Stroke (cont.)

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What is the treatment of a stroke?

Tissue plasminogen activator (tPA)

There is opportunity to use alteplase (tPA) as a clot-buster drug to dissolve the blood clot that is causing the stroke. There is a narrow window of opportunity to use this drug. The earlier that it is given, the better the result and the less potential for the complication of bleeding into the brain.

Present American Heart Association guidelines recommend that if used, tPA must be given within 4 ½ hours after the onset of symptoms and ideally within 3 hours. For patients who waken from sleep with symptoms of stroke, the clock starts when they were last seen in a normal state.

tPA is injected into a vein in the arm. The time frame for its use may be extended to 6 hours if it is dripped directly into the blood vessel (intra-arterial) that is blocked requiring angiography. Not all hospitals have access to this technology. It had been hoped that using the same technique, the clot could be indentified and removed by suction. Unfortunately, studies show that patient outcomes were not improved compared with tPA therapy.

tPA may reverse stroke symptoms in more than one-third of patients, but may also cause bleeding in 6% patients, potentially making the stroke worse.

For strokes involving the cerebellum of the brain and involving the vertebrobasilar circulation, the time frame for treatment with TPA potentially may be extended even further to 18 hours.

Heparin and aspirin

Drugs to thin the blood (anticoagulation for example, heparin) are also sometimes used in treating stroke patients in the hopes of improving the patient's recovery. It is unclear, however, whether the use of anticoagulation improves the outcome from the current stroke or simply helps to prevent subsequent strokes (see below). In certain patients, aspirin given after the onset of a stroke does have a small, but measurable effect on recovery. The treating doctor will determine the medications to be used based upon a patient's specific needs.

Managing other medical problems

Blood pressure will be tightly controlled often using intravenous medication to prevent stroke symptoms from progressing. This is true whether the stroke is ischemic or hemorrhagic.

Supplemental oxygen is often provided.

In patients with diabetes, the blood sugar (glucose) level is often elevated after a stroke. Controlling the glucose level in these patients may minimize the size of a stroke.

Patients who have suffered a transient ischemic attack may be discharged with blood pressure and cholesterol medications even if the blood pressure and cholesterol levels are within acceptable levels. Smoking cessation is mandatory.

Rehabilitation

When a patient is no longer acutely ill after a stroke, the health care staff focuses on maximizing the individual's functional abilities. This is most often done in an inpatient rehabilitation hospital or in a special area of a general hospital. Rehabilitation can also take place at a nursing facility.

The rehabilitation process can include some or all of the following:

  1. speech therapy to relearn talking and swallowing;
  2. occupational therapy to regain as much function and dexterity in the arms and hands as possible;
  3. physical therapy to improve strength and walking; and
  4. family education to orient them in caring for their loved one at home and the challenges they will face.

The goal is for the patient to resume as many, if not all, of their pre-stroke activities and functions. Since a stroke involves the permanent loss of brain cells, a total return to the patient's pre-stroke status is not necessarily a realistic goal in many cases. However, many stroke patients can return to vibrant independent lives.

Depending upon the severity of the stroke, some patients are transferred from the rehabilitation hospital setting to a skilled nursing facility to be monitored and to continue physical and occupational therapy.

Many times, home health workers can assess the home living situation and make recommendations to ease the transition home. Unfortunately, some stroke patients have such significant nursing needs that they cannot be met by relatives and friends. Long-term nursing home care may be required.

Medically Reviewed by a Doctor on 4/10/2013

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Stroke - Symptoms Question: For stroke, what were the symptoms and signs you experienced?
Stroke - Therapy Question: What therapy did you undergo after your stroke?
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