What is a stroke?
Brain cell function requires a constant delivery of oxygen and
glucose from the bloodstream. A stroke, or cerebrovascular
accident (CVA), occurs when blood supply to part of the brain is
disrupted, causing brain cells to die. Blood flow can be
compromised by a variety of mechanisms.
What causes a stroke? Blockage of an artery
The blockage of an artery in the brain by a clot (thrombosis) is
the most common cause of a stroke. The part of the brain that is
supplied by the clotted blood vessel is then deprived of blood and
oxygen. As a result of the deprived blood and oxygen, the cells of
that part of the brain die and the part of the body that it
controls stops working. Typically, a cholesterol plaque in a small
blood vessel within the brain that has gradually caused blood
vessel narrowing ruptures and starts the process of forming a
small blood clot.
Risk factors for narrowed blood vessels in the brain are the same
as those that cause narrowing blood vessels in the heart and heart
attack (myocardial infarction). These risk factors include:
high blood pressure (hypertension),
high cholesterol,
diabetes, and
smoking.
What is the treatment of a stroke? Tissue plasminogen activator (TPA)
There is opportunity to use alteplase (TPA) as a clot-buster drug
to dissolve the blood clot that is causing the stroke. There is a
narrow window of opportunity to use this drug. The earlier that it
is given, the better the result and the less potential for the
complication of bleeding into the brain.
Present American Heart Association guidelines recommend that if
used, TPA must be given within 4 1/2 hours after the onset of
symptoms. for patients who waken from sleep with symptoms of
stroke, the clock starts when they were last seen in a normal
state.
TPA is injected into a vein in the arm but, the time frame for its
use may be extended to six hours if it is dripped directly into
the blood vessel that is blocked requiring angiography, which is
performed by an interventional radiologist. Not all hospitals have
access to this technology.
TPA may reverse stroke symptoms in more than one-third of
patients, but may also cause bleeding in 6% patients, potentially
making the stroke worse.
For posterior circulation strokes that involve the vertebrobasilar
system, the time frame for treatment with TPA may be extended even
further to 18 hours.
Heparin and aspirin
Drugs to thin the blood (anticoagulation; for example, heparin)
are also sometimes used in treating stroke patients in the hopes
of improving the patient's recovery. It is unclear, however,
whether the use of anticoagulation improves the outcome from the
current stroke or simply helps to prevent subsequent strokes (see
below). In certain patients, aspirin given after the onset of a
stroke does have a small, but measurable effect on recovery. The
treating doctor will determine the medications to be used based
upon a patient's specific needs.
Managing other Medical Problems
Blood pressure will be tightly controlled often using intravenous
medication to prevent stroke symptoms from progressing. This is
true whether the stroke is ischemic or hemorrhagic.
Supplemental oxygen is often provided.
In patients with diabetes, the blood sugar (glucose) level is
often elevated after a stroke. Controlling the glucose level in
these patients may minimize the size of a stroke.
Patients who have suffered a transient ischemic attacks, the
patient may be discharged with blood pressure and cholesterol
medications even if the blood pressure and cholesterol levels are
within acceptable levels. Smoking cessation is mandatory.
Rehabilitation
When a patient is no longer acutely ill after a stroke, the health
care staff focuses on maximizing the individuals functional
abilities. This is most often done in an inpatient rehabilitation
hospital or in a special area of a general hospital.
Rehabilitation can also take place at a nursing facility.
The rehabilitation process can include some or all of the
following:
1. speech therapy to relearn talking and swallowing;
2. occupational therapy to regain as much function dexterity in
the arms and hands as possible;
3. physical therapy to improve strength and walking; and
4. family education to orient them in caring for their loved one
at home and the challenges they will face.
The goal is for the patient to resume as many, if not all, of
their pre-stroke activities and functions. Since a stroke involves
the permanent loss of brain cells, a total return to the patient's
pre-stroke status is not necessarily a realistic goal in many
cases. However, many stroke patients can return to vibrant
independent lives.
Depending upon the severity of the stroke, some patients are
transferred from the acute care hospital setting to a skilled
nursing facility to be monitored and continue physical and
occupational therapy.
Many times, home health providers can assess the home living
situation and make recommendations to ease the transition home.
Unfortunately, some stroke patients have such significant nursing
needs that they cannot be met by relatives and friends and
long-term nursing home care may be required.
Growing Stronger, Growing
Better
Global Health
Healthcare Provider
Stroke - treatment of Stroke, Stroke types,
Disease medicines, Stroke symptoms, Stroke and Disease symptoms, Stroke
symptoms Disease and diagnosis, Symptoms and Solutions, Signs and Symptoms,
type of Stroke, cause common, common Stroke, Stroke List, causes list,
Infectious Stroke, Causes, Diseases , Types, Prevention, Treatment and
Facts, Stroke information, Stroke: Definition, Stroke names, medical Stroke,
medical Stroke and disorders, cell Stroke, Stroke Worldwide, Stroke
Research, Stroke Control, Stroke Center, Digestive Stroke Week, Information
about Stroke, causes of different Stroke, Stroke Articles, Stroke and
conditions, Health and Stroke, Stroke Patients, Stroke and Sciences, causes
of alzheimer's Stroke, Stroke causes, alternative medicine heart Stroke,
body ailments, Stroke medicines, medical antiques, type of blood Stroke