Stroke

Treatment Approaches for Stroke

The course of emergency treatment for stroke hinges on whether it is an ischemic stroke or a hemorrhagic stroke.

Ischemic Stroke

To address an ischemic stroke, it is imperative to swiftly restore blood flow to the brain. This is accomplished through:

1. Emergency Intravenous Medication: Administering medications that can dissolve clots within 4.5 hours of symptom onset is crucial. The sooner these drugs are administered, the better the outcomes. The gold standard treatment is an intravenous injection of recombinant tissue plasminogen activator (tPA), also known as alteplase (Activase) or tenecteplase (TNKase). tPA dissolves the clot causing the stroke and can be given within the first three hours, with a limited extension up to 4.5 hours in some cases. Its effectiveness lies in promptly removing the stroke’s root cause, potentially leading to a fuller recovery. However, the decision to use tPA considers potential risks, such as brain bleeding.

2. Emergency Endovascular Procedures: In certain cases, doctors opt for direct treatment inside the obstructed blood vessel. Endovascular therapy has shown remarkable effectiveness in improving outcomes and reducing long-term disability after an ischemic stroke. These procedures should be conducted as soon as possible and encompass:

• Medications delivered directly to the brain through a catheter inserted through an artery in the groin.
• Clot removal with a stent retriever, often in combination with tPA. This is especially beneficial for large clots that cannot be fully dissolved by medication. The time window for these procedures may be extended with advanced imaging technology like perfusion imaging (CT or MRI) to assess their suitability.

3. Other Procedures:

• To mitigate the risk of recurrent stroke or transient ischemic attack, your physician may suggest procedures to address narrowed arteries. Options include:
  • Carotid Endarterectomy: This surgery entails removing plaque obstructing a carotid artery, potentially reducing the risk of ischemic stroke. However, it carries inherent risks, especially for individuals with heart disease or other medical conditions.
  • Angioplasty and Stents: In this procedure, a catheter is used to expand a narrowed artery in the carotid arteries, followed by the insertion of a stent to maintain the artery’s patency.

Hemorrhagic Stroke:

Emergency treatment for a hemorrhagic stroke focuses on controlling bleeding and alleviating brain pressure due to excessive fluid. Treatment options encompass:

1. Emergency Measures: Individuals taking blood-thinning medications may receive drugs or blood product transfusions to counteract the anticoagulant effects. Additionally, medications may be administered to reduce intracranial pressure, lower blood pressure, prevent blood vessel spasms, and avert seizures.

2. Surgery: For significant bleeding, surgery may be performed to evacuate blood and relieve brain pressure. Surgical intervention may also address blood vessel anomalies associated with hemorrhagic strokes. Such procedures are considered post-stroke or if an aneurysm, arteriovenous malformation (AVM), or other vascular issues caused the hemorrhagic stroke. These procedures may include:

• Surgical Clipping: Placing a tiny clamp at the aneurysm’s base to prevent blood flow and potential rupture.
• Coiling (Endovascular Embolization): Inserting detachable coils into the aneurysm via a catheter to induce clot formation and block blood flow.
• Surgical AVM Removal: Removal of smaller accessible AVMs to eliminate rupture risk.
• Stereotactic Radiosurgery: Employing highly focused radiation beams to treat blood vessel malformations in a minimally invasive manner.

Post-Emergency Stroke Care and Recovery

Following emergency stroke treatment, a critical phase of close monitoring ensues, typically spanning at least one day. Subsequently, the focus shifts to facilitating recovery and striving for the restoration of as much functional independence as possible. The extent of the stroke’s impact hinges on the specific brain region affected and the extent of tissue damage.

If the stroke implicates the right hemisphere of the brain, it can result in impaired movement and sensation on the left side of the body. Conversely, damage to the left hemisphere can affect movement and sensation on the right side, potentially leading to speech and language disorders.

The majority of stroke survivors embark on a rehabilitation program, tailored to their unique circumstances. Your healthcare provider will recommend the most appropriate therapy regimen, accounting for factors like age, overall health, and the degree of post-stroke disability. Lifestyle preferences, personal interests, caregiver availability, and priorities also factor into this decision.

The rehabilitation process may commence even before you are discharged from the hospital. After leaving the hospital, you might continue your rehabilitation journey in various settings, including a dedicated rehabilitation unit within the same hospital, another rehabilitation facility, outpatient programs, or within the comfort of your own home.

Stroke recovery is highly individualized, and your treatment team may encompass a range of specialists depending on your specific needs. This team could include:

• A neurologist, specialized in brain conditions.
• A physiatrist, a doctor specializing in rehabilitation.
• Rehabilitation nurses.
• Dietitians to address nutritional requirements.
• Physical therapists to enhance mobility and strength.
• Occupational therapists to facilitate daily life activities.
• Recreational therapists to promote engagement and enjoyment.
• Speech pathologists to address speech and language challenges.
• Social workers or case managers to provide support and resources.
• Psychologists or psychiatrists to address emotional and psychological aspects.
• Chaplains to provide spiritual support and guidance.

The goal of this comprehensive team is to guide you through a tailored recovery process, helping you regain independence and improve your quality of life after a stroke.