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Last session an NPC suffered a significant stroke, with the typical symptoms of partial paralysis of one side of the body, drooping face on that side, slurred speech, and so on.

However, a stroke doesn't inflict a mechanical condition that could be cured by lesser restoration. Because it isn't necessarily a disease, either (no contagion, no real cure), it wouldn't be affected by heal or a Paladin's Lay on Hands. Greater restoration lists a specific list of "debilitating effects" that it can cure, which might leave it out.

Can any magic or class feature restore this NPC's vitality, short of a wish spell?

To clarify, I am the DM, so I am looking for in-game mechanics for possible resolutions.

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  • \$\begingroup\$ Comments are not for extended discussion; this conversation has been moved to chat. \$\endgroup\$ – Rubiksmoose Dec 9 '19 at 19:47
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Regenerate for this DM

I took a few minutes to learn about strokes here, and the general gist is that due to a combination of ruptured/blocked blood vessels a bunch of brain cells die. This progressing to full death depends on how far it gets, but regardless the creature in question effectively has severed body parts by virtue of brain cells being dead and effectively disconnected from the overall organ.

Given that Regenerate states:

You touch a creature and stimulate its natural healing ability. The target regains 4d8 + 15 hit points. For the duration of the spell, the target regains 1 hit point at the start of each of its turns (10 hit points each minute).

The target’s severed body members (fingers, legs, tails, and so on), if any, are restored after 2 minutes. If you have the severed part and hold it to the stump, the spell instantaneously causes the limb to knit to the stump.

Natural healing could include stem cells, reinvigorating the dead brain cells back to life, or growing new ones. Whichever logic works for you.

As a 7th level spell, this would finally make me happy to see some reason for it to be as high level as it is. Using this spell, this DM would permit the caster to fully restore mental faculties to someone who has degenerated from a stroke, dementia, etc.

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Non-disease illnesses are not modeled in the rules

The mechanics of D&D are mainly focused around combat, exploration, and social interaction, not to mention magic. While infectious diseases are covered in the DMG Chapter 8, as far as I can tell there is no attempt in the rules to model any kind of illness other than that caused by disease or magical curses. Hence, any interaction between a stroke and the existing mechanics around healing or curing disease is necessarily going to be home-brewed. If you are incorporating mundane non-disease illnesses such as heart attacks and strokes, then it's reasonable to let a PC who is proficient in medicine ask the DM whether their medicinal knowledge would apply here, both in terms of mundane healing and in terms of knowing which kind of magical healing to apply in situations like this. You might ask them to make a medicine check to determine this.

Potential resolutions

For what it's worth, I can think of several reasonable resolutions to this (and you might also think of others; this isn't meant to be an exhaustive list). First, if you're feeling generous as a DM, you might allow Lesser Restoration to cure the stroke, since paralysis is one of the conditions cured by Lesser Restoration, and (partial) paralysis is one of the symptoms of the stroke. Alternatively, you may determine that in mechanical terms, any kind of mundane illness does in fact count as a "disease" regardless of whether it is actually described as such in real life. This would also allow the stroke to be cured via Lesser Restoration (or any other disease-curing spell/effect, such as a paladin's Lay on Hands). If you feel a 2nd level spell is too "easy" for a cure, you could also decide that a stroke is on the same level of "severity" as the conditions cured by Greater Restoration, and thereby justify requiring Greater Restoration instead.

Second, you might allow a medicine check, probably with a quite high DC, to "stabilize" the person (assuming the stroke has them in imminent danger of dying), or as mentioned above, the medicine check may allow a PC to determine which spell is required to treat the stroke.

Lastly, if all else fails and the stroke proves fatal, resurrecting the person is an option, although some intervention may be required beforehand to prevent them from resurrecting right back into another stroke. Read each resurrection spell carefully to determine whether it would also cure the cause of the stroke.

(Note that if you don't want to allow resurrection as a potential solution, all resurrection spells (except Revivify) require the creature's soul to be "free and willing" to return, which means that the DM is not obligated to allow the PCs to resurrect a character.)

