Stroke
Treating stroke
Source: NHS
In this topic (27)
Treating ischaemic strokes
If you have had an ischaemic stroke, a combination of medications to treat the condition and prevent it from happening again will usually be recommended.
Some of these medications will need to be taken immediately and only for a short time, while others may only be started once the stroke has been treated and may need to be taken in the long-term.
Thrombolysis
Ischaemic strokes can often be treated using injections of a medication calledalteplase that dissolves blood clots and restores the flow of blood to the brain. This use of "clot-busting" medication is known as thrombolysis.
Alteplase is most effective if started as soon as possible after the stroke occurs and is not generally recommended if more than four-and-a-half hours have passed, because it's not clear how beneficial it is when used after this time.
However, before alteplase can be used, it is very important that a brain scan to confirm a diagnosis of an ischaemic stroke is carried out because the medication can makethe bleeding that occurs inhaemorrhagic strokes worse.
Antiplatelets
Most people will also be offered a regular dose of Low dose aspirin which as well as being a painkiller makes the cells in your blood called platelets less sticky, reducing the chances of another clot forming.
In additionto aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.
Anticoagulants
Some people may also be offered an additional medication called an anticoagulant to help reduce their risk of developing further blood clots in the future.
Anticoagulants prevent blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Warfarin , rivaroxaban, dabigatran and apixaban are examples of anticoagulants for long term use. There are also a number of anticoagulants called heparins that can only be given by injection and are used in the short term.
Anticoagulants may be offered if you:
- have a type of irregular heartbeat called atrial fibrillation that can cause blood clots
- havea history of blood clots
- are at risk of developing clots in your leg veins known as deep vein thrombosis (DVT) because a stroke has left you unable to move one of your legs
Antihypertensives
If your blood pressure is too high, you may be offered medicines to lower it. Medicines that are commonly used include:
- thiazide diuretics
- angiotensin-converting enzyme (ACE) inhibitors
- calcium channel blockers
- beta-blockers
- alpha-blockers
Statins reduce the level of cholesterol in your blood by blocking an enzyme (chemical) in the liver that produces cholesterol.
You may be offered a statin, even if your cholesterol level is not particularly high, because a statin may help reduce your risk of stroke whatever your cholesterol level is.
Carotid endarterectomy
Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.
If the carotid stenosis is particularly severe, surgery may be offered to unblock the artery. This is done using a surgical technique called a carotid endarterectomy . It involves the surgeon making an incision in your neck to open up the carotid artery and remove the fatty deposits.
Treating haemorrhagic strokes
As with ischaemic strokes, some people who have had a haemorrhagic stroke will also be offered medication, such as ACE inhibitors, to lower blood pressure and prevent further strokes from occurring.
If you were previously taking anticoagulant medicine before you had your stroke, you may also need treatment to reverse the effects of the medication and reduce your risk of further bleeding.
Surgery
Occasionally, emergency surgery maybe needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy.
During a craniotomy, a section of the skull is cut away to allow the surgeon access to the cause of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain.
After the bleeding has been stopped, the piece of bone removed from the skull is replaced, often by an artificial metal plate.
Surgery for hydrocephalus
Surgery can also be carried out to treata complication of haemorrhagic strokes called hydrocephalus .
This is where damageresulting froma stroke causes cerebrospinal fluid to build up in the cavities (ventricles) of the brain, causing symptoms such as headaches , sickness, vomiting and loss of balance.
Hydrocephalus can be treatedby surgically placing an artificialtube called a shuntinto the brain to allow the fluid to drain properly.
Stroke experts have set out standards which define good stroke care, including:
- a rapid response to a 999 call for suspected stroke
- prompt transfer to a hospital providing specialist care
- an urgent brain scan for example, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan undertaken as soon as possible
- immediate access to a high-quality stroke unit
- early multidisciplinary assessment, including swallowing screening
- stroke specialised rehabilitation
- planned transfer of care from hospital to community and longer-term support
The National Institute for Health and Care Excellence (NICE) has also produced guidelines on the diagnosis and management of stroke and a quality standard for stroke that describes the level of care the NHS is working towards.
If you are concerned about the standard of care provided, speak to your stroke specialist or a member of the stroke team.
Further reading
What social care services are available?
Articles for Stroke
Can stress and anxiety cause a stroke?
A person’s emotional state is an important factor in the function and development of their daily activities. Anxiety, depression and stress are conditions which compromise and affect a person’s daily life.
Can you die from a stroke?
A stroke is a very severe condition. Immediate medical attention is necessary; the medical staff usually conducts a series of examinations and medical procedures to offer first aid.
Causes of stroke
There are two main types of stroke - ischaemic strokes and haemorrhagic strokes - which affect the brain in different ways and can have different causes. Ischaemic strokes are the most common type of stroke.
Diagnosing stroke
Strokes are usually diagnosed by carrying out physical tests and studying images of the brain produced during a scan. Even if the physical symptoms of a stroke are obvious, brainscans should also be carried out to determine: if the stroke has been caused by a blocked artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke), which part of the brain has been affected, how severe the stroke is.
