Stroke Treatment Options
Immediate treatment is needed to:
- dissolve a clot causing an ischemic stroke
- stop the bleeding during a hemorrhagic stroke
Other stroke care aims to:
- reduce the chance of subsequent strokes
- improve functioning
- overcome disabilities
Medications
Medications include:
- clot-dissolving drugs
Given within three hours of the onset of symptoms. Tissue plasminogen activator (tPA) is given through a vein after the doctor has confirmed the stroke's cause and there is no evidence of bleeding.
- nerve-protecting drugs
Help prevent additional nerve-cell damage caused by the chemicals released from dying brain cells. These drugs are promising but not yet routinely used.
Other drugs are used to:
- control blood pressure
- reduce the chance of additional clot formation (aspirin or similar medications)
- reduce brain swelling
- correct irregular heart rhythm
Other interventions during an acute stroke include:
- providing adequate oxygen
- administering glucose
- taking precautions to prevent choking
Surgery
Surgery may be performed following a stroke or transient ischemic attack (TIA) to prevent a recurrence. Surgical techniques include:
- carotid endarterectomy
fatty deposits are removed from a carotid artery (major arteries in the neck that lead to the brain)
- extracranial/intracranial bypass
reroutes the blood supply around a blocked artery using a healthy scalp artery
Rehabilitation
Some people do not need rehabilitation after a stroke because the stroke was mild or they have fully recovered. Others may be too disabled to participate. However, many patients can be helped by rehabilitation. Hospital staff will help the patient and family decide about rehabilitation and choose the right services or program.
There are several kinds of rehabilitation programs:
- hospital programs
These programs can be provided by special rehabilitation hospitals or by rehabilitation units in acute care hospitals. Complete rehabilitation services are available. The patient stays in the hospital during rehabilitation. An organized team of specially trained professionals provides the therapy. Hospital programs are usually more intense than other programs and require more effort from the patient.
- nursing facility (nursing home) programs
As in hospital programs, the person stays at the facility during rehabilitation. Nursing facility programs are very different from each other, so it is important to get specific information about each one. Some provide a complete range of rehabilitation services; others provide only limited services.
- outpatient programs
Outpatient programs allow a patient who lives at home to get a full range of services by visiting a hospital outpatient department, outpatient rehabilitation facility, or day hospital program.
- home-based programs
The patient can live at home and receive rehabilitation services from visiting professionals. An important advantage of home programs is that patients learn skills in the same place where they will use them.
- individual rehabilitation services
Many stroke survivors do not need a complete range of rehabilitation services. Instead, they may need an individual type of service, such as regular physical therapy or speech therapy. These services are available from outpatient and home care programs.
When rehabilitation is not recommended
Some families and patients may be disappointed if the doctor does not recommend rehabilitation. However, a person may be unconscious or too disabled to benefit. For example, a person who is unable to learn may be better helped by maintenance care at home or in a nursing facility. A person who is, at first, too weak for rehabilitation may benefit from a gradual recovery period at home or in a nursing facility. This person can consider rehabilitation at a later time.
Hospital staff are responsible for helping plan the best way to care for the patient after discharge from acute care. They can also provide or arrange for needed social services and family education. This is not the only chance to participate in rehabilitation. People who are too disabled at first may recover enough to enter rehabilitation later.
What happens during rehabilitation?
In hospital or nursing facility rehabilitation programs, the patient may spend several hours a day in activities such as physical therapy, occupational therapy, speech therapy, recreational therapy, group activities, and patient and family education. It is important to maintain skills that help recovery. Part of the time is spent relearning skills (such as walking and speaking) that the person had before the stroke. Part of it is spent learning new ways to do things that can no longer be done the old way (for example, using one hand for tasks that usually need both hands).
Setting rehabilitation goals
The goals of rehabilitation depend on the effects of the stroke, what the patient was able to do before the stroke, and the patient's wishes. Working together, goals are set by the patient, family, and rehabilitation program staff. Sometimes, a person may need to repeat steps in striving to reach goals. If goals are too high, the patient will not be able to reach them. If they are too low, the patient may not get all the services that would help. If they do not match the patient's interests, the patient may not want to work at them. Therefore, it is important for goals to be realistic. To help achieve realistic goals, the patient and family should tell program staff about things that the patient wants to be able to do.
Prevention
The following may help prevent a stroke:
- exercise regularly
- increase intake of fruits and vegetables and limit dietary salt and fat
- stop smoking
- drink alcohol only in moderation (one to two drinks per day)
- maintain a healthy weight
- frequently check blood pressure and follow physician recommendations for keeping it in a safe range
- consider taking a low dose of aspirin (75 mg/day) if your physician determines it is safe
- keep chronic medical conditions under control (such as high cholesterol and diabetes)
- seek medical care if you have symptoms of a stroke, even if symptoms stop