Treatment for Stroke
Specific treatment for stroke will be determined by your physician based on:
- Your age, overall health, and medical history
- Severity of the stroke
- Location of the stroke
- Cause of the stroke
- Your tolerance for specific medications, procedures, or therapies
- Type of stroke
- Your opinion or preference
Although there is no cure for stroke, advanced medical and surgical treatments are now available, giving many stroke victims hope for optimal recovery.
Treatment is most effective when started immediately. Emergency treatment following a stroke may include the following:
- Medications used to the dissolve blood clot(s) that cause an ischemic stroke
Medications that dissolve clots are called thrombolytics or fibrinolytics, and are commonly known as "clot busters." These drugs have the ability to help reduce the damage to brain cells caused by the stroke. In order to be most effective, these agents must be given within several hours of a stroke's onset.
- Medications and therapy to reduce or control brain swelling
Special types of intravenous (IV) fluids are often used to help reduce or control brain swelling, especially after a hemorrhagic stroke (a stroke caused by bleeding into the brain).
- Medications that help protect the brain from damage and ischemia (lack of oxygen)
Medications of this type are called neuroprotective agents, with some still under investigation in clinical trials.
- Life support measures including such treatments as ventilators (machines to assist with breathing), IV fluids, adequate nutrition, blood pressure control, and prevention of complications
Other medications that may help with recovery following a stroke, or may help to prevent a stroke from occurring, include the following:
- Medications to help prevent more blood clots from forming
Medications that help to prevent additional blood clots from forming are called anticoagulants, as they prevent the coagulation of the blood. Medications of this type include, for example, heparin and warfarin (Coumadin®) and enoxaparin (Lovenox®).
- Medications that reduce the chance of blood clots by preventing platelets (a type of blood cell) from sticking together
Examples of this type of medication include aspirin, clopidogrel (Plavix®) or dipyridamole (Aggrenox®).
- Medications to treat existing medical conditions such as diabetes, heart, or blood pressure problems
Several types of surgery may be performed to help treat a stroke, or help to prevent a stroke from occurring, including the following:
- Carotid endarterectomy
Carotid endarterectomy is a procedure used to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help prevent a stroke from occurring.
- Carotid stenting
A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery. The femoral artery is used as the site for passage of a special hollow tube to the area of blockage in the carotid artery. This procedure is often done in radiology labs, but may be performed in the cath lab.
A craniotomy is a type of surgery in the brain itself to remove blood clots or repair bleeding in the brain.
- Surgery to repair aneurysms and arteriovenous malformations (AVMs)
An aneurysm is a weakened, ballooned area on an artery wall that has a risk for rupturing and bleeding into the brain. An AVM is a congenital (present at birth) or acquired disorder that consists of a disorderly, tangled web of arteries and veins. An AVM also has a risk for rupturing and bleeding into the brain. Surgery may be helpful, in this case, to help prevent a stroke from occurring. The surgery may involve surgical clips placed on aneurysms to prevent them from rupturing (and thus causing life-threatening bleeding in the future) or tiny coils curled up inside the aneurysm. The coils are placed inside the aneurysm through a special catheter advanced mechanically through the arteries of the body from a puncture site, usually through the large artery located in the groin. An AVM may be treated not only surgically, but also through the use of new chemical substances commonly called glues, which clot off some of the blood vessels that are part of the AVM. Special energy waves known as gamma waves are part of a relatively new mode of radiosurgery, in which part of an AVM can be scarred (and thus prevented from bleeding in the future) by use of a tool known as a "gamma knife."
- Patent foramen ovale (PFO) closure
The foramen ovale is an opening that occurs in the wall between the two upper chambers of a baby's heart before birth. It functions to provide oxygen-rich blood to the baby from the mother's placenta while in the womb. This opening normally closes soon after birth. If the flap does not close, blood flows from the right atrium directly to the left atrium. It then flows out to the central circulation of the body. If this blood contains any clots or air bubbles, they can pass into the brain circulation causing a stroke or transient ischemic attack (TIA). PFO closure procedure can be performed through a percutaneous (through the skin) approach. Signs and symptoms of a PFO may not occur until early or middle adulthood and may even go undetected. Currently, it is controversial as to whether a PFO ought to be closed, and current research studies are still trying to determine when and under what circumstances this should be done.
Many individuals who have a stroke are left with paralysis of the upper extremities. CIT is a treatment that encourages the use of the stroke-affected limb by constraining the non-affected limb in a mitt, sling, splint or glove. Intense exercises are done using the stroke-affected arm or hand.
- CIT restraints are worn for up to 90 percent of the waking hours.
- Restraints can be removed for activities such as bathing.
- Small steps are used to break down complex tasks such as making a phone call.
- Verbal and written feedback is used to help motivate and inform persons undergoing CIT.