Though many people don't know it, the brain is fairly resilient and it is often able to bounce back relatively well  after a stroke.   I have seen people recover to near-normal shape from extensive strokes ,and even from other forms of severe brain damage.  Multiple factors can speed recovery, including adequate rehabilitation, nutrition, and prompt treatments. However, in-hospital complications after stroke can also slow down and sometimes even halt recovery.

Some of these factors include, infections, respiratory problems, and swallowing difficulties. For a long time it has also been suspected that fever can have a negative impact on recovery, and studies are slowly beginning to confirm this.

This is the case with a recent study by the Virtual International Stroke Trial Archive (VISTA) investigators, who compared the outcomes of ischemic stroke patients who were affected by high body temperatures in the acute period of their stroke.

The study  found that high body temperatures, (i.e., hyperthermia) defined as higher than 37.2 degrees Celcius, predicted a poor outcome.   It mattered when in the first week after stroke the high temperatures occurred, with later, rather than earlier, fevers leading to a worse outcome.

The results suggest that neurologists and other doctors treating acute stroke patients in the hospital should implement aggressive measures to suppress fevers and to cool down the body temperature in patients in the first week after stroke.

After a stroke many people complain that their brain capacity is just "not the same". They simply aren't as "quick witted as they used to be", and they forget names more easily. Though there is no miracle cure for that feeling of slow mental function, and NO medicines that can help, there is one thing you can do to sharpen your mind: Exercise. Yes, plane old exercise will surely make your brain work better.

This is a concept that over the years has been tested over and over again, and time and time again it shows positive results. Exercise makes blood flow faster through your brain, bringing essential nutrients, and removing the harmful toxic byproducts of your brain's metabolism a lot more frequently - yes, your brain makes a whole lot of toxic waste just by thinking, and having an inefficient clean-up system is a sure way to worsen your brain function over time. I strongly recommend a book called "Brain Rules", by Dr John Medina, who quite nicely summarizes the research that has made this concept evolve over the years in his first chapter.

Other recommended reading
Long Term Effects of Stroke
Six Ways to Stay Stroke Free
Blood Thinners and Their Side Effects

By definition a TIA is a brief episode of a given neurological abnormality that resolves on its own, and by definition, TIA sufferers recover completely within a few minutes (or a few hours, at the most). No big deal then, right? Actually this is a big, big deal as the studies have shown over and over again that a TIA is a warning sign that a stroke is about to happen. And the problem is that patients and many medical professionals fail to acknowledge the significance of the event.

This is why a key aspect in the care given to TIA patients is performing a full medical workup rapidly after the TIA occurs. This is done with the intention of looking for potential sources of stroke, such as blood clots inside the heart, cholesterol plaques in the carotid arteries, and atherosclerotic plaques inside the brain's blood vessels.

And not surprisingly, stroke hospitals (those with stroke units) appear to be better than other hospitals at doing this. This is probably due to the presence of stroke experts in their facilities, which guarantees that patients with TIAs undergo rapid and thorough testing. This was shown in a recent article in the Medical Journal of Australia.

Recommended Reading:
Difference between TIA and Silent Stroke
What is a TIA
Stroke Symptoms
Stroke Hospitals

Stroke in pregnancy is an extremely rare event. However, when it occurs, it does in the context of high blood pressure, sinus thrombosis, or reversible posterior leukoencephalopathy syndrome (RPLS). Yet another cause is the Call Phleming syndrome, in which areas of blood vessels suffering from severe vasoconstriction cause bleeding in the brain.

And the usual suspects also tend to increase the risk of stroke in pregnancy. Thus, women who smoke, who are older, or who already suffer from high blood pressure, diabetes or high cholesterol, tend to have an increased risk of stroke during pregnancy.

Recommended reading
What is a stroke?
What is a mini stroke?
Stroke Risk Factors

When a blood vessel becomes narrow due to atherosclerosis, doctors sometimes can re-open it by performing an endovascular procedure in which a "stent", a small metal device, is placed in the area of narrowing in order to improve or reestablish the blood flow. This has been done in the heart and in the carotid arteries, which bring blood to the brain, for many years with great results. But doctors have been shy to place stents inside vessels that course through the brain (i.e., intracranial blood vessels) due to a dearth of studies about safety and efficacy of the procedure. Presently there is a trial to assess whether intracranial stents are superior to medical management after narrow vessel has caused a stroke.

