's stroke risk. The total increase in risk for those who dose off during the day as a result of poor sleeping at night is still small (about twice that of normal), so please, don't lose any more sleep over this! A few common reasons why people lose sleep include snoring or chocking at night, periods of poor breathing during sleep, and depression, among other causes.

Recommended reading:
Drugs, alcohol and stroke
Who is at risk of stroke?
What is a TIA anyway?
Six ways to remain stroke free

When it comes to headache, most people know the meaning of the word "migraine", but only a few know the meaning of the word "aura". An aura is a sensation that occurs just before a migraine strikes. Auras vary widely, but they usually affect vision just for a few seconds or minutes before a headache starts. Symptoms include sparkling lights, wrinkly lines, or simply, blurry vision. Other more rare auras include abdominal pain, transient numbness or weakness on either side of the face, arm or leg, vertigo, and even a feeling of deja vu!

People who suffer from the type of migraines heralded by an aura have an increased risk of suffering a stroke. The risk is still pretty small (please, don't lose sleep over this blog--1.5-2 times that of people without migraine), but because migraines often occur in young women, it is worth knowing that oral contraceptives (i.e., the pill) and smoking have been shown to increase the stroke risk to up to 7 times that of people without migraines.

The take home message: If you have migraines with aura, try to quit smoking, and if at all possible, also try to avoid taking oral contraceptives. If you must be on the pill, talk to your doctor about your overall stroke risk before you start taking it.

Related reading:
Migraines and other stroke mimics
Are you at risk of stroke?
What are the symptoms of a stroke?

If you suffered a stroke, you are at high risk of getting a second stroke. In fact, out of the 700,000 strokes that occur in our country each year, almost 30% are repeat strokes. Usually the problem or abnormality that caused the first stroke (e.g., high blood pressure) is the very problem or abnormality that causes the repeat stroke. What does this have to do with taking your medicines?

When a person suffers a stroke, or a TIA, doctors perform an aggressive search for a cause. If they can find the cause, they can prescribe appropriate medicines to prevent a second stroke. Many people suffer strokes for unknown reasons and they must simply live a healthy lifestyle and hope that they do not suffer a second stroke. But many people are fortunate enough to find out what caused their stroke. They are fortunate because in most cases they can do something to prevent a second stroke. For instance, to prevent repeat strokes caused by blood clots or by high blood pressure, people can take blood thinners or high blood pressure medicines.

The risk for a recurrent stroke is approximately 4% in the first month and about 12% in the first year after a stroke. These are not trivial odds. Yet many stroke survivors fail to take their medicines. Don't allow a second stroke to creep up on you. Be very aggressive about taking you medications. Do not miss doses. If you dislike the medicine you are taking because of its side effects, talk to your doctor about changing it. But unless the side effects are obviously harmful (e.g., bleeding) try to continue taking it until you have discussed it with your doctor.

Ever since the advent new treatments for acute stroke, there is a concern among stroke doctors that not enough stroke patients are actually enjoying the benefits of these treatments. Only a small percent of people who would be candidates for acute stroke treatment with tPA actually receive it because they don't make it to the hospital in time to be treated. Why don't they? In many cases, perhaps in most cases, it is because people with strokes take too long to seek medical attention. Sadly, many people don't even call 911 (i.e., the ambulance) when they first discover their symptoms, and instead they prefer to make an appointment with their doctor for a quick visit! Don't deprive yourself from receiving the latest stroke treatments

Here are a few symptoms that should ALWAYS make you call 911 BEFORE you even think about calling your doctor.

• Weakness of the face, arm, and/or leg on one side of body
• Numbness in the face, arm, and/or leg one side of body
• Inability to understand spoken language
• Inability to speak
• Inability to write
• Vertigo and/or gait imbalance
• Double vision
• An unusually severe headache

Suggested reading:
What is a transient ischemic attack (aka ministroke)?
Stroke risk factors
All about stroke symptoms

Researchers in the 1990s came up with tissue plasminogen activator, otherwise known as tPA, for the treatment of ischemic stroke. Over 80% of all strokes are of this type, and are commonly caused by blood clots that interrupt blood flow in an area of the brain. tPA acts by dissolving these stroke-causing blood clots. Its efficacy has been proven by several large clinical trials which show a greater chance of recovery in stroke patients who are treated with it. However, these trials also show that, if given later than three hours after a person first realizes he/she is feeling stroke symptoms, tPA can cause them dangerous bleeding inside the brain. Consequently, it is only safe to give tPA within 3 hours of the beginning of stroke symptoms, which is why physicians think of this time as the "golden three hour tPA window".

