Is anger and agitation normal during stroke recovery?

Oldestdaughter asked...

My father suffered a Basil Ganglia stroke 11/09. He had rebounded and was doing quite well physically and cognitively as of January 2010. He is still in a Rehab Facility and has recently become extremely agitated (swinging at staff, etc). Is this common in a recovery? Could it be from medication and/or confinement?

Expert Answer

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

This sounds suspicious for "delerium" (a medical term that indicates a fluctuating level of awareness and attentiveness). It frequently causes patients to become suspicious and combative. I would guess that this occurred when he was tired, or in the evening hours. It is very common in patients who have suffered a stroke, particularly if they are elderly or have underlying memory trouble.

Often, as people age they lose their mental reserve to deal with new surroundings, particularly when they are tired. This can be made substantially worse by a new stroke, lots of new medications, or by infections that occur after a stroke - commonly pneumonia or urinary tract infection. Patients suffering from delerium tend to become very confused and suspicious of caregivers. This comes and goes, evnetually improving a great deal over weeks to months.

A review of his medications and a quick check for basic infections and metabolic derangements should be made by his doctors. Otherwise, often the best course of action is to have a familiar person calm him down, either in person, or by telephone.