Now I am happy to report that a new retrospective study by investigators at the NIH has identified some risk factors for poor outcomes after an intracranial stent procedure. This is important going forward as it will help identify those people who can benefit or be harmed from intracranial stenting procedures. The major risk factors identified included "posterior circulation" procedures, which refers to a group of blood vessels in the back of the brain. Interestingly, the hospital where the stenting procedure is performed also influenced the outcome so that hospitals where these procedures are not so common have worse outcomes. Another important factor was the timing of the stent placement, with worse outcomes when the procedure was performed fewer than 10 days after the event that prompted the decision to place it in the first place (e.g., stroke, tia, etc). Finally, people did worse when stroke was the reason for stenting.

Overall, the rate of stroke or death at 30 days was 9.2%. You can see more about this study in the original article, which is now published in the journal Neurology

.

Recommended reading:
What is a Stroke?
Blood Thinners for Stroke
What is a Mini Stroke?

As we learn more about the treatment of acute stroke with tPA, more and more questions become answered by different studies across the globe. One obvious question has been whether tPA is as effective in women as it is in men. In short the answer is a loud "of course it is".

This was recently found by a study in France which followed the safety and the outcome of 163 men and 111 women treated with tPA between 2002 and 2008. The study demonstrated that there are no significant differences in the rates of bleeding due to tPA, nor in the outcomes three months after the stroke.

Although this was rather expected, based on experience and previous results, it is good to know from prospective data that this is in fact the case.

Recommended Reading:
What is a Stroke?
Stroke Symptoms
Blood Thinners and Their Side Effects

About half of the people who suffer a TIA, or ministroke, tend to suffer an actual stroke within 24 hours. This was recently found in a study out of England in which the medical charts of 1,247 people who experienced a TIA were analyzed for the earliest time point when they progressed from a TIA to a full stroke.

The 6, 12 and 24 hour time points after TIA were looked to see how many people with TIA actually progressed to having a full stroke. By the 24 hour time point the percent of TIA patients progressing to a full stroke was a whopping 5%.

This is why you should learn about TIAs so that you can act quickly when its symptoms appear. There is simply no a second to be wasted when someone is suffering a TIA.

Read more about TIAs.

Stroke symptoms can be very strange, and challenging, and they say a lot about the complexity of our brains. One of the most interesting symptoms of stroke is called Utilization behavior, by which a person who has suffered a stroke that affects both of his frontal lobes constantly has an unstoppable urge to explore and use objects that are placed in his immediate environment.

They pick things up and explore them with major curiosity. It could be something as simple as a pen, or a salt shaker. A person with this symptom may open the salt shaker and watch the salt spill out with certain degree of surprise. The symptoms are reminiscent of the exploratory behavior one sees in babies and children as they are growing up.

Recommended reading:
Six Ways to Avoid Stroke
What is a Stroke
Frontal Lobe Strokes
What is a Mini-Stroke

One of the most interesting symptoms of certain strokes is called the alien hand syndrome, which causes a person who has suffered strokes in very specific areas of both frontal lobes to intermittently lose complete control of one of their hands. The hand seems to act by its own volition and very often completely against the will of the stroke survivor. In fact, at times, the "alien" hand seems to have specific intentions to act against the the other hand!

For instance, when the affected person tries to pick up a cup of coffee with one hand, the affected hand is doing everything it can to prevent that from happening. There is often a struggle between the two hands until the person finally figures out some way to control the alien hand. If you or any one you know is affected with this, please share your story by clicking on the comment link below.

Believe it or not the US only has 4 neurologists for each 100,000 people. This is rarely a problem in most large cities, but it is a major one in the rest of the country, especially in rural areas where stroke victims may not see a neurologist for several days. This has had many people in the public health sector scratching their heads.

The good news is that telemedicine has become an increasingly attractive idea to tackle the problem.

Telemedicine would allow a neurologist in New York to examine a stroke patient in Indiana or anywhere else thorough the help of live video feed. The idea has been tested and it is so attractive that authorities in the field have now come up with a scientific statement that an neurological examination through videoconferencing is as effective as doing it in person.

A similar technology allows the neurologist to examine brain imaging (CT or MRI) and thus to dictate what the best medical plan is for a particular patient.

A lot still needs to be accomplished before this wonderful plan can be completely implemented, including the drafting of new laws which mandate that health insurance reimburses telemedicine, and coming up with ways to train and certify those who will participate. In the end, this great system will provide a real solution to the dearth of neurologists in rural America.