Unfortunately, the 3 hour window is often missed due to multiple delays which are caused both by the patient and by the medical system. As of 2008 only a fraction of stroke patients who could receive tPA actually receive it because of these delays.

Perhaps the most common reason for missing the golden three hour tpa window is the lack of awareness about stroke signs and symptoms by the general public. Most people wait up to a day after their symptoms start before seeking medical attention. Many organizations are now working to correct this knowledge gap so that many more people affected by stroke can benefit from tPA. You can help get this much needed treatment to those who one day might need it, by educating them before they are ever affected by a stroke. If you know the signs and symptoms of stroke, teach them to your parents, your children and other people around you. This simple act of kindness might one day save their lives.

Recommended reading:
What are the symptoms of a stroke?
The best hospitals for stroke treatment
Acute stroke teams and the timely delivery of tPA

When a person develops stroke symptoms, doctors must first assess whether these symptoms are the result of bleeding inside the brain (hemorrhagic stroke). If so, chances are that this person will require emergent brain surgery. However, hemorrhagic strokes are usually diagnosed after a CT of the brain is performed in the emergency room of the hospital where a person is transported for treatment. But not every hospital is equipped to manage emergent brain surgery, and many smaller hospitals must transfer such patients to larger ones where the right personnel and equipment for the surgical management of hemorrhagic strokes are available around the clock. Unfortunately, these transfers come at a price as they are costly, dangerous, and lead to significant delays in treatment. Wouldn't it be better if these transfers could be avoided?

Almost 10 years ago researchers reported the ability to accurately differentiate between hemorrhagic and non-hemorrhagic strokes using a technique called transcranial color-coded duplex sonography (TCCDS). This technique is performed using equipment that could be carried, and easily handled inside of any ambulance. Because of this, some stroke specialists have proposed TCCDS as a tool to expedite the diagnosis of stroke before a patient's destination hospital is chosen. In this way, when hemorrhagic strokes are diagnosed in the field, possibly under the remote supervision of a physician, the patient can be brought to the appropriate hospital for treatment.

Nonetheless, despite the fact that TCCDS is routinely used by most hospitals, no studies have been performed to investigate whether its use inside an ambulance can in fact expedite treatment of dangerous hemorrhagic strokes. Hopefully studies will be designed in the near future to test whether this technology is everything it promises to be for the early diagnosis of dangerous hemorrhagic strokes.

Further reading on the diagnosis and treatment of stroke:
Stroke Centers Provide Superior Care for Stroke Patients
Acute stroke teams for acute stroke patients
How are strokes treated?

Sometimes a stroke is so large that vital portions of the brain are damaged beyond repair. In these cases families are often asked to consider whether or not they have any documentation, or knowledge, regarding the patient's thoughts or wishes about being permanently dependent on medical support. Many families in this situation have knowledge about a patient's wishes based on discussions that happened prior to having the stroke that landed them in the hospital. For instance the patient might have spoken to a parent, or a sibling, about their wish to be "disconnected" or "unplugged" in a similar situation. Families considering withdrawal of medical support in these cases, should make their best effort to honor the patient's wishes.

Medical teams can be very helpful in providing information needed to make a decision. Don't get me wrong. This can be extremely difficult, but in many cases it is clear from the extent of brain damage that, independent of whether a person's heart and lungs could continue to work, it is unreasonable to expect that a meaningful recovery can occur because large or vitals parts of the brain are no longer alive (i.e., there is no reasonable chance of recovery of awareness, future independent living, ability to eat, walk or talk).

Should you ever be the decision-maker in one of these cases, try to remember whether your family member ever expressed any opinions about being permanently bed-bound, or about being dependent on a respirator or a feeding tube. Very often, the memories of these discussions have the answer of what to do in these most difficult moments.

Recommended reading:Does my loved one need palliative care?

Some people who were unfortunate enough to be taking zetia or vytorin during the past few months, or years, are expressing their concern over the possible effects that these medications could have on their health. Although ezetimibe, the main compound in zetia and one of the two compounds in vytorin was shown to have no effect in stopping the buildup of cholesterol plaques it was intended to stop, there is no evidence, at least as of April of 2008, that it can cause you any more harm that any other FDA approved medication.

Ezetimibe has poor efficacy, but not necessarily a poor safety profile. Therefore, although you should see your doctor in order to start a new medication which is able to deliver reliable effects on plaque build-up, there is no reason at this time to fear that your time on ezetimibe will have an ill effect on your health. We will continue to follow the FDA's announcements on this matter.