【Cerebral Infarction Sequelae】Complete Guide by Frequency: Paralysis, Aphasia, Dysphagia, and More! Maximizing Recovery in the “First 3 Months”

While acute treatment for stroke is vital for survival, the way a patient copes with the subsequent long-term effects (sequelae) significantly determines their Quality of Life (QOL). Sequelae extend beyond “hemiplegia” to include higher brain function disorders affecting language, memory, and emotion, each requiring appropriate rehabilitation.

Sequelae of Cerebral Infarction

RankType of SequelaeFrequency (Approx.)Specific SymptomsImpact on Daily LifeRecovery Outlook (Estimate)
1Hemiplegia (Paralysis)70−80%Weakness/inability to move limbs on one side, especially difficulty using the hand.Inability to walk, hold chopsticks, or dress oneself.Most recovery occurs within the first 3 months. Peaks around 6 months.
2Sensory Impairment50−60%Numbness, pain.Inability to grasp objects properly, stumbling when walking.Generally recovers well, but residual numbness is common.
3Language Disorder (Aphasia)20−30%* Inability to speak * Difficulty comprehending * Inability to read/write.Conversation is impossible; difficulty returning to work.Many show significant improvement within 1 year.
4Dysphagia (Swallowing Difficulties)30−50%(Acute) →15−20%(Discharge)Choking, inability to drink water, recurrent pneumonia.Aspiration pneumonia is life-threatening.Early rehabilitation allows 80% to return to oral feeding.
5Higher Brain Dysfunction30−50%* Poor attention span * Memory impairment * Emotional lability * Spatial agnosia.May look healthy but cannot return to society. Often goes unnoticed but is the most difficult.
6Visual Field Deficit20−30%Half vision is lost (hemianopsia), double vision (diplopia).Bumping into things, inability to read, unable to drive.Spontaneous recovery is rare, but compensatory techniques are possible.
7Bladder/Bowel Dysfunction20−40%(Acute)Urinary incontinence, reliance on diapers.Causes shame and limits going out.Most cases improve within a few weeks.
8Depression / Apathy30−40%Lack of motivation, frequent crying.Most distressing for family members.Often improves with antidepressants + rehabilitation.
9Spasticity (Muscle Stiffness)Appears 1−3months post-onsetLimbs are stiff, contracted, painful; difficulty walking; heavy caregiver burden.Can be mitigated with Botox and Baclofen.

Severity of Sequelae (mRS Score) Guide

ScoreMeaningProportion (Japan Average)
0No symptomsApprox. 15%
1−2Mild (Mostly independent in daily life)Approx. 40%
3Moderate (Requires some assistance)Approx. 20%
4−5Severe (Bedridden to total assistance)Approx. 20%
6DeathApprox. 10−15% (During hospitalization)

Critical Keys to Maximizing Recovery (As of 2025)

ItemSpecific Action for Higher Recovery Rate
Start of RehabilitationStart within 24−48 hours of onset.
Daily Rehab TimeMinimum 3 hours per day (9 units).
Robot RehabilitationHAL, ReoGo-J, etc. (Insurance coverage expanding).
Brain Stimulation TherapytDCS (transcranial direct current stimulation), rTMS (repetitive transcranial magnetic stimulation).
Swallowing ImprovementEarly videofluoroscopic swallowing study (VFSS) + balloon dilation therapy.
Spasticity TreatmentBotox injections (every 3−4 months).

Summary

  • “The first 3 months are critical.”
  • Approx. 70−80% of recovery occurs within the first 3 months of onset.
  • Recovery plateaus after 6 months (transitioning to the maintenance phase).