A stroke can have serious long-term health consequences. After a stroke, the damage to the blood vessels in the brain can lead to serious complications. Understanding the types of strokes, whether caused by a blockage or brain bleeding, is important because each affects brain tissue differently and impacts the chances of survival. While most people who survive a stroke will recover to some degree, some may face the risk of impending death in the following days or weeks if not given proper care. As frightening as it sounds, being aware of the signs can help ensure the best possible outcome for the patient.
When a patient begins showing signs such as difficulty breathing, decreased responsiveness, severe weakness, or changes in skin color, these may indicate that they are approaching the end of life. Recognizing these warning signals early is crucial because it allows caregivers and medical professionals to provide the necessary support and make informed decisions about the patient’s care.
In this article, we’ll discuss the most common indicators that a person may be nearing the end of life after experiencing a stroke. Our goal is to provide you with clear, fact-based information so you understand what to watch out for and can make informed decisions about the patient’s treatment. By recognizing these signs early, medical interventions have a better chance of succeeding. Let’s get started.
Signs of Impending Death After Stroke
- Lack of Consciousness
- Difficulty Breathing
- Incontinence
- Swelling
- Changes in Vital Signs
1. Lack of Consciousness
One of the most obvious signs that a stroke survivor is approaching death is a lack of consciousness or alertness. After a stroke, the patient may experience decreased levels of awareness as their condition deteriorates. This could range from being less reactive or engaging to fully unresponsive.
Signs to look for:
- Inability to open their eyes or track movement around them
- No response to verbal commands or stimuli, like a painful pinch
- Limp and lifeless physical state.
Research shows that only about 20% of stroke patients regain consciousness if they remain in a coma for a week or more. While not impossible, a prolonged state of unresponsiveness greatly increases the likelihood of death.
2. Difficulty Breathing
Breathing problems are another major red flag. Fluid may build up in the lungs as the heart and lungs struggle to function properly, making it very difficult to breathe.
Signs to look for:
- Shallow, gasping, or labored breathing
- A bluish tint to lips and fingernails due to a lack of oxygen
- Inability to cough or clear secretions from the lungs.
Without medical intervention, breathing issues often lead to respiratory failure – when the body is no longer able to oxygenate the blood sufficiently. This is a life-threatening medical emergency.
3. Incontinence
Losing control of the bladder and bowels is a sign that basic bodily functions are breaking down. The muscles and nerves involved are no longer able to work together properly due to brain or spinal cord damage from the stroke.
Signs to look for:
- Inability to voluntarily hold urine or feces
- Soiled clothing or bedding from accidents.
While not universally present, incontinence indicates advanced impairment that reduces survival chances significantly. It’s a sign that the body is starting to shut down fully.
4. Swelling
Major swelling, bloating, or fluid retention throughout the body is another ominous sign. Fluid builds up when organs like the kidneys fail to properly filter and regulate fluids internally.
Signs to look for:
- Significant weight gain from fluid retention
- Puffy swollen hands, feet, legs or abdomen
- Skin pits, when pressed (leave an indentation)
Swelling impacts circulation and stresses major organs and tissues. It’s rarely a good sign when it occurs after a stroke or other medical event.
5. Changes in Vital Signs
Changes in basic vital signs should also raise concern.
This includes drops or irregularities in:
- Heart rate (pulse)
- Blood pressure
- Body temperature
- Respiration rate
Specifically, a rapid drop in blood pressure to shock levels, an irregular heartbeat, or very slow/shallow breathing are dangerous indicators that the body is going into organ failure. Vital signs provide important clues about overall physiological health and stability.
6. Jaundice
A yellowish tint to the skin or the whites of the eyes occurs, which indicates liver dysfunction, which can occur in some patients nearing the end of life, this condition is known as Jaundice. This happens when the liver is no longer processing toxins properly due to limited circulation, organ shutdown, or complications from medications or infections after a stroke.
Signs to look for:
- Yellowing of the skin and eyes
- Dark-colored urine
- Pale or clay-colored stool
- Fatigue and abdominal swelling (in severe cases)
7. Bleeding Problems
The body’s ability to form blood clots starts to diminish significantly. This can lead to easy bruising, unexplained bleeding, or hemorrhaging, especially if the patient is on blood thinners following a stroke. It may also signal liver dysfunction or a failing circulatory system.
