Q1. My mother had a mini-stroke a few weeks ago and was seen at the ER. The doctor gave her a prescription for a blood thinner. Her regular doctor was on vacation. She got a very big bruise on her arm last week and does not think she bumped it on anything; then today she got another one on her arm near her wrist. Both the bruises are on the right side, the side affected by her stroke. Were the bruises caused by the stroke or the blood thinner?

— Jean, Nevada

A stroke would not cause bruising. Blood thinners, however — such as coumadin and warfarin — have to be well controlled or they can lead to excessive bleeding, which might account for your mother's bruises. Bruising can also occur in older people after a minor, often unnoticed, trauma because of their fragile skin and vessels. This sensitivity is exacerbated by warfarin, which interferes with the blood's ability to clot. Although bruises may be unsightly, if there are no other signs of bleeding, they are usually not dangerous.

It is important for your mother to have regular blood examinations to be sure that her prothrombin time, or clotting time, is normal and not endangering her by causing either internal hemorrhage of any sort or external bruising. You should take her back to her doctor to have these tests done, and adjustments should be made in her blood thinner if the results are abnormal.

Q2. What is the reason some stroke victims have involuntary movements or stretching of the affected hand or arm while yawning? Is this likely to be diagnosed as a secondary movement disorder, or is it just a side effect of the stroke?

— Roma, Texas

Some stroke patients may experience involuntary movements on the affected side of the body. This is, in fact, a side effect of the stroke itself and is caused by damage to the brain that limits its ability to control motor functions on the affected side. Stroke, of course, is a very serious condition. In addition to being the second-leading cause of death in the United States, stroke is the number-one cause of adult disability around the world, particularly in the United States and Europe.

Obviously good care and rehabilitation following a stroke is very important. This means working with physical therapists and perhaps occupational therapists who are knowledgeable about treating people who have suffered strokes. These therapies are the cornerstones of the rehabilitation process, although other measures play a role, too. There may also be a need for speech and language therapists, psychologists, social workers, and even pharmacists. All of these medical experts can play a role in helping to mitigate the side effects of a stroke and help a patient reach the main objective of rehabilitation, which is a return to his or her normal life by regaining the basic skills needed for everyday living.

Q3. My 72-year-old mother had a stroke that affected her bilateral frontal lobes. She has become progressively disoriented, sluggish, and incoherent. She has now lost function in both her lower extremities and is deteriorating. Her therapists say they have not had a patient display her symptoms and believe it's something other than the stroke. Her diabetes is well controlled, and she has no other diagnosis; her doctor says she is very healthy otherwise. What do you think this could be?

Your mother needs to have a thorough evaluation by an internist or geriatrician as well as a neurologist, who can look for other possible issues related to the disorientation and incoherence she is experiencing. In particular, I would ask her physician to look for any subacute infections and to evaluate the medications she is receiving, since some could be contributing to the incoherence and delirium. Her loss of function in the lower extremities needs neurological evaluation to determine if, in addition to the stroke she experienced, she has a central nervous system lesion or a metabolic condition, like a tumor. An MRI and a CT are useful in determining what the problem is and can also help you find out whether the stroke was caused by a clot or a hemorrhage. Any continuation of the confusion your mother has been experiencing is not a favorable sign.

Q4. My husband had a stroke three years ago at the age of 57. One-third of his brain is no longer functioning as it should be. Although he did well during the first year of rehabilitation, he no longer has the motivation to perform the exercises that are necessary to improve his condition, and he has gained a lot of weight due to inactivity. As his caregiver, I find myself extremely frustrated and unable to recognize the line between my responsibilities as a spouse and as a caregiver. What can I do to understand my role, to be a more efficient caregiver, and to encourage him to continue his treatment?

— P, South Carolina

I have lots of sympathy for people who have taken on a caregiver role, and the situation you're in — caring for a stroke patient — can be particularly difficult. The aftermath of a stroke is not an easy situation to manage, and it can be even harder if the person you're caring for becomes overweight, whether due to inactivity or overeating. It adds an enormous burden on an already-taxed caregiver.

