Left Hemispheric Stroke

What is a left hemispheric stroke?

A stroke occurs when blood cannot flow to your brain. This is caused by a blood clot blocking a vessel in your brain, or a torn vessel bleeding into your brain. The left side (hemisphere) of your brain controls the right side of your body. It also controls your speech and language abilities. After a left hemispheric stroke, you may have trouble talking, swallowing, or walking. You may act more slowly and carefully, and your memory may be worse than before the stroke.

What causes a stroke?

• Ischemic stroke: This happens when an artery to your brain gets blocked. This can be caused by having plaque in your artery. Plaque happens when fatty deposits and other things build up in an artery. You can also get a blocked artery from a blood clot. The clot can break loose from an artery somewhere else and travel to your brainstem. The clot may get stuck in a narrow blood vessel, stopping blood and oxygen from reaching your brain. This is called an ischemic stroke. Most strokes are ischemic strokes.
  
  
• Hemorrhagic stroke: A blood vessel may break and leak if a clot gets stuck in it, or the vessel wall is weak. Blood then flows out of the vessel and into brain tissue. This is called a hemorrhagic stroke.

What increases my risk of having a stroke?

• You are at least 55 years old.
  
  
• You are a man.
  
  
• You are a woman and use birth control pills, or you take hormone replacement medicine after menopause. Menopause occurs when an adult woman stops having monthly periods.
  
  
• You are African American, or Native American.
  
  
• Your father or mother had a stroke, or you had a low weight when you were born.
  
  
• You have high blood pressure, or blood vessel or sickle cell disease that is not being treated.
  
  
• You have atrial fibrillation, diabetes or other heart or blood vessel conditions.

What lifestyle changes can decrease my risk of having a stroke?

• Lower your blood pressure. Take your blood pressure medicine as ordered by your caregiver. Do not stop taking these medicines without asking your caregivers. Check your blood pressure often, and write the numbers down to show your caregiver.
  
  
• Manage your diabetes. Diabetes (high blood sugar) increases your risk of a stroke. Manage diabetes by keeping your blood sugar level within a normal range. Ask your caregiver what your blood sugar level should be, and how often to check it. Use a glucose monitor to check your blood sugar. A glucose monitor is a small device that tells how much sugar is in your blood. Write down your blood sugar each time you check it, and show your caregiver at follow-up visits.
  
  
• Eat healthy foods. High blood pressure, high cholesterol, and diabetes increase your risk of stroke. Eat foods low in fat, cholesterol, salt, and sugar. Eat at least 5 servings of fruits and vegetables each day.
  
  
• Reach or keep a healthy weight. If you are overweight or obese (weigh more than your caregiver suggests), you may need to lose weight. Weight loss can decrease your blood pressure and your risk of stroke. Ask your caregiver how much you should weigh and about how you can lose weight.
  
  
• Exercise. Get 30 minutes of moderate exercise each day to help prevent a stroke. Good exercises are cycling, fast walking, or jogging. Ask your caregiver about what exercises you should do.
  
  
• Limit alcohol. Alcohol can damage your brain, heart, and liver. Men should not have more than 2 drinks per day. Women should not have more than 1 drink per day. Tell your caregiver if you drink alcohol.
  
  
• Quit smoking. Cigarette smoke increases your risk of a stroke. It is never too late to quit smoking. You are more likely to have a stroke if you smoke. Quit smoking to improve your health and the health of those around you. Ask for help if you are having trouble quitting.
  
  
• Do not use street (illegal) drugs. Cocaine, methamphetamines (meth), and heroin increase your risk of a stroke.

What are the signs and symptoms of a left hemispheric stroke?

After a left hemispheric stroke, you may have trouble talking, swallowing, or walking. Your memory may be worse than before the stroke. You may act more slowly and carefully. You may have 1 or more of the following:

• Movement problems:
  
  
  • Loss of movement: You may not be able to move the right side of your body as much, or at all. You may find it hard to do certain things, such as make gestures, copy movements, or use your hand to draw.
    
    
  • Muscle weakness: The muscles in the right side of your body may become weak after a stroke. You may lose some or all movement of your right arm or leg. You may find it hard to walk.
    
    
  • Right-sided neglect: You may not dress, shave or be aware of the right side of your body. You may fall towards your right side.
    
    
  • Body awareness problems: You may not know that you cannot move as you should. You may say that you cannot walk, but still try to. You may think you have moved a part of your body when you have not.
  
  
• Language and speech problems: You may have trouble speaking or you may not be able to talk. When someone is talking, you may not understand what they are saying. You may have trouble reading or writing. You may not know common letters, numbers, or words. It may be hard for you to name certain objects, or know the meaning of movements such as waving.
  
  
• Trouble thinking: You may have trouble paying attention, remembering things, or solving problems.
  
  
• Sadness and mood changes: You may feel depressed. You may feel tired, have trouble sleeping, and you may not want to eat. You may want to stay away from people. You may lose interest in the activities you used to enjoy. You may feel hopeless and helpless, and think about killing yourself. Your mood may change quickly from sad to happy.

How is a left hemispheric stroke diagnosed?

