Stroke - Treatment






Immediate Intervention

Stroke treatment usually occurs in two phases. The first phase involves immediate steps to save the patient's life. In many cases, this involves dissolving the blood clot. The most effective substance currently available for this step is tissue plasminogen activator, or tPA. In order to be effective, tPA must be given to the patient within three hours of the stroke. In such cases, tPA goes to the blood clot and begins dissolving it immediately. The normal flow of blood to the brain is restored.

Some patients can not be given tPA. For example, the doctor may not know exactly when the stroke occurred. In these cases, other blood-thinning agents can be used. The substance known as heparin is often used. Even ordinary aspirin can be effective in dissolving the blood clot.

The factors that determine a person's risk of having a stroke include age, sex, heredity, lifestyle choices, and other medical problems:

  • Age and sex. The risk of stroke increases with increasing age. Men are more likely to have a stroke than women.
  • Heredity. Blacks, Asians, and Hispanics all have higher rates of stroke than do whites. People with a family history of stroke are also at greater risk.
  • Lifestyle choices. Lifestyle choices that increase a person's risk for stroke include smoking, low level of physical activity, excessive alcohol consumption, or use of cocaine or other illegal drugs.
  • Other medical problems. Stroke risk is higher for people with diabetes, heart disease, high blood pressure, previous stroke, obesity, high cholesterol level, or high red blood count.

The primary goal in treating brain hemorrhages is to relieve pressure on the brain. Certain drugs can be used for this purpose. They include urea, mannitol, and the corticosteroids.

In some cases, surgery can be used to treat brain hemorrhages. A surgeon can close off blood vessels that have ruptured (broken open) in order to stop bleeding and help reduce pressure on the brain.

Rehabilitation

Once a patient's condition has been stabilized, rehabilitation can begin. Rehabilitation refers to a variety of methods for helping a patient recover normal functions to the extent possible. The patient may also need to learn how to use existing functions to take the place of those lost by the stroke.

About 10 percent of all patients who survive a stroke recover completely. Another 10 percent suffer severe disability and require institutional care for the rest of their lives. The remaining 80 percent of stroke survivors are able

A hemorrhagic stroke (left) compared to a thrombotic stroke (right). (Reproduced by permission of Hans & Cassady, Inc.)
A hemorrhagic stroke (left) compared to a thrombotic stroke (right). (Reproduced by permission of
Hans & Cassady, Inc.
)

to return to their homes and their daily routines. However, they may require additional therapy and support services.

PREVENTITIVE REHABILITATION. A program of rehabilitation consists of two parts. The first objective is to prevent medical complications of stroke. People who have had a stroke are at high risk for other serious medical problems including a second stroke.

Another possible complication is deep venous thrombosis (a blood clot in a vein). This condition may develop when a limb has become paralyzed and blood is no longer flowing normally in the limb. In such cases, the chance that a blood clot will develop greatly increases. If a blood clot forms and then breaks loose, it may travel to the lungs. In the lungs, it may cause a pulmonary embolism, (a blot clot in the lungs) that can very quickly lead to death.

Stroke patients may be kept on a special program of medication to prevent this complication. The program includes the use of drugs that thin blood out and reduce the chance that blood clots will form.

Another complication of stroke is caused by damage to throat muscles. A stroke patient may find it difficult to swallow normally. Food may get into the lungs, causing pneumonia or other infections. This condition can be treated with breathing exercises and temporary use of soft foods in the diet.

Depression is another side effect of stroke. Depression can be treated with drugs and with counseling that helps patients cope with the conditions caused by the stroke.

REHABILITATIVE THERAPY. Brain cells killed by stroke do not grow back. The functions those cells control may be seriously damaged or lost. For example, cells in one part of the brain control the ability to speak. If those cells are killed, the patient may lose the ability to speak.

Fortunately, surviving brain cells can sometimes be trained to take on new functions and patients may recover some or all of the function lost during the stroke. For instance, areas of the brain that were not previously responsible for a patient's ability to speak may learn how to control speech.

Rehabilitative therapy draws primarily on four types of treatment:

  • Physical therapy is used to help patients recover as much of their original body functions as possible. Treatment may involve exercises that help patients regain strength and become better able to move around. A physical therapist can provide advice on aids such as wheelchairs, braces, and canes.
  • Occupational therapy helps patients improve self-care skills, such as feeding, bathing, and dressing. The occupational therapist may also help the patient redesign his or her living area or work area to make movement easier. A specialist in speech and language may also be needed to help patients relearn the ability to speak and swallow correctly.
  • Mental health professionals treat mental problems, such as depression and loss of memory and thinking skills. They may also provide counseling to help patients deal with the new physical conditions resulting from stroke. Social workers and home caregivers may be needed to help patients adapt to the new challenges of dealing with tasks of everyday lives.
  • Support groups can provide an important source of information, advice, and comfort for stroke patients and their families. A support group consists of other individuals who have the same medical problem as the patient.

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