To the degree to which you can manage it, you might want to try restricting your husband's food intake by serving him smaller portions of food, for example, and meals with fewer calories. This may not be easy, and your husband may resist the change at first. But, as you know, it's important to stand firm in your efforts.

Because you say he lost his motivation, another possibility is that your husband is depressed. So it might be wise to talk with his doctor about his situation and have him evaluated by a mental-health professional if the doctor thinks it’s a good idea.

When it comes to you, my impression from the character of your letter is that you are already taking your caregiver responsibilities very seriously. One of the things I always recommend to caregivers is that they arrange to have some time to themselves each day; if economically feasible, you may want to hire outside help. After all, if you become too burdened and exhausted you will not be able to take care of yourself or your husband as well as you're intending. Reach out to friends and family, and don't hesitate to take them up on their offers of assistance. Stroke recovery can be a long process and you can't do it all alone.

Q5. My mom is a 65-year-old stroke patient. Unfortunately, she also suffers from diabetes, hypertension, and high cholesterol. She seems to be forgetting things a lot. I would love for you to guide me in dealing with this.

— Keshia

Unfortunately, all the conditions you mention increase the risk of dementia, especially for someone who has already had a stroke. That's why it is very important that every effort be made to control your mother's diabetes, hypertension, and cholesterol levels. Your mother's doctor would be wise to put her on one of the statin medications (if she isn't already), which help control cholesterol levels and, therefore, help prevent heart disease and stroke. Statins work by inhibiting the enzyme that is the principal regulator of cholesterol synthesis in the body. They decrease LDL (the bad cholesterol) and triglyceride levels and increase HDL (the good cholesterol) levels. It is also critical that your mother's blood-sugar levels are kept within normal range — as much as possible — and that she takes her blood pressure drugs as prescribed.

In terms of helping her cope with day-to-day life, some people find the following can help:

Big calendars

Lists of the plans for each day

Notes about safety in the home

Written directions for using common household items

In addition, you should think about her quality of life and how to maintain or improve it, and consider your own quality of life and that of family members who might participate in caregiving responsibilities. By planning early, you may be able to reduce the family conflict and distress that caregivers can experience if they are unable to have time off.

Q6. My 83-year-old mother had a stroke a few months ago, and she passed away in May. When the stroke first occurred, we didn't recognize it - several hours passed before we realized what was going on. The stroke was on the right side of the brain, causing paralysis on her whole left side. My question is, Would she have been able to pull through it if we'd recognized it sooner? Or is a massive stroke, once it happens, pretty much a death sentence?

That depends on the type of stroke your mother had, and it's essential to properly determine which kind it was.

There are two kinds of stroke: The first, embolic stroke, is caused by a clot that lodges in a blood vessel, thereby preventing oxygen-rich blood from getting to brain tissue. The other kind, hemorrhagic stroke, is caused by the rupture of a blood vessel with subsequent bleeding into the brain, which damages tissue.

There is a brief window of opportunity (several hours at the most) during which embolic stroke may be treated with some effectiveness with an anticlotting agent. An anticlotting agent is appropriate only in the case of an embolic stroke, and does not help in the case of a hemorrhagic stroke.

If your mother had a hemorrhagic stroke, there was little that could have been done. Also, the older the individual, the lower the odds of survival. A truly massive stroke in an elderly person is likely to be very grave.

Q7. I have heard that for some seniors there is a risk of stroke in getting their hair washed at a beauty salon because of the way people need to lean back in order for their hair to be washed. Is this true and if so what can be done to avoid this?

— Phyllis, Maryland

Salon-stroke syndrome does exist. It comes as a result of the stress upon arteries in the neck that go to the brain. If these arteries are pinched or kinked, clots can develop. It is an alarming situation, as many people are unaware that having their hair done is a risk for stroke. However, it is an extremely rare event. For the record, though, tilting the head back is not a good idea for anybody.

Salon-stroke syndrome usually occurs in older women, especially those with cervical arthritis. It has been recommended that older people with arthritis in their neck avoid having their hair washed at an angle in which they need to lean back more than 15 to 20 degrees. Instead, they can lean forward over the sink.

Learn more in the Everyday Health Stroke Center.