Fatigue Is Very Common After Stroke

Fatigue is very common after stroke.  Forty (40%) to 74% of people experience fatigue after stroke. In one study there was a significant decrease in fatigue up to three months post stroke, but from then on fatigue stayed constant.

Sometimes people will have no other symptoms or visible signs of stroke other than fatigue. They will be told by others, “you are so lucky you aren’t disabled.” But post-stroke fatigue is disabling.   It  is different from ordinary tiredness and seems to be a significant problem as stroke survivors’ struggle to regain a new normalcy (Kirkevold et al, 2012)

Persisting pathological fatigue was associated with a lower chance of returning to paid work.

Kirkevold (2012) asked 30 stroke survivors to describe their fatigue. Patients clearly described and differentiated their experience between: (1) tiredness as an ordinary life event and (2) fatigue as a post-stroke life condition.  This is very similar to Dr. Karin Olsen’s research about fatigue in cancer treatment.

Kirkevold (2012) identified three strategies that stroke survivors use to handle post-stroke fatigue:

• being on a mission, 
• settling for less and 
• stalling.

Stalling seemed to put the stroke survivors in a particularly vulnerable situation. Over time, some participants moved between tiredness and fatigue and their range of strategies.

Is stroke location in the brain associated with fatigue?

In an analysis of 17 studies on stroke fatigue, there was no association between white matter lesions, brain atrophy or pathological type of stroke and fatigue (seven studies, stroke survivors n = 4746). The data on relationship between lesion location and fatigue were inconclusive: four (n = 675) of 13 studies (n = 1613) showed associations between fatigue and infratentorial lesion location (brainstem area shaded in pink) or basal ganglia stroke.

Inflammation associated with fatigue? 

One study reported C-reactive protein levels and found an association with fatigue.

Links to references:

• Andersen G, Christensen D, Kirkevold M, Johnsen SP.  Fatigue and Return To Work, Acta Neurol Scand: 2012: 125: 248–253.
•  Marit Kirkevold1, Doris Christensen, Grethe Andersen, Søren Paaske Johansen & Ingegerd Harder.  Fatigue Manifestations and Strategies, Disability & Rehabilitation, 2012; 34(8): 665–670.
• Kutlubaev MA, Duncan FH, Mead GE.  Biological Coordinates of Post stroke Fatigue, Acta Neurol Scand: 2012: 125: 219–227.