Hailey Tran
Stroke treatment begins as soon as emergency services arrive, and patients are urged to call an ambulance immediately as this can increase the chances of survival. In hospital, treatment depends on the type of stroke and the time passed since symptoms started. Treatment may include medication, surgery, breathing support, compression therapy, feeding tubes, fluids, fever medication, and rehabilitation.
| Characteristics | Values |
|---|---|
| Treatment Start Time | Treatment should begin as soon as possible, ideally within 3 hours of the first symptoms. |
| Ambulance | Call 911 or the local emergency services number to ensure timely treatment and transport to a specialized stroke center. |
| Hospital Treatment | Emergency care, treatment to prevent another stroke, and rehabilitation to address side effects. |
| Medical History | Information about the patient's medical history and the time symptoms started is collected. |
| Brain Scans | Performed to determine the type of stroke and guide treatment. |
| Specialists | Neurologists, neurosurgeons, or other specialists may be involved in the patient's care. |
| Medicines | Tissue plasminogen activator (tPA), anticoagulants, blood-thinning medicines (e.g., aspirin), clot-busting drugs (thrombolytics), and fever reducers may be administered. |
| Surgery | Surgery may be required to treat hemorrhagic strokes or blocked arteries. |
| Additional Treatments | Breathing support, compression therapy, feeding tubes, fluid administration, and rehabilitation plans may be included in the patient's treatment. |
| Discharge | The patient's ability to speak, swallow, and walk is assessed before leaving the hospital. |
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What You'll Learn
Administering medicine to break up blood clots
Treatment for a stroke depends on whether it was ischemic or hemorrhagic, the time passed since symptoms started, and the patient's medical history. Ischemic strokes, which are caused by blood clots, can be treated with tissue plasminogen activator (tPA), a thrombolytic drug that breaks up blood clots. tPA must be administered within 3 hours of the onset of stroke symptoms, and sometimes up to 4.5 hours. It is injected into a vein in the patient's arm, with 10% of the total dose given in the first minute and the rest over the next hour. The total dose should not exceed 90 mg.
Thrombolytics or clot-busting drugs are used to prevent long-term problems caused by strokes and heart attacks. They are administered through an IV in the arm or through a catheter inserted at the clot's location. Thrombolytics are enzymes that break down the proteins (fibrins) that form clots. tPA, for example, activates the enzyme plasminogen, converting it into plasmin, which dissolves the links between fibrin molecules in the blood clot.
If patients arrive at the hospital too late for the effective use of IV thrombolytics, or if IV thrombolytics are not appropriate for them, physicians may use endovascular surgery procedures or neuro-interventional techniques to remove the clot. Endovascular procedures involve navigating a small catheter through the blood vessels to the location of the blockage. Once the catheter is positioned within the blocked artery, thrombolytics can be injected to dissolve the clot. Alternatively, a device can be used to suction the clot (aspiration) or trap and remove it (retrieval).
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Surgery to treat a ruptured aneurysm
A ruptured aneurysm is a life-threatening condition that requires immediate medical attention. A cerebral aneurysm is a weak spot on an artery in the brain that balloons and fills with blood. When an aneurysm ruptures, it causes bleeding in the brain, leading to serious health complications, including stroke, brain damage, coma, and even death.
Surgery is a common treatment for a ruptured cerebral aneurysm. The main goal of the surgery is to stop or reduce the flow of blood into the aneurysm, thereby preventing further bleeding and reducing the risk of complications. During the surgery, a neurosurgeon cuts a small opening in the skull to access the aneurysm. Using a microscope and specialized instruments, the surgeon attaches a small metal clip at the base of the aneurysm to block the blood flow. This procedure is known as microvascular clipping or surgical clipping. It is important to note that surgery carries some risks, such as potential damage to other blood vessels, the possibility of rebleeding, and stroke.
Endovascular treatments are often considered a less invasive alternative to open brain surgery. These procedures use flexible mesh tubes (stents) or catheters to block the aneurysm from within the blood vessel. One common endovascular treatment is platinum coil embolization, which involves placing coils within the aneurysm to block blood flow. Another option is to use flow diverters, which may lead to better blood vessel repair and a reduced risk of stroke or brain hemorrhage.
In addition to surgery, there are other treatments available to manage symptoms and prevent complications. Antiseizure medications can help prevent seizures associated with ruptured aneurysms. Calcium channel blockers reduce the risk of stroke due to vasospasm, a common complication caused by irritation from leaked blood that narrows the blood vessels. Shunts may be used to drain cerebrospinal fluid (CSF) from the brain, preventing hydrocephalus, a condition where the spaces within the brain that produce CSF enlarge.
