Stroke Prognosis and Life Expectancy
Every year, almost 800,000 people in the United States have a stroke—either their first ever or a repeat. Although some strokes are devastating from the beginning, the damage from a stroke may be limited with fast treatment. It’s hard to tell right away how much a stroke will affect your life, temporarily or permanently, since your outlook depends on the type of stroke you had, where in the brain the blockage or bleed occurred, and how much damage it caused. Learn about the different types of strokes, the survival rates, stroke rehabilitation, and life after stroke.
Aside from transient ischemic attacks (TIAs), or mini strokes that resolve on their own, the two main types of stroke are ischemic and hemorrhagic.
Ischemic strokes occur when something blocks the blood flow to a part of your brain. This is the most common type of stroke, affecting 87% of people in the U.S. who have a stroke. Treatment involves trying to dissolve the blood clots or fatty deposits, or removing them manually, to allow normal blood flow to return to the brain. If this is done quickly enough and it is effective, there may be limited or no lasting damage to the brain tissue.
A hemorrhagic stroke is rarer. It occurs when blood flows out of a ruptured or leaky blood vessel and because the skull is a closed compartment the excess blood creates pressure on the surrounding brain tissue. If you take an anticoagulant (blood thinner), the first step is to stop that medication to encourage your blood to clot and stop flowing into the neighboring brain tissue. Other treatment options include surgery to stop the bleeding.
How well you recover from a stroke depends on many things, aside from the severity and location of the stroke itself. They include:
- Your age when you have the stroke
- Your outlook and personality, how you were before the stroke
- Your overall general health
- Your personal motivation to recover and participate in rehabilitation
- Your support system
Some people recover completely from a stroke; some are left with lasting issues; while others are completely incapacitated. Most of the progress in stroke recovery takes place during the first 6 to 12 months after the event. Of course, you may still see improvements over time, but the majority of progress is in the first year.
Within the first months after a stroke, certain parts of the damaged brain tissue may heal themselves. Any progress after the first year is mostly due to relearning how to do things or to compensate, rather than the brain itself healing.
There are many lasting effects that could remain after a stroke, such as:
- Aphasia, the inability to speak or to speak in an understandable manner
- Change in personality
- Hemiplegia, or paralysis on one side of the body
- Inability to swallow
- Memory loss
- Swinging emotions, inability to control emotions
Treatment within one hour of the stroke gives patients the best chances of a good recovery. Time is of the essence, so act “FAST” when you see the symptoms of a stroke: Facial drooping, Arm weakness, Speech difficulty mean it’s Time to call 911.
Depending on the type of stroke, doctors may choose from a variety of stroke treatment options, including:
- Medication to dissolve the clot: If you had an ischemic stroke caused by a blood clot, doctors may recommend an intravenous (IV) medication called alteplase (brand name Activase) that may dissolve the clot. However, there is a short window of time for the medication to be effective, only up to four and a half hours after the stroke. If the clot dissolves, normal blood flow can return to the brain tissue.
- Mechanical removal of the clot: If it is too late for the clot to be dissolved or the blockage is caused by fatty deposits, a cardiovascular or neurosurgeon may try to remove the clot mechanically. The doctor threads a stent retriever, a tiny device on the end of a long catheter, through an artery to the brain to grab the clot and remove it.
- Surgery may be needed if you had a hemorrhagic stroke, to try to stop the bleeding in the brain. If the cause is due to an aneurysm, the surgeon may clip the aneurysm to keep it from bursting.
Your doctor may recommend additional treatments based on your individual stroke and medical history.
Once the immediate danger has passed, the process begins to recover from the effects of stroke. Some people recover fully but if you do have any lingering issues, the more work you do at this early stage, the better the chances of a more complete recovery.
The type of rehabilitation you may require will depend on the side of the brain that sustained the stroke. Strokes on the right side of the brain can leave you with difficulty moving the left side of your body. You may also have difficulty with speaking and swallowing. Damage to the left side of the brain can leave you with difficulty moving the right side of the body.
If you are sent to a rehabilitation facility, you might see a physical therapist, occupational therapist, and/or a speech therapist, who can assess swallowing ability as well as speech. You may also see a counselor or psychologist to address any psychological issues you might experience after a stroke. If you are sent home instead of a rehabilitation facility, your doctor will likely give you exercises to do on your own or schedule appointments for you to see physical therapists to help ensure you are making on-track progress in your recovery.
There are several stroke assessment scales. The most common ones used during the acute phase, just after you had the stroke, are the Glasgow Coma Scale, the NIH Stroke Scale, the Modified NIHSS Scale, and the Intracerebral Hemorrhage Scale. These scales take into account how you are responding to commands, checking your eye responses, verbal responses, and motor (movement) responses. They also check for how you understand questions and directions.
Once the dangers of the stroke have passed, you may then be assessed for functional ability—how well you function since the stroke. The Modified Rankin Scale, one such assessment, looks at your ability to walk independently, if you can live alone, and if you can return to your activities from before the stroke. Other scales assess your mental status, alertness, if you can perform personal care, and more.
These assessments help the stroke team determine the best recovery and rehabilitation plan for each individual. The assessments also give an idea of what the life expectancy may be. The worse the lasting effects, the higher the risk of dying earlier than someone who has not had a stroke.
Once you have had a stroke, you will be followed quite closely by your doctor, even if you have no lasting effects. If the stroke was caused by a condition, such as high blood pressure or endocarditis, then you will have to be treated for those conditions to reduce the risk of a second stroke. If the stroke was caused by a blood clot, you may have to take an anticoagulant to prevent further clots.
It is important that you follow your stroke team’s advice. Attend all medical appointments and take prescriptions as given. Report any changes to your health to your stroke doctor and be sure that any other doctors or healthcare professionals (including dentists) know you have a history of stroke before any treatment. Even your pharmacist should know to protect against any drug interactions or medications that may put you at risk for another stroke, particularly over-the-counter medications or supplements.
After you’ve recovered from a stroke, it’s natural to fear having another one. By following your treatment plan, you do reduce that risk. Up to 75% of stroke survivors never have another one. But that means 25% of people who have a stroke will have another one within five years. Be prepared by ensuring that those around you can recognize the symptoms of a stroke and know to call 911 immediately.
By working with your stroke treatment team, your personal support network, family members, and caregivers, you can improve your likelihood of a successful stroke recovery and lower your risk of future strokes.