Signs to look for:
- Unexplained or excessive bruising
- Bleeding gums or nosebleeds
- Blood in urine or stool
- Skin that looks blotchy or purplish
8. Insomnia or Excessive Sleep
Changes in sleep patterns are common as the brain begins to shut down. Some individuals may experience insomnia, while others may sleep excessively or drift in and out of consciousness. These shifts can reflect declining brain activity and energy levels.
Signs to look for:
- Long periods of sleep with little or no interaction
- Restlessness or inability to sleep at night
- Difficulty waking the patient or keeping them alert
- Periods of confusion after waking
9. Confusion and Disorientation
As stroke damage progresses or complications worsen, the patient may become increasingly confused, forgetful, or disoriented. This can be a sign of further brain impairment or reduced oxygen supply to the brain, often indicating a serious decline in neurological function.
Signs to look for:
- Difficulty recognizing familiar people or places
- Hallucinations or talking to people who aren’t there
- Inability to follow simple instructions
- Sudden mood swings or agitation
10. Loss of Reflexes
Another common impending sign of death after a stroke is the gradual loss of reflexes. This happens due to progressive deterioration of neurological function, where the brain and nervous system can no longer communicate effectively with the rest of the body.
Signs to look for:
- No response when the soles of the feet or knees are lightly tapped (e.g., absent plantar or knee-jerk reflexes)
- Limbs may become completely unresponsive to touch
- Lack of blinking or gag reflex in very late stages
11. Decreased Urine Output
Another sign of approaching death is a lack of urine output, almost just a noticeable drop. This can occur due to a combination of reduced fluid intake, impaired kidney function, and the body entering a shutdown phase.
Signs to look for:
- Urine becomes very dark, concentrated, or stops almost entirely
- Less frequent need for catheter changes or bathroom visits
- Swelling in the legs or abdomen may also appear due to fluid retention
This is a sign of kidney failure, as a result of poor blood circulation, dehydration, or multiple organ systems beginning to fail. With decreased urine output, other signs like low blood pressure and confusion also occur at the same time, which marks the critical point in the dying process from the stroke.
Pay attention to these warning signs in someone who has suffered a stroke. It’s completely normal to feel overwhelmed, but it’s in those moments that you need to stay calm and focus on making thoughtful decisions about the best care and support for your loved one.
Common Myths About Stroke Recovery
There are some common misconceptions people may have about what to expect after a serious stroke:
Myth: All stroke patients will eventually recover fully.
Fact: Strokes can cause permanent impairments. Some patients regain most functions, but others face ongoing disability or die from complications.
Myth: Most strokes only affect one side of the body.
Fact: Major “ischemic” strokes often impact both sides due to large vessel blockages. Hemorrhagic strokes also risk widespread damage.
Myth: Stroke recovery always follows a steady upward trajectory.
Fact: Recovery is unpredictable. Plateaus and setbacks are common. Early improvements don’t guarantee further gains later on.
Myth: Returning home means the hard part is over.
Fact: Long-term rehabilitation is often needed. Stroke can still be life-threatening due to complications like infections.
Myth: All that’s needed is rest, and the body will heal itself over time.
Fact: Medical rehabilitation involving physicians, nurses, and therapists is critical to achieving the best possible outcomes.
While every patient’s story is unique, it’s important to have realistic expectations about stroke recovery based on medical facts rather than optimistic assumptions. This helps set appropriate long-term recovery goals and anticipate potential challenges down the road.
Related Post: ACLS Stroke Algorithm
Making Treatment Decisions
Facing such dire signs can be very upsetting for any family. But depending on the person’s condition and what matters most to them, there may still be treatment options to think about.
Some key steps:
- Evaluate the likelihood of benefit through frank physician discussions. Aggressive care may not help if major organ damage has already occurred.
- Consider temporary life-extending measures like ventilation to “buy time” only if the patient previously expressed wanting to fight as long as possible.
- If CPR/intubation is not desired, make sure “Do Not Resuscitate” (DNR) wishes are officially documented beforehand.
- Weigh the potential pain/discomfort of further treatment vs expected outcomes and quality of life. Prioritizing comfort over prolonging the dying process is valid.
- Involve a palliative care team to help manage pain and other end-of-life symptoms compassionately.
Focus on creating a peaceful atmosphere during the final moments and allowing natural passing with loved ones present if discontinuing aggressive interventions.