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  • \$\begingroup\$ @Medix2 Those are also good ideas. I think those are worth writing your own answer, as they're quite outside the scope of mine. \$\endgroup\$ – Ryan C. Thompson Dec 8 '19 at 18:41
  • \$\begingroup\$ Ah, you mentioned resurrecting then so I was unsure, I'll write it up then, thank you \$\endgroup\$ – Medix2 Dec 8 '19 at 18:42
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    \$\begingroup\$ Just note that a 2nd level spell is not exactly a random grade school level common occurrence. The PCs are heroes in the D&D universe. The average civilian has 1d8 hit die... A wizard by the 3rd level will have more HP than a commoner. Lessor Restoration has a cost of 40gp, which can be months to years of wages for a normal person. This is basically a surgery as a modern day equivalent. \$\endgroup\$ – Nelson Dec 9 '19 at 2:56
  • \$\begingroup\$ @Nelson I was thinking more in terms of game mechanical balance than in-universe justification. I trust the DM can come up with something to justify whatever level of magical healing they decide to require. \$\endgroup\$ – Ryan C. Thompson Dec 9 '19 at 5:05
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    \$\begingroup\$ +1 for lesser restoration. If a potion/1st level spell can knit injured arteries back together from a contusion, the ability to do that within shouldn't be more than a second level spell. \$\endgroup\$ – Carduus Dec 9 '19 at 14:01
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You could treat the stroke symptoms as a custom lingering injury

The DMG Chapter 9 includes a variant rule called Lingering Injuries, which includes a table of several such injuries. Most of the injuries have some mechanical detriment based on the nature of the injury. In addition, each injury specifies a custom condition for healing it. Examples include:

Lose an Eye. [...] Magic such as the regenerate spell can restore the lost eye.

Internal Injury. [...] The injury heals if you receive magical healing or if you spend ten days doing nothing but resting.

Horrible Scar. [...] Magical healing of 6th level or higher, such as heal and regenerate, removes the scar.

For your stroke victim, you could implement a custom lingering injury in the same style as the ones in the DMG: a set of one or more mechanical detriments, and an arbitrary condition for ending the injury. Feel free to use any of the conditions quoted above, or make up your own based on what level of healing you deem appropriate to the injury. The advantage of this approach is that you completely sidestep any need to parse out the text of specific healing spells, which were clearly not written with something like a stroke in mind.

Personally, based on comparison to the existing injury table, I would lean toward the "Magic such as the regenerate spell" condition, which puts me in agreement with Pyrotechnical's answer.

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  • \$\begingroup\$ I've posted this separately from my other answer because it takes a completely unrelated approach, which I only thought of later after running across the lingering injuries table. \$\endgroup\$ – Ryan C. Thompson Dec 8 '19 at 23:33
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    \$\begingroup\$ Nice use of that optional rule in the DMG. +1 and golf clap \$\endgroup\$ – KorvinStarmast Dec 9 '19 at 15:19
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There aren't many ways to cure a stroke

A stroke, at least usually, would not be cured simply by removing its conditions as strokes have lasting physical effects such as clotting and ruptured blood vessels, which would need to be healed, unless it's a transient ischemic stroke. Additionally a stroke may be caused by a disease but the stroke itself is not a disease so things such as lesser restoration may not work (it's up to the GM).

Additionally, as Ryan C. Thompson's answer points out, a stroke is not something modeled by the game rules of fifth edition, so whether things such as curing diseases and the like would work is going to be up to the GM.

Some out-of-the-box options:

The true resurrection and reincarnate spells:

Both of these spells revive a creature into a new body if the old one does not exist (some disassembly would thus be required), this would completely remove all the physical side-effects of the stroke, though it is more or less up to the GM whether the mental ones persist. Presumably they would also vanish as it's a new brain, only the soul remains the same.

However, as user Ryan C. Thompson pointed out in a comment, the true resurrection spell may have some oddities as it states:

You touch a creature that has been dead for no longer than 200 years and that died for any reason except old age. If the creature's soul is free and willing, the creature is restored to life with all its hit points. This spell closes all wounds, neutralizes any poison, cures all diseases, and lifts any curses affecting the creature when it died. The spell replaces damaged or missing organs and limbs [...]

If the stroke was caused by old age then that could certainly be interpreted as death due to old age, preventing this spell from working. Additionally, the cardiovascular system is often considered an organ, but whether blood vessels would be restored by this spell is, again, up to the GM.

The sequester spell helps a bit:

[...] If the target is a creature, it falls into a state of suspended animation. Time ceases to flow for it, and it doesn't grow older [...]

This would allow a temporary fix for some of the problems (similar to immediate cryogenic freezing) and allow you to wait until further medical/magical help can be found (perhaps there's some distant magical item that can heal this).

