Management can be divided into emergency treatment and the prevention of recurrences. It is critical to seek medical attention as fast as possible. A stroke is a "brain attack" and this type of stroke is one in which rapid medical attention can be the difference between life and death or between mild and severe disability.
When the patient arrives to the hospital within 3 hours after the onset of symptoms, the use of a medication called "t-PA," can be considered. This medication is a "clot buster," which is given intravenously (injected into the veins), and has been shown to improve the chances of a meaningful recovery.
Unfortunately, t-PA is a potentially dangerous drug because it can cause bleeding in the brain. Since it can be hard to tell whether a stroke has been caused by a clot or by bleeding, and since giving this medication in the case of a stroke caused by bleeding could be fatal, careful evaluation must be done. Physicians need to order several tests and do careful physical examinations to make sure that t-PA is the right treatment.
In some cases, physicians may deliver the clot buster using a small catheter inserted through the skin, which is then advanced to the blocked area of the brain circulation with the aid of X-ray angiography.
This may be tried when the patient arrives too late for the 3-hour window required for the intravenous t-PA. It is unclear at this time, however, if this is better than using other treatments.
The prevention of new strokes depends on the underlying cause. It is always critically important that blood pressure, heart conditions, blood sugar, and cholesterol problems are all addressed.
When plaques have caused a stroke, blood thinners that block the function of some sticky cells of the blood (the "platelets") can be used. The most important of these drugs is aspirin.
However, some other drugs of similar efficacy are available, like clopidogrel, ticlopidine, and dipyridamole. One recent European study showed that the combination of two of these "anti-platelet" drugs (aspirin and dipyridamole) is better than either drug alone to prevent first or recurring strokes.
If a dissection is found, it may be left to resolve on its own or treated with aspirin or warfarin (another blood thinner) for 3-6 months.
If there is a significant blockage of a blood vessel, an "angioplasty" can open up the artery with a balloon, and a stent can be used to keep it open. However, stents are not universally available and contrarily, their placement may cause a stroke.
If vascular problems exist as a result of another illness (such as vasculitis) steroids or other immune-suppressing drugs may be used.