Your caregiver will ask about your and your family's medical history. He will ask about the medicines you take and if you use street drugs. He will also do a physical exam and look for signs that show what part of your brain was injured. You may need blood tests and other tests to help your caregiver learn if you have had a stroke. Tests also help your caregiver know where in your brain a stroke happened, and how much damage from it you have. Ask caregivers for more information about the tests that you need. You may need one or more of the following:

• CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your skull and brain. You may be given dye, also called contrast, before the test. Tell the caregiver if you are allergic to dye, iodine, or seafood.
  
  
• MRI: This scan uses powerful magnets and a computer to take pictures of your brain. It will also take pictures of the blood vessels and structures in your head. You may be given dye, also called contrast, before the test. Tell caregivers if you are allergic to dye, iodine, or seafood. Remove all jewelry, and tell caregivers if you have any metal in or on your body. Metal can cause serious injury. Tell caregivers if you cannot lie still or are anxious or afraid of closed spaces.
  
  
• Arteriography: X-rays are taken of your arteries to look for blood flow blockage and bleeding.
  
  
• Carotid ultrasound: This test uses sound waves to show the blood flow in your carotid arteries. The carotid arteries are blood vessels in your neck that carry blood to your brain. A carotid ultrasound checks for narrow or blocked carotid arteries.

How is a left hemispheric stroke treated?

Treatment depends on what caused your stroke, and your signs and symptoms. You may need the following medicines:

• Cholesterol medicine: This type of medicine is given to help decrease (lower) the amount of cholesterol (fat) in your blood.
  
  
• Other medicines: You may need medicine to treat diabetes or to prevent seizures. Medicine may be given to keep your blood pressure at a certain level if it is too high or too low.

• Thrombolytics: This medicine is given to break apart blood clots and help blood flow more easily.
  
  
• Aspirin: This medicine may be given to help thin the blood to keep blood clots from forming. This medicine makes it more likely for you to bleed or bruise.
  
  
• Antiplatelets: This medicine is given to prevent blood clots from forming.

What other treatment may be needed with a left hemispheric stroke?

• Ventilator: This is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your airway through your mouth or nose. You may need a trach if an ET tube cannot be placed. A trach is an airway tube put into an incision (cut) in the front of your neck. The ET tube or trach is attached to the ventilator.
  
  
• Surgery:
  
  
  • Ventriculostomy: If you have too much fluid and swelling around your brain, a tube may be placed through your skull to drain the fluid. This tube also checks the pressure in your brain.
    
    
  • Craniotomy: If your stroke was caused by bleeding into brain tissue, your caregiver may do surgery on your brain to remove the blood or fix a damaged blood vessel.
    
    
  • Carotid endarterectomy: Blocked carotid arteries can cause poor blood flow to your brain. If your carotid arteries are blocked, surgery called carotid endarterectomy may be done. This surgery widens the arteries so that blood can flow through more easily.
    
    
  • Blood vessel filter: If you are at high risk of getting a clot in your leg (DVT), you may need to have a filter device placed in your blood vessel. This is called an inferior vena cava filter. Ask your caregiver for more information about this procedure.

What can I do to help recover from a left hemispheric stroke?

• Go to your rehabilitation sessions:
  
  
  • Rehabilitation (rehab) is an exercise and activities program. Rehab can help you return to your usual activities and prevent problems, such as muscle shortening (contractures) and skin breakdown (bedsores). Physical therapists may work with you to strengthen your arms, legs, and hands. They may help you relearn or improve how you walk (gait training). Occupational therapists may teach you new ways to do daily activities, such as getting dressed. A speech therapist may help you relearn or improve your ability to talk and swallow.
    
    
  • Your rehab program may include functional electrical stimulation to help your muscles work better. You may do weight lifting to increase your strength. You may do exercises to improve your balance and movement to decrease your risk of falling. Stretching exercises, riding a bike, or walking can also help you recover. Ask your caregivers what activities you should do to help you recover from your stroke.
  
  
• Get help for depression: The way you think and feel about things may change after a stroke. You may be forgetful, or have trouble thinking clearly. You may get angry or start crying easily, or you may feel depressed. Talk to caregivers about your feelings. Counseling, medicines, and support groups can help you cope with the changes that happen after a stroke.

How can I tell if someone is having a stroke?

Know the F.A.S.T. test to recognize the signs of a stroke:

• F = Face: Ask the person to smile. Drooping on 1 side of the mouth or face is a sign of a stroke.
  
  
• A = Arms: Ask the person to raise both arms. One arm that slowly comes back down or cannot be raised is a sign of a stroke.
  
  
• S = Speech: Ask the person to repeat a simple sentence that you say first. Speech that is slurred or strange sounding is a sign of a stroke.
  
  
• T = Time: If you see that the person has any of these signs, it is an emergency. Call an ambulance to take the person to the hospital.

When should I call my caregiver?

Call your caregiver if:

• Your blood pressure is higher than your caregiver has told you it should be.
  
  
• You have skin tears, or sores on your heels, head, or buttocks from lying in bed.
  
  
• You have bowel movement problems.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You cannot make it to your next appointment.
  
  
• You have questions about your therapy, medicine, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have a seizure.
  
  
• You are bleeding from your rectum, nose, or another body area.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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