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Stroke
Treatment: Overview |
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Treatment Overview
Prompt treatment of
stroke and medical problems related to stroke, such as
high blood sugar and pressure on the brain, may minimize brain damage and
improve the chances of survival. Starting a
rehabilitation program as soon as possible after a
stroke increases your chances of recovering some of the abilities you
lost.
Initial treatment for stroke
Initial treatment for a stroke varies
depending on whether the stroke was caused by a blood clot (ischemic) or bleeding
in the brain (hemorrhagic). Before starting treatment, your doctor will use a computed
tomography (CT) scan of your head and possibly magnetic
resonance imaging (MRI) to diagnose the type of stroke you've had. Further
tests may be done to determine the location of the clot or bleeding and to
assess the amount of brain damage. While treatment options are being determined,
your blood pressure and breathing ability will be closely monitored, and you
may receive oxygen.
Initial treatment focuses on restoring blood flow (ischemic stroke) or controlling
bleeding (hemorrhagic stroke). As with a heart
attack, permanent damage from a stroke often develops within the first
few hours. The more quickly you receive treatment, the less damage will occur.
Ischemic stroke
- Emergency treatment for an ischemic stroke depends
on the location and cause of the clot. Measures will
be taken to stabilize your vital signs, including administering
you medications.
- If your stroke is diagnosed within three hours of
the initial symptoms, you may be given a clot-dissolving
medication called tissue
plasminogen activator (t-PA), which can increase
your chances of survival and recovery. However, t-PA
is not safe for everyone. If you have had a hemorrhagic
stroke, use of t-PA would be life-threatening. Your
eligibility for t-PA will be quickly assessed in the
emergency room.
- You may also receive aspirin or
aspirin combined with another antiplatelet
medication.
However, aspirin is not recommended within 24 hours
of treatment with t-PA. Other
medications may be given to control blood sugar levels,
fever, and seizures. In general, high blood pressure
won't be treated immediately unless systolic pressure
is over 220 millimeters of mercury (mm Hg) and diastolic is
more than 120 mm Hg (220 over 120).
Hemorrhagic stroke
Initial treatment for hemorrhagic stroke is
difficult. Efforts are made to control bleeding, reduce pressure
in the brain and stabilize vital signs such as blood
pressure.
- There are few medications available to treat hemorrhagic stroke.
In some cases, medications may be given to control
blood pressure, brain swelling, blood sugar levels,
fever and seizures. You will
be closely monitored for signs of increased pressure
on the brain, such as restlessness, confusion, difficulty
following commands
and headache. Other measures will be taken to keep
you from straining from excessive coughing, vomiting
or lifting, or straining to pass
stool or change position.
- Surgery generally is not used to control mild to
moderate bleeding resulting from a hemorrhagic stroke.
However, if a large amount of bleeding has occurred
and the person is rapidly getting worse, surgery may
be needed to remove the blood that has built up inside
the brain and to lower pressure inside the head.
- If the bleeding is due to a ruptured brain
aneurysm, surgery may be initiated to repair
the aneurysm. The procedure used to repair
a brain
aneurysm
is called endovascular
coil embolization. It involves inserting a
small coil into the aneurysm to block it off. Whether
this
surgery can be done depends on the location of the
aneurysm and your condition following the stroke.
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Stroke
Treatment: Ongoing
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Ongoing treatment for stroke
After emergency treatment for stroke and once your condition has stabilized,
treatment focuses on rehabilitation and preventing another stroke. It will
be important to control risk factors for stroke such as high
blood pressure, atrial fibrillation, high cholesterol or diabetes.
Your doctor will probably want you to take aspirin
or other antiplatelet
medications. If you had an ischemic
stroke (caused by a blood clot), you may need
to take anticoagulants to
prevent another stroke. You may also need to take
medications such as statins,
to lower high cholesterol or medications to control
your blood pressure.
Your doctor may also recommend carotid
endarterectomy surgery to remove plaque buildup
in the carotid
arteries.
Early aggressive rehabilitation may help the patient to regain some normal
functioning. Rehabilitation will be based on physical abilities
that were lost,
general health before the stroke and your ability to participate.
Rehabilitation begins with helping the patient resume activities of
daily living such as eating, bathing and dressing.
Changes in lifestyle may also be an important part of your ongoing treatment
to reduce your risk of having another stroke. It will be important for
you to exercise to the greatest extent possible, eat a balanced diet and
quit smoking. Your doctor may suggest that you follow the Dietary
Approaches to Stop Hypertension (DASH) diet if you have high blood
pressure. If you have high cholesterol, you may need to follow the Therapeutic
Lifestyle Changes (TLC) diet. These diets are low in fat (notably
saturated fat) and contain more whole grains, fruits, vegetables and
low-fat dairy products. |
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Stroke
Treatment: Declining Condition
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Treatment
for stroke if the condition gets worse
Depression is
common in people who have had a stroke.
You may need medications
for depression and pain to help you cope.
If your condition worsens, it may be necessary to move to a care
facility that can meet your needs, specifically if
your
caregiver
has his or her own health problems that make it difficult to properly care
for you. It is common for caregivers to neglect their own health when they
are caring for a loved one who has had a stroke. If your caregiver's health
declines, the risk of injury to you and your caregiver may increase. |
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