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    \$\begingroup\$ Note that True Res also says "the spell replaces damaged or missing organs and limbs," so destroying the body to force the creation of a new one may not be necessary. Also, if the cause of the stroke was old age, then True Res may not work at all. \$\endgroup\$ – Ryan C. Thompson Dec 8 '19 at 18:59
  • \$\begingroup\$ Speaking as the DM, old age was absolutely a cause. There were other factors that brought it forward, but it would have happened sooner or later. \$\endgroup\$ – user55434 Dec 8 '19 at 19:05
  • \$\begingroup\$ @RyanC.Thompson I've added a bit on that, hopefully to catch those points you brought up \$\endgroup\$ – Medix2 Dec 8 '19 at 19:06
  • \$\begingroup\$ "the stroke itself is not a disease" - that's not true. There are diseases which are not infectious diseases. See my comment on the question. \$\endgroup\$ – Martin Bonner supports Monica Dec 9 '19 at 10:03
  • \$\begingroup\$ @MartinBonnersupportsMonica It may be a disease, medically. But it does not line up with the standard English meaning of disease that the books use \$\endgroup\$ – Medix2 Dec 9 '19 at 10:15
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Lay on Hands can work - as DM, first decide what fits the narrative

Technically, the afflictions caused by a stroke can be classified as a disease, so a class ability can be the way to cure this. (Or a spell can, up to you).

  • RL observation: some of the people who I know who have had strokes still have some permanent loss of function, and while others have more or less recovered. (It really depends ...)

A disease is (Per @MartinBonner's comment))

A disorder of structure or function ... especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury."

A stroke can be described as a disease but you are not required to. For the disease case, the paladin's Lay On Hands can heal that NPC.

The description of Lay on Hands says:

Alternatively, you can expend 5 hit points from your pool of healing to cure the target of one disease or neutralize one poison affecting it.

As the DM, you don't have to hold to that definition, nor even use it. The DMG discusses how a DM deals with a disease in a way that you may find useful.

... the specifics of how a disease works aren't bound by a common set of rules. [...] What matters is the story you want to tell. (DMG p. 256)

You, the DM, may want something more powerful for narrative reasons so you need to decide ...

What is your story-intent for giving the NPC a stroke?

  1. Do you want to see if the PCs will try to heal the NPC?
  2. Do you want the NPCs to have to go on a quest to get access to a regenerate spell? (See Pyrotechnical's excellent answer)
  3. Do you want this to be beyond the PCs' power to heal?
  4. Do you want to equate this to being Turned to Stone (medusa, Gorgon, etc)? Petrified is a very severe condition, far more severe than a stroke - and it is reversible with Greater Restoration.

    What is it that you want out of this story element that challenges your PCs? First answer that - it's OK to talk to yourself, all of us DMs do that (8^D) - and then decide on the power level needed to cure a stroke. A stroke has no mechanical equivalent in the rules as written, so this is by necessity a DM- ruling-required situation.

    If nothing else, curing this NPC will make for the party at least one ally - the NPC - and possibly others who are friends/family of this NPC.

How does this fit into your narrative/story/campaign? Decide that, and then choose a power level required for this healing (listed in ascending order):

  • Lay on Hands (stroke ~ disease, cures disease)
  • Lesser Restoration (stroke has partial paralysis, this removes paralyzed condition)
  • Greater Restoration (can reverse turn to stone, more severe than partial paralysis)
  • Divine Intervention (level 10+ cleric ability; {Deity} works in wondrous ways)
  • Heal (ends blindness, deafness, any diseases; cf LoH)
  • Regenerate (makes like new)

  • Wish ("wish the stroke had never happened" - there's nothing wish can't do, you are the DM)

    And so on ...

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    \$\begingroup\$ @V2Blast Ah, thanks for the edit/clean up. \$\endgroup\$ – KorvinStarmast Dec 9 '19 at 20:47
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    \$\begingroup\$ I think this is the most general answer: the stroke is ultimately a plot device, and it should work however the DM needs it to work in order to fulfill its narrative purpose. \$\endgroup\$ – Ryan C. Thompson Dec 9 '19 at 22:08
  • \$\begingroup\$ @RyanC.Thompson I like both of your answers. :) \$\endgroup\$ – KorvinStarmast Dec 10 '19 at 0:09
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A stroke is a disease

Not all diseases are infectious diseases.

From Oxford:

disease: A disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.

Lesser Restoration is fine

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