Signs of Impending Death After Stroke

Physical outcomes of a stroke can range from very minimal impairment to coma and death, with stroke being the fifth leading cause of death in the United States. Signs of impending death after a stroke may include difficulty breathing, pain, and a rattling sound in the lungs.  

A person who has had a serious stroke may require palliative care, a type of care that provides symptom relief for patients with a serious illness that interferes with their quality of life. Palliative care may be temporary or long-term while a patient is receiving treatment, or they can transition into hospice care if the prognosis becomes terminal.

This article goes over the symptoms of stroke, when palliative care is appropriate, and how to identify the signs of impending death in someone who has had a stroke.

Acute Stroke vs. Chronic Cerebrovascular Disease

A stroke, or cerebral vascular accident (CVA), is an abrupt interruption in the brain’s blood supply. The interruption could be caused by an occlusion of the arteries that supply blood to the brain (ischemic stroke) or from bleeding within the brain (hemorrhagic stroke).

The effects of a stroke on functional recovery and mortality are mediated by the patient’s age, the location of the brain affected, the severity of damage to the brain tissue, and the presence of other comorbid conditions.

After a stroke, a person's prognosis depends on many different factors. It may take a few weeks to know whether they can be expected to recover.

• Acute stroke: A stroke, as with any injury to the neurological system, takes time to manifest its full effect. The most progress occurs between the first three to four months after a stroke, according to the American Heart Association, adding full recovery can take up to two years. A stroke victim, therefore, will be given time to begin to recover before any prognosis is reached. This is when palliative care becomes appropriate.
• Chronic stroke: A stroke that leaves significant neurological deficits is sometimes referred to as chronic stroke or chronic cerebrovascular disease. With adequate medical care and rehabilitation, some people are able to regain some lost function. Others may not respond as well and will continue to decline in health, regardless of the intensity of care they are receiving. This is when end-of-life treatment options such as hospice will be considered.

Symptom Management

Palliative care for an acute stroke or chronic cerebrovascular disease from a stroke focuses on symptom management. Because the neurological system is involved in the functioning of practically every other body system, the distressing symptoms requiring treatment can be very diverse.

Some of these symptoms include the following:

• Immobility and or conditions may cause pain due to involuntary muscle contractions or spasms related to neurological damage.
• Aspiration pneumonia can lead to dyspnea (shortness of breath).
• Nausea, vomiting, and constipation can be caused by a number of factors including medications and eating.
• Sores on the skin from immobility (bed sores) can be uncomfortable or painful.
• Anxiety, restlessness, and depression can result from damage to areas of the brain or from the dying process itself.
  

Accessing palliative care as soon as it becomes appropriate will ensure that symptoms are managed properly and will help prepare you for what lies ahead.

Signs of Impending Death After a Stroke

It is not always possible to tell whether someone who has had a severe stroke will die. Getting medical help as soon as possible can improve a person's chance of survival, but certain types of strokes are more likely to be fatal, especially those that affect the part of the brain responsible for automatic functions like breathing and circulation.

In the most severe cases, a patient may be in a coma and exhibit abnormal neurological responses such as no response to painful stimulation, no verbal response, and no brain stem activity. Hospice is considered when there is a poor prognosis.

Death from stroke may occur immediately or it may happen in the weeks or months afterwards. Signs of impending death after a stroke may include:

• Shortness of breath
• Pain
• Dry mouth
• Anxiety, agitation, or psychological distress
• A rattling sound in the lungs

What Is the Average Lifespan After a Stroke?

Because death can occur at any time following a stroke, someone who has experienced a severe stroke should receive hospice care as early as is appropriate. For example, if there is no improvement in neurological functioning after the first three days following a stroke, this can be a sign that the person needs to be placed in hospice care.

Life expectancy after stroke can vary considerably depending on the overall health of the person as well as the type of stroke they had, how quickly they were able to receive medical care, and whether they became disabled after their stroke.

For example, the life expectancy after a stroke for an 80-year-old male who has no significant disabilities is around nine years, while someone the same age and gender who has a severe disability after a stroke has a life expectancy of years years. 

What Is the Most Common Cause of Death After a Stroke?

Factors associated with increased risk of death from a chronic stroke include:

• Dysphagia (trouble swallowing), which can lead to malnutrition or aspiration pneumonia caused by inhaling, or aspirating, bits of food
• Receiving artificial nutrition through a nasogastric (NG) or gastrostomy (G) tube yet still showing signs of malnutrition through significant weight loss
• Recurrent post-stroke infections, including urinary tract infections without a known cause
• Being bed bound
• Requiring maximal assistance for self-care
• Inability to perform activities of daily living
• Inability maintain hydration or caloric intake
  

Types of Consciousness After Stroke

A person who is in a coma after having a stroke will be evaluated using the Glasgow Coma Scale. This helps their healthcare provider monitor them for signs that they may be improving or worsening. 

A score between 3 and 15 is given based on how the person responds to a painful stimulus, whether they respond verbally or move in response to a command, and whether they open their eyes spontaneously or in response to a stimulus.

• A score of 8 or less suggests a severe brain injury.
• A score between 9 and 12 suggests a moderate brain injury.
• A score of 13 or higher suggests a mild brain injury.

Locked-in Syndrome

Locked-in syndrome is a very rare condition in which a person is conscious but unable to move or speak. It can occur after someone has a stroke in the brain stem.

Summary

Someone who has had a stroke may recover completely or may experience permanent disability. Others may die in the weeks or months after having a stroke.

It is not always possible to tell whether someone will die after a stroke. If they show little signs of recovery after the first few days, it's a sign that they may need to be transferred to hospice care. Signs that someone who has had a stroke is close to death include difficulty breathing, pain, and a characteristic rattling sound in the lungs.