FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

POST-STROKE EMOTIONAL PROBLEMS NOT UNCOMMON

Question: I had a stroke in October. In general, I'm doing well now, accept for my emotions. I get upset easily, and I cry constantly, even over little things. My doctor seems to be afraid to give me something for this. Is this normal after a stroke?

Answer: First, I need to explain a few general things about stroke. My American Heritage Dictionary defines stroke in a clear fashion. It says that it is: "A sudden loss of brain function caused by a blockage or rupture of a blood vessel to the brain." As you know, the brain controls how we think and also how we move. Once a portion of the brain is deprived of its normal circulation for more than a few minutes, those specific cells die. Therefore, the function they served is lost.

Immediate death occurs when a stroke affects brain centers that control breathing or other essential life functions. Destruction of other important but less life-threatening areas results in paralysis of one side of the body, blindness in one eye, partial loss of vision, difficulty with speech, or other symptoms characteristic of stroke. Emotional change is common after a stroke, too. This sometimes manifests itself as depression - which may be the condition you have. "Emotional lability," a condition characterized by moment-by-moment swings in mood, can also develop after a stroke. Post-stroke emotional problems can be the result of damage to areas of the brain that elicit emotions, or simply as the emotional component of dealing with new stroke-induced physical disability.

There are a number of medicines that are helpful for those suffering from depression, including those like yourself who have previously had a stroke. Most of these medicines are safe for a stroke victim whose condition is medically stable, as yours is. In addition to taking medicine, it is also important to promote your general recovery by working on those areas that may be damaged by the stroke. Physical therapy, speech therapy, occupational therapy and counseling are helpful for many.

Question: How common is stroke and is there anything I can do to prevent a second stroke?

Answer: Stroke is the third leading cause of death in the United States following heart disease and cancer. About 500,000 people have a stroke each year, and 150,000 of these individuals die from it. The estimated total cost to our society from stroke, when counting lost productivity and necessary health care, is $20 billion each year. Wow! Despite these gloomy numbers, there are many risk factors that can be controlled. The most common risk factors are:

- High blood pressure - the most common treatable cause of stroke - which is associated with a six-fold increase in stroke risk;
- Smoking, which gives rise to a two-fold increase;
- Diabetes, which generates a four-fold increase;
- Coronary artery disease, which creates a six-fold increase; and
- A previous stroke or transient ischemic attack, which produces a ten-fold increase in the risk of subsequent stroke.

Fortunately, treatment of each of these conditions dramatically reduces the risk of stroke. Prevention is possible! Please talk to your doctor about your risks, particularly if you have one or more of these stroke-related medical conditions.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.