Stroke
Alternate Names : Cerebrovascular disease, CVA, Cerebral infarction, Cerebral hemorrhage, Ischemic stroke, Stroke - ischemic, Cerebrovascular accident
Treatment
A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek immediate medical care at the first signs of a stroke. It is important to get the person to the emergency room immediately to determine if the stroke is due to bleeding or a blood clot so appropriate treatment can be started within 3 hours of when the stroke began.
Treatment depends on the severity and cause of the stroke. A hospital stay is required for most strokes. TREATMENT IN THE HOSPITAL Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. However, not everyone can receive this type of medicine. - For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.
- If the stroke is caused by bleeding rather than clotting, clot-busting drugs (thrombolytics) can cause more bleeding.
Other treatments depend on the cause of the stroke: - Blood thinners such as heparin or warfarin (Coumadin) are used to treat strokes due to blood clots. Aspirin of clopidogrel (Plavix) may also be used.
- Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.
- In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.
- For hemorrhagic stroke, surgery is often required to remove blood from around the brain and to repair damaged blood vessels.
- Surgery on the carotid artery may be needed. See also Carotid artery disease and Carotid artery surgery.
Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent. Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital. LONG-TERM TREATMENT The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include: - Occupational therapy
- Physical therapy
- Speech therapy
Therapies such as repositioning and range-of-motion exercises can help prevent complications related to stroke, such as infection and bed sores. Those who have had a stroke should try to remain as active as physically possible. Alternative forms of communication such as pictures, verbal cues, and other techniques may be needed in some cases. Sometimes, urinary catheterization or bladder and bowel control programs may be needed to control incontinence. A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions. Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems. In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs. Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful. Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke. See also: Stroke recovery
Support Groups
Additional support and resources are available from the American Stroke Association -- www.strokeassociation.org.
Prognosis (Expectations)
The outlook depends on the type of stroke, how much brain tissue is damaged, what body functions have been affected, and how quickly treatment is received. Recovery may occur completely, or there may be some permanent loss of function. Over half of the people who have a stroke are able to function independently at home. If treatment with clot-busting drugs is successful, the symptoms of a stroke may completely go away. However, patients do not often arrive at the hospital soon enough to receive these drugs, or there are complicating medical conditions that preclude their use. People who have an ischemic stroke (stroke due to a blood clot) have a better chance of surviving than those who have a hemorrhagic stroke (stroke due bleeding in the brain). The risk for a second stroke is highest over the first few weeks or months after the first stroke and then begins to lessen.
Complications
- Breathing in a food into the airway (aspiration)
- Decreased life span
- Difficulty communicating
- Permanent loss of brain functions
- Permanent loss of movement or sensation in one or more parts of the body
- Problems due to loss of mobility, including joint contractures and pressure sores
- Fractures
- Malnutrition
- Muscle spasticity
- Reduced ability to function or care for self
- Reduced social interactions
- Side effects of medications
Calling Your Health Care Provider
Stroke is a medical emergency that requires immediate treatment. Call your local emergency number (such as 911) if someone has symptoms of a stroke.
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