Overall, the treatment for a ruptured aneurysm requires a personalized approach, taking into account the patient's vascular anatomy, aneurysm size, location, and other factors. A team of specialists, including neurosurgeons, neuroradiologists, and neurologists, will work together to determine the best treatment plan for each individual.
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Breathing support
When treating a stroke in hospital, breathing support may be necessary if the stroke has made it difficult for the patient to breathe or their oxygen levels are low. In such cases, ventilator support may be provided.
Ventilator support involves the use of a machine to help the patient breathe. This may be non-invasive, where the patient wears a mask or a mouthpiece, or invasive, where a tube is inserted through the mouth and into the airway. The decision to use a ventilator is typically made based on the patient's respiratory rate, oxygen levels, and ability to breathe independently.
In addition to ventilator support, compression therapy using an air-filled sleeve on the leg can be used to lower the risk of venous thromboembolism, which is a potential complication of stroke. This therapy helps improve blood flow and circulation in the leg, reducing the risk of blood clots.
The patient's oxygen levels and respiratory function will be closely monitored while they are in the hospital. The medical team will also assess the patient's breathing ability before they are discharged from the hospital. This may include evaluating their ability to cough effectively, clear their airways, and take deep breaths without assistance.
Overall, breathing support is a critical aspect of stroke treatment in the hospital, as strokes can impact the patient's health and affect a patient's ability to breathe effectively.
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Rehabilitation to treat side effects
Rehabilitation is a critical aspect of stroke treatment, aiming to address the side effects and support the patient's transition from hospital to home. This process often begins within a day or two after the stroke and can involve various therapies to mitigate the lasting impact of the stroke and prevent another occurrence.
One of the primary focuses of rehabilitation is to improve physical functioning. Physical therapy can help patients regain strength, balance, and coordination, aiding them in relearning essential movements and improving their mobility. This may include exercises to strengthen muscles and improve gait, as well as activities to enhance fine motor skills and coordination.
Speech therapy is another crucial component. Speech-language pathologists work with patients to improve their speech and communication abilities, which can be severely impacted by a stroke. They help patients regain articulation, fluency, and comprehension skills, as well as explore alternative communication methods if necessary.
Occupational therapy is also often part of the rehabilitation process. Occupational therapists assist patients in adapting to their new physical and cognitive abilities, helping them relearn everyday tasks such as dressing, bathing, and eating. They may also recommend adaptive equipment or modifications to the patient's home environment to enhance safety and independence.
Additionally, psychological and emotional support are integral to stroke rehabilitation. A stroke can have a significant impact on a person's mental health, and counselling or psychotherapy can help patients cope with the emotional aftermath, including any personality changes or mood disorders that may arise. Support groups can also provide valuable peer support and a sense of community during recovery.
The rehabilitation process is tailored to each patient's specific needs and may involve a combination of therapies. The overall goal is to help patients regain independence, improve their quality of life, and reduce the risk of another stroke.
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Preventing another stroke
As a stroke survivor, you are at high risk of experiencing another stroke, with nearly 1 in 4 survivors having another within five years. However, there are several ways you can reduce your chances of having another stroke.
Firstly, it is important to manage your blood pressure. High blood pressure is a leading cause of hemorrhagic strokes, so controlling your blood pressure can significantly reduce your risk. This may involve taking prescribed medications and adopting lifestyle changes such as improving your diet, exercising regularly, and losing weight.
Secondly, it is crucial to take any medications prescribed by your doctor and follow their instructions. These may include blood-thinning medications such as aspirin or clopidogrel to prevent blood clots, or other drugs to manage conditions such as high cholesterol and blood glucose levels.
Additionally, making healthy lifestyle choices can also lower your risk of another stroke. This includes eating a healthy diet, being physically active, and quitting smoking, tobacco, and vaping. These changes can help to manage your weight, blood pressure, and overall health, reducing your risk of stroke.
Finally, rehabilitation after a stroke is essential to preventing another one. This may include activities, therapy, and lifestyle changes recommended by your healthcare team. Rehabilitation can help you manage the side effects of your stroke and improve your overall health, reducing your chances of experiencing another stroke.
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Frequently asked questions
Call 911 or your local emergency services number immediately. Strokes are life-threatening and require immediate medical attention.
Treatment for stroke in a hospital may include medication, surgery, and rehabilitation. The type of treatment depends on the type of stroke and the time passed since the onset of symptoms.
The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA), which breaks up blood clots blocking blood flow to the brain. It must be administered within 3 hours of the onset of symptoms.
Hemorrhagic strokes, caused by bleeding in the brain, may be treated with surgery. A metal clip may be placed to stop blood loss from a ruptured aneurysm.
Rehabilitation after a stroke can include activities, therapy, and lifestyle changes to lower the risk of another stroke. It may begin in the hospital and continue after discharge, helping to ease the transition back to everyday life.
