Treatment options for stroke - Diabetic Stroke Treatmen...

Treatment options for stroke

Treatment options for stroke
Nikheel Kolatkar, M.D.
Your Total Health

Individuals experiencing symptoms of a stroke, or another person present, should immediately summon emergency medical assistance (phoning 911 in the United States and some other countries).

When the patient arrives at the hospital, staff will order an emergency CAT scan (computed axial tomography) to help determine whether the patient is experiencing cerebral ischemia (a stroke caused by the blockage of an artery) or a cerebral hemorrhage (a stroke caused by the rupture of an artery).

Staff will then attempt to stabilize the patient by using the following common strategies:

Maintaining breathing in individuals who are losing consciousness. Breathing can often be maintained through the use of supplemental oxygen or special breathing equipment.

Administering clot-busting drugs (thrombolytics) intravenously to dissolve obstructing blood clots in patients with ischemic stroke.

Administering fever-reducing medications (if applicable).

Taking special measures to prevent pneumonia, a complication that often occurs after a stroke.
The U.S. Food and Drug Administration (FDA) has approved the clot-dissolving drug tissue plasminogen activator (tPA). This intravenous medication is used only to treat strokes caused by blood clots, within three hours of the stroke. It works by dissolving the clot and allowing blood to flow normally to the brain. Though tPA does carry a risk of bleeding in the brain, its benefits outweigh the risks when properly used by an experienced physician. Patients who have suffered a hemorrhagic stroke should not be treated with tPA. Men appear to benefit more than women from tPA, according to recent research.

In an experimental procedure, tPA is delivered directly into the blood clot using microcatheters. Early results are promising, but more research is needed before the FDA could approve this treatment.

In cases where the stroke was caused by a partial blockage of a carotid artery in the neck, a surgery called carotid endarterectomy might be used to remove the plaque. This procedure involves the removal of accumulated fat along the walls of the carotid arteries, which supply blood to the brain. While the patient is under general anesthesia, the plaque and the inner lining of the artery are removed.

In other cases, cerebral angioplasty may be used to treat problems with the brain’s blood vessels. This procedure commonly uses balloons, stents and coils to widen arteries, prevent closure or to remove blood clots.

Surgery may also be recommended for hemorrhagic stroke, such as clipping (in which an aneurysm is snipped off) to prevent additional bleeding from an aneurysm, or coiling to close an aneurysm by inserting a small coil through a catheter.

Imaging tests of the carotid arteries and other structures can indicate who is at risk of a second stroke. These include ultrasound, magnetic resonance imaging (MRI) and cerebral angiogram, in which a dye (contrast medium) that highlights vessels of the brain is injected through a catheter that has been threaded through an artery. Several studies show that such tests are underused, especially in women.

Stroke survivors often require rehabilitation to minimize neurological damage and maximize function. According to the American Heart Association (AHA), between 50 percent to 70 percent of stroke survivors are able to maintain their independence after recovery. However, strokes leave 15 percent to 30 percent of patients permanently disabled.

Individuals who experience severe strokes generally require more post-stroke rehabilitation than those who experience minor strokes. Patients should begin treatment soon after experiencing a stroke to increase the likelihood of regaining functions. Changes in functioning that are often addressed in rehabilitation include:

Paralysis (hemiplegia) or weakness (hemiparesis) on one side of the body

Lack of coordination (ataxia) or balance

Immobilization of a joint

Spasms or stiffness in muscles

Impaired awareness of one side of the body

Impaired sensation

Difficulty speaking (dysarthria) or communicating in general (aphasia)

Difficulty swallowing (dysphagia) or eating

Drooping on one side of the mouth or face

Difficulty planning and carrying out a task (apraxia)

Confusion or dementia

Visual or auditory difficulties

Emotional disturbances

Incontinence (difficulty controlling the bladder or bowels)

Rehabilitation may include physical therapy to address walking and strengthening, occupational therapy to work on fine-motor coordination and activities of daily living (ADLs) such as dressing and driving, and speech therapy to improve swallowing, communication and cognition.

About 10 percent of stroke survivors experience pain in the areas that lost sensation after their stroke. The cause of this central post-stroke pain is unknown and often difficult to treat. However, treatment methods for this condition are being tested.

Temporary or permanent loss of basic functions may cause depression in some patients. These individuals are strongly encouraged to seek assistance from a mental health counselor.