Consequences of an AVM hemorrhage

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.