Planning ahead and open communication between family and doctors eliminate guesswork during crisis moments. With care and compassion, it’s possible to pass with dignity according to the patient’s real priorities and values.
Hospice After Stroke
When a stroke causes severe, irreversible damage and there’s no chance of meaningful recovery, the focus of care often shifts from treatment to comfort. This is where hospice after stroke plays a vital role.
Hospice care is designed to support patients in the final stage of life, ensuring they remain as comfortable and dignified as possible. For stroke patients, this may involve managing pain, easing breathing difficulties, and providing emotional and spiritual support to both the patient and their loved ones.
Hospice After Stroke Involves:
- Symptom management: Addressing pain, shortness of breath, agitation, and other distressing symptoms.
- Emotional and spiritual care: Helping patients and families cope with fear, grief, and uncertainty.
- Assistance with daily needs: Including feeding, bathing, and mobility, often provided at home or in a hospice facility.
- Family support: Providing breaks from caregiving, emotional support, and guidance for final decisions.
Choosing hospice doesn’t mean giving up, it means focusing on the quality of life of what is remaining. It allows patients to pass peacefully, surrounded by care and compassion, rather than undergoing aggressive treatments with little benefit.
If your loved one is showing above mentioned signs of death after a stroke, hospice can provide the support needed during this deeply personal time.
The Role of CPR in Stroke Emergencies
While stroke and cardiac arrest are different medical emergencies, there are rare cases when they overlap, and in those moments, CPR can be life-saving.
A stroke happens when blood flow to the brain is blocked or reduced, but if the stroke is severe, it can trigger cardiac arrest, causing the heart to stop. When this happens, CPR plays a critical role in keeping oxygen flowing to the brain and other vital organs until emergency services arrive.
When Is CPR Needed in a Stroke?
- If the person is unresponsive, not breathing, or has no pulse, start CPR immediately.
- If the stroke causes breathing to stop, CPR can help buy precious time.
- Always call emergency services first and then begin chest compressions if instructed.
You don’t need to be a medical professional to help. CPR is the life-saving skill that everyone should learn, practice, and apply when it matters the most. CPR training of different levels, from beginner level designed for laypersons to advanced level designed for professional healthcare providers, is widely available. With regular CPR training, you will be prepared to respond quickly and confidently in cardiac emergencies.
Related Post: How to Perform Emergency CPR
Conclusion
This article has helped explain what to watch for as a potential stroke patient declines at the end of life. Please let us know if you need any clarification or have additional questions.
Whether you’re a healthcare professional looking to enhance your skills or a family member wanting to be better prepared, our courses offer valuable insights and hands-on practice. Don’t wait for an emergency to strike – empower yourself with the knowledge to act confidently when every second counts.
Contact HeartStartCPR today to learn more about our training programs and take the first step towards becoming a potential lifesaver. In the face of a stroke or any medical emergency, your quick action and knowledge could be the difference between life and death.
FAQs About Stroke and End of Life
Q1. Can people survive after being completely unresponsive for days?
Ans: It’s certainly possible but unlikely. The longer unconsciousness persists, the poorer the odds become. Only 20% regain awareness after 7+ days in a coma from a stroke. Survival would depend on the severity and presence of other organ dysfunction.
Q2. What is palliative care, and how does it help at the end of life?
Ans: Palliative care focuses on relieving suffering through expert pain management, symptom control, and psychosocial support for patients and families. It allows focus on comfort without prolonging the dying process through futile treatments.
Q3. Can stroke victims feel pain at the end, even if unconscious?
Ans: Although it’s uncertain whether unconscious stroke patients can feel pain at the end, it’s very important to manage pain well by using the proper pain medication. Some brain regions might still register pain signals. Proper pain relief prevents possible suffering of the patient.
Q4. How long does the actual dying process usually take after withdrawal of life support?
Ans: It varies, but most patients pass away within hours or a few days once Ventilation/ tube feeds/IV fluids are removed after shared decision-making. The body gradually shuts down organ systems in its own time without extreme suffering if managed properly.
Q5. What signs should prompt a 911 call after a stroke at home?
Ans: Call 911 for any sudden or new neurological symptoms, such as weakness on one side, speech/vision changes, dizziness, or severe head/neck pain, especially if they are more than a few hours old. Immediate emergency care within 3-4.5 hours of symptom onset is crucial for clot-busting stroke treatment eligibility.
