Are memory and cognitive changes expected after a stroke regardless of the area affected?

1 answer | Last updated: Sep 14, 2017
A fellow caregiver asked...

In August my father had a stroke in his cerebellum followed by a stroke in his medulla (brain stem) - the doctors now think it was one stroke that progressed over the course of a week. He had difficulty with balance and walking and has now regained his walking ability. We do not know the cause of the stroke -they believe it was in the PICA area of his brain. The neurologists have not recommended any follow up but I still have concerns. His cognitive skills are not what they used to be - he has difficulty with understanding irony, cause and effect, predicting, etc. There are also some minor memory differences. His personality has also changed and he is much more impulsive than he used to be. When we asked the neurologist about these changes, he said that they are not expected based on the area of his brain that was affected. Are memory and cognitive changes expected after a stroke regardless of the area affected? He has seen 2 different neurologists and they feel that he is fine (mainly b/c his physical skills are good) - should he see a stroke specialist? How can we find one in our area? Thanks for your help! I am concerned that we are not doing all that we can to prevent another stroke, especially because we do not know the cause (he has low BP, no diabetes, nonsmoker, etc).

Expert Answers

James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Although the cerebellum and brainstem are not commonly associated with cognitive and personality changes, there is no question that these things can occur with strokes in those locations.

With regards to the cause of the stroke, I agree with you that it is always best to try and identify exactly what happened. I would call the nearest academic University Hospital and ask for an appointment with one of their Stroke Specialists. If they have none, branch out to a regional University - such as the major university in your state. It is important for treatment to get a better understanding of the cause.

As for his symptoms, they should recover slowly with time (I cannot guarantee full recovery) if he actively exercises the skills that are lacking. Reading, crossword puzzles, taking an elective class at a local college, etc. are very helpful for this.

As a final thought, if you want to better quantify exactly what deficits exist, I would seek out a local Neuropsychologist. These are typically PhD doctors who spend several hours testing different elements of cognition, and are often very helpful in aiding the medical doctors with a tailored treatment plan.

Good luck!