Stephen Makin, PhD

Hinkle JL, Becker KJ, Kim JS, Choi-Kwon S, Saban KL, McNair N, et al, on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing and Stroke Council. Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association. Stroke. 2017

After a stroke, fatigue is a big deal; even my patients who make an excellent physical recovery can be very limited by the fatigue. From my clinical practice, it appears to be very common and often very disabling. So, I was interested to read this interesting review on poststroke fatigue.

The prevalence of poststroke fatigue varies depending on different methods used to measure it, but it’s estimated at 40%. It’s associated with a reduced quality of life, so it’s something we should all be aware of. Although it’s more common after stroke, some people who have a TIA also suffer from fatigue.

When I first heard about poststroke fatigue I thought it was simply depression, which is also common poststroke. However, only 38% of fatigued patients are depressed, and anti-depressant medication doesn’t seem to be effective.

There are some interesting biological factors which may play a role, though we don’t know the full pathophysiology. It doesn’t seem to be linked to the location of the stroke lesion, but it may be related to altered cortical excitability. Meanwhile, it is also proposed that inflammation may play a role.

Are there any available treatments for fatigue? A number of drugs and non-drug interventions have been tried, but none are convincingly effective.

Where does this leave us? I will continue to warn my patients they may experience fatigue, and keep a close look out for any new therapeutic interventions that may be available. I hope one can be developed soon because there are a lot of people who would benefit.