Consequences of an AVM hemorrhage

Cognition (invisible consequences) after a cerebral hemorrhage

Other people are most likely to notice the physical limitations of a cerebral hemorrhage. The “invisible” consequences are often less noticeable and often only become evident at a later stage.

• Fatigue

  A lot of people experience (severe) fatigue after a cerebral hemorrhage. This is common and prolonged. The cause of this fatigue is not always clear. Researchers think that the fatigue is a direct consequence of the damage in the brain itself, but it may also be related to physical and mental exertion. Things that used to be easy now cost a lot of effort and energy. Fatigue affects your physical, emotional and mental functioning.

• Memory

  In general, people who have suffered a cerebral hemorrhage can remember things from long ago, but they are unable (or struggle) to remember new information. Fatigue and reduced attention and concentration can play an important role in this. If you experience this, then this can also have a negative effect on your memory.

• Attention and concentration problems

  Problems with attention and concentration are common after a cerebral hemorrhage and can decrease or even disappear over time. Attention and concentration problems can be expressed in various ways. Someone might struggle to concentrate, for example, when trying to follow a conversation, read a book or watch a movie. Or someone can become distracted more easily by stimuli in the environment, such as a radio or conversations of other people. This often makes it more difficult to do several things simultaneously, such as driving a car and chatting to the passenger at the same time, or cooking and talking.
  A lot of people notice their thought process slowing down and the information in their surroundings going much too fast. Following a cerebral hemorrhage, it takes much more effort to follow a conversation or TV program. Activities that involve a lot of people, such as a birthday party, are also tricky for many people. They feel that the information passes too quickly for them to follow and process it. This is called delayed information processing or a delayed thinking speed. This can also become apparent in activities that require quick actions, such as in traffic, sports or certain fast activities at work.

• Reduced flexibility

  Some people are not as flexible as they used to be after a cerebral hemorrhage. This can become apparent, for example, in struggling to think of a different solution to a problem when they encounter one. Or they struggle to implement a different plan if something does not go as they had planned or thought out.

• Perception

  Everyone recognizes errors that we sometimes make in spatial perception: estimating a distance incorrectly, meaning that we place the cup next to the table instead of on the table. Or we think that there is another tread on the stairs when we are already downstairs. A cerebral hemorrhage patient who has suffered damage to the right side of the brain will often experience these types of situations. He or she confuses left and right, or cannot accurately estimate the distance to a certain object. This can affect actions that require good spatial planning, such as getting dressed.

• Planning and organization

  Following a cerebral hemorrhage, some people are no longer able to plan and organize their lives. This can affect their ability to organize their day, household chores and work. As a result, this person might not be able to maintain an oversight when performing complex tasks, such as preparing a meal. Sometimes they are no longer able to plan in advance which items then need for an activity. For example, they will walk to the bathroom without taking the items they need to have a shower.

Physical (visible) consequences of a cerebral hemorrhage

A stroke can have severe and less severe consequences. The limitations that occur depend on the part and the size of the area of the brain that is damaged. As a result, someone can experience physical (visible) problems with:

• Altered consciousness

  A very severe cerebral hemorrhage can cause a person to lose consciousness and slip into a coma. Fluctuations in consciousness can also occur immediately after the cerebral hemorrhage. This depends, for example, on the time of the day, the level of fatigue, the activities that were performed just prior to this fluctuation and the pressure in the brain.

• The Motor System

  Many patients suffer paralysis on one side of the body as a result of a cerebral hemorrhage. In addition to not being able (or struggling) to move an arm and/or leg, the muscles of the trunk (core) are also affected. A person might struggle to sit or stand without falling over as a result. Walking and movement may also become more difficult as a result of the paralysis. The paralysis is floppy immediately after a stroke, but extreme muscle tension (spasm) develops in the weeks after the cerebral hemorrhage.

• Language

  A person can develop problems with comprehension and expression, if the language area of the brain is affected. This can make communication very difficult or impossible. This is also referred to as aphasia. The severity and extent of the language problem depend on factors such as the location and severity of the brain damage, the previous language ability and your personality. Some people with aphasia are still able to understand language, but they struggle to find the right words or construct a sentence. Others talk just as much, but their conversation partner cannot understand what they are saying (or struggles to do so).

• Speech

  People sometimes experience problems with speech due to problems with the strength and coordination of the muscles controlling the voice, breathing and speech. This is known as dysarthria. There are different types of dysarthria:

  • Speech problems, in which the speed of the speech is too high, too low or varying.
  • Sounds are left out or replaced and the speech can sound nasal or monotonous. It sounds as if someone is mumbling.
  • Problems involving the voice, causing someone to sound hoarse or husky, have a voice that is pitched too high or too low, or speak too loudly or softly. The person’s voice can disappear altogether.
  • Breathing problems: a person can only speak a few words in one breath, breaths rapidly or superficially, or breathes audibly and/or forcibly.

• Swallowing

  Swallowing is a complicated interplay between various muscles in the mouth and in the throat. Timing, coordination, sensation in the mouth/throat and muscle strength all play an important role in swallowing. Problems can occur in all these aspects, meaning that you are no longer able to chew or swallow, struggle to swallow or choke easily. Choking means that liquid or food ends up in the windpipe instead of in the gullet. This can result in pneumonia. This is normally prevented because the person starts coughing, but you may struggle to cough as a result of the cerebral hemorrhage.

• Loss of the field of vision

  This means that you have lost a part of your field of vision on one side of your eyes. This often affects both eyes. You may also lose a quarter of a section of the field of vision, this is called quadrantanopia.
  This condition is caused by damage to the brain, not damage to the eyes. 

• Coordination

  As a result, movements can become slower and uncoordinated, causing problems with walking. The person appears to be moving like a drunk person.

• Altered sensation

  If you have problems with sensation, you may experience numbness or tingling in a part of the body, or parts of the body feel different when touched. Or you may no longer be able to feel the temperature of — for example — water or feel pain on the skin. It is also possible that a person no longer feels whether his leg is bent or straight or no longer feels where his or her arm or leg is when he or she is not looking at it.

• Urination

  Urinary incontinence can occur as a result of a cerebral hemorrhage. This means that you have no control over your bladder. This results in problems holding in urine for a longer period and can result in unwanted loss of urine.
  You also may no longer be able to urinate properly or completely empty your bladder. You will require regular catheterization to empty your bladder. This involves a thin tube being inserted in the bladder, so that the bladder can be drained. The tube is removed once the bladder is empty.

Changes in emotions and behavior

Some patients with a cerebral hemorrhage respond differently to events (including emotional events) immediately after the stroke than before. Their reactions are more intense, because they have less control over their emotions and sometimes they are unable to tolerate stimuli in their surroundings, making them more irritable.
Some people respond more impulsively, aggressively or they may swear, whilst they would never have done this before. Others become more passive, lacking in initiative and more negative than previously. Others become emotional more quickly and will laugh or cry more quickly than normal. Some people will also be more selfish after a cerebral hemorrhage and those around them will see them as being more self-centered. They pay less attention to their surroundings or their partner. The loss of independence, self-reliance and not being considered a complete person can also cause frustration, outbursts of anger and feelings of helplessness and depression. Some people say: “It is as if my partner/father developed a different personality than he used to have”.
All these reactions are the result of damage in the brain and/or the fact that their life has been turned upside down.