Stroke
How is it treated?
Strokes can be treated and often prevented. At the moment, no treatment can cure a stroke, and most people will have some form of residual damage, which will vary from person to person. Residual damage can range from a slight limp to paralysis on one side of the body. Prevention will be the key to avoid further damage and subsequent strokes.
Prevention:
Antihypertensive agents: Reducing even mild to moderate blood pressure has been shown to lower the risk of stroke.
Cholesterol lowering agents: These agents -- "statins" like Zocor, Lipitor, Crestor, Lescol, Mevacor and Pravachol -- reduce the risk of stroke in people with existing coronary artery disease.
Treatment of Atrial Fibrillation (irregular heartbeat): The main goal of treatment for atrial fibrillation (irregular heartbeat) is to prevent blood clots from forming by first restoring and then maintaining normal heart rhythm.
Treatment for ischemic stroke:
Acute Treatment:
An acute ischemic stroke is usually treated with a thrombolytic agent. Thrombolytics, sometimes called "clot busters," dissolve the blood clot that is blocking the flow of blood through the vessel. They are considered a first-line treatment for stroke because of their high rate of effectiveness. Despite this, there is a risk of causing an intracranial hemorrhage (bleeding in the brain) with thrombolytics. Due to this increased risk for bleeding, doctors have several specific criteria that a patient must meet before thrombolytic therapy can be administered. One of the key criteria is that thrombolytics need to be administered within a certain time frame after stroke symptoms are initially recognized. So, it is really important for the patient or family members to recognize the symptoms of stroke and to get the patient to the nearest hospital within 3 hours of the onset of stroke symptoms to even qualify for thrombolytic therapy. Call 911 if you witness anyone having a stroke because time is of the essence.
Aspirin is the other important agent in the treatment of an acute ischemic stroke. Aspirin should be given more than 24 hours after the thrombolytic, but within 48 hours of symptoms. Early aspirin use has been shown to decrease long-term death and disability in stroke patients.
Chronic Treatment:
After hospitalization, most patients will need to be placed on either an antiplatelet or anticoagulant as well as other medications to control blood pressure and lower cholesterol for the rest of their lives in order to prevent another stroke.
Blood clots are also responsible for TIAs, so medications that prevent blood from clotting are also used in people who have had a TIA and are at risk for stroke.
Carotid endarterectomy is a surgical procedure used to treat and prevent an acute ischemic stroke. This procedure is an effective treatment in protecting against a first stroke in patients with severe stenosis (constriction or narrowing of a blood vessel by 70%-99%) of the main blood vessel in the brain.
Treatment for hemorrhagic stroke:
A cerebral hemorrhage is associated with extremely high death rates. It can be treated with either surgery or medical intervention and there is currently no medical consensus as to which treatment is best.
Surgical treatment involves removing the large clot from the area. The blood clot (referred to as a hematoma) size and level of consciousness of the patient are critical. Patients who are awake and have small hematomas (less than 3 centimeters diameter or less than 20cc) will usually improve without surgery, whereas comatose patients with large hematomas (greater than 6 centimeters diameter or greater than 80cc ) will usually do very poorly, regardless of management. The best candidates for surgery may be patients with moderate to large hematomas who are still awake or conscious.
Medical treatment involves monitoring blood pressure while providing adequate blood flow to the brain. If increased pressure is suspected treatment with intravenous manntiol (which reduces the pressure and excess fluids by reducing the clot) with or without furosemide (a diuretic that reduces pressure and removes excess water) may be helpful.
A subarachnoid hemorrhage can be treated with either surgery or medical treatment. Surgical treatment involves not only finding the site of the bleeding, but also stopping the bleeding in the brain. Currently, surgery in all patients in good neurological condition (meaning there are no other complications affecting the nervous system) would be the treatment of choice, if the site is surgically easy to get to and there are no other medical complications present. Medical treatment involves normalizing blood pressure, bedrest, analgesics (acetaminophen) to relieve headache and nimodipine (Nimotop) (to reduce pressure and decrease brain cell loss). Nimodipine has been shown to reduce death and hospitalizations.
Drug classes used to treat Stroke Antiplatelets Oral Anticoagulants Salicylates Thrombolytic Agents
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How is it treated?
