Can headaches and vision loss after a stroke be related?

A fellow caregiver asked...

My 74 year old mother, who was in good physical and mental condition, had an ischemic stroke four days ago. Her speech is fine, she is very weak but has not lost complete movement of anything. The stroke was on the right side above her forehead and so her left side is very weak.

She seems to have lost extensive vision, I'm unsure to what extent, and she is having severe headaches mainly in the area around the stroke location. The doctors are not even talking about the vision loss and say they don't know why she is having the headaches. She is at a small town hospital.

My questions are: Do you think the vision loss and headaches are related; what should be done to determine the cause and treatment; how long do we have to improve the condition before something worse happens?

Expert Answer

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

Based on your description, it sounds like she likely had a stroke in either the right middle cerebral artery (inferior division) or the right posterior cerebral artery. These strokes often cause loss of vision in both eyes to the visual field opposite the side of the stroke (in other words, her left visual field in both eyes). If the stroke involved the middle cerebral artery, she may also be neglecting the left side of her body - forgetting to pay attention to anything on her left side.

With regards to your questions:

Headaches are uncommon after ischemic strokes, but they certainly can occur. Most common reasons would be 1) swelling from the stroke, 2) small bleeding into the stroke, 3) a dilation of the small arteries in the area of the stroke when the bigger arteries are clogged with plaque or clot. Best to get an image of the brain and the arteries (as I suspect is being done) to figure out which one is occuring.

With regards to the vision, in almost all circumstances, symptoms are worst in the first few days of the stroke, then slowly improve thereafter. No one can tell you how much better her vision will get. The body simply has to heel itself. For ischemic strokes, unless there is bleeding or dangerous swelling in the stroke area, best to treat her ongoing stroke by 1) thinning the blood - usually with aspirin, 2) allowing the blood pressure to run high. Beyond that, physical and occupational therapy are helpful to help regain function. I don't think you need to worry about "something happening". The stroke is the worst part, and it is presumably over. There should be little chance of her vision getting worse from here on out.

Good luck!