How are strokes diagnosed?
Shortly after the patient arrives at the hospital, physicians look for the typical symptoms of a stroke. These symptoms involve; Symptoms evident in the face, its retraction to one side (the face seems to droop on one side), problems with the limbs, (usually arms), hands and legs are numb or cannot be moved, etc.
How are strokes treated?
A Stroke can be Ischemic or Hemorrhagic. Since these two types of stroke develop via different mechanisms, the treatment is accordingly different. Important for the treatment of strokes is preventing the disease a long time in advance.
How does a stroke occur?
Due to another disease or condition, a blood vessel in a certain area of the brain may rupture (break) and cause the blood to spread to the surrounding tissue and damage it.
Introduction
A stroke is a serious and life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. Strokes are a medical emergency and urgent treatment is essential because the sooner a person receives treatment for a stroke, the less damage is likely to happen.
Is a stroke a disease that develops gradually, or does it occur suddenly?
Strokes occur suddenly and all at once; they pose a very serious threat to a patient’s life. This condition requires immediate medical attention.
Patient story: "Everyday was a new challenge."
Having a stroke on the first day of his summer holiday was the last thing Stephen Harnet expected, especially as he was a healthy 32-year-old at the time. It turned out that the stroke was due to a condition I was born with called AVM (arteriovenous malformation), which is a tangle of abnormal blood vessels (arteries and veins), and can affect the brain and lead to a stroke. Before the stroke I was a technical manager working 12-hour days, seven days a week.
Patient story: "I was just 26 and had my whole life ahead of me."
Manjit Bains was just 26 when he had a stroke. Determination, support from his family and friends and rehabilitation helped him get his life. "This hasn't been a solo journey. I've had a lot of support, including psychologists and counselling. After intensive care I was nursed on a medical ward at the hospital where I had been working."
Patient story: "I'm sure the doctors thought I wouldn't get better, let alone run a marathon."
David Diston had a major stroke that left him paralysed down his right side and unable to speak. Now he has made a near total recovery, and has even run a marathon. He woke up in an assessment ward at Swindons Princess Margaret Hospital. He had no feeling or movement down his right side, and he couldn't speak. After a few days, he was moved to a specialist stroke unit where the doctors explained that he would have to learn to speak, write and walk again from scratch.
Patient story: "We call ourselves stroke survivors, not patients - that's very important"
Jim Whyte was forced to give up work after having a stroke, but he's proved that there is life after a stroke. Jim had high blood pressure and was diabetic, which are both risk factors for stroke. However, he had never smoked and, due to his diabetes, was already following the healthy diet recommended for stroke survivors.
Patient story: “Doctors said I had had a massive stroke.â€ÂÂ
Before June/ 17/ 2000, Jane Stokes CBE was a successful lawyer with a 25-year career in the civil service. She says her lifestyle may have raised her risk of a stroke. As a smoker, she had developed a two-pack-a-day habit. She drank moderately and neglected her fitness when her career began to take over. Recovery is a long process.
Preventing strokes
The best way to prevent a stroke is to eat a healthy diet, exercise regularly, and avoid smoking and excessive consumption of alcohol. Ensuring a balance in your diet is important. If you have not fully recovered from your stroke, you may find that you will have become particularly sensitive to alcohol and even the recommended safe limits as above for the general population may be too much for you.
Recovering after a stroke
Two of the mostcommon psychological problems that can affect people after a stroke are: Depression many people experience intense bouts of crying and feel hopeless and withdrawn from social activities, anxiety where people experience general feelings of fear and anxiety, sometimes punctuated by intense, uncontrolled feelings of anxiety (anxiety attacks). The injury to the brain caused by a stroke can lead to widespread and long-lasting problems.
Symptoms and signs of stroke
If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance. Even if the symptoms of a stroke disappear while you are waiting for the ambulance to arrive, you or the person having the stroke should still go to hospital for an assessment.
Treating stroke
Effective treatment of stroke can prevent long-term disability and save lives. If your blood pressure is too high, you may be offered medicines to lower it. Medicines that are commonly used include: thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, beta-blockers, alpha-blockers. Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain. The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.
What are some of the warning signs of a stroke?
It could occur that prior to a patient experiencing a stroke, they may experience warning signs. A few days or weeks in advance they may experience light symptoms such as unusual headaches, a light lip distortion, numbness in the arm or leg, vertigo, brief loss of vision, difficulties articulating, amnesia, etc.
What are the causes of TIA (Transitory Ischemia)?
The causes of Transitory Ischemia include: a blood clot, the narrowing of blood vessels in the brain, diabetes, high cholesterol levels.
What are the main symptoms of strokes?
At the onset of a stroke, a few main symptoms should be notices, which are easy to remember by using the acronym F.A.S.T. (Face, Arms, Speech, Time).
What is a stroke?
A stroke is a severe condition and a serious threat, which requires immediate medical intervention. This disease is a major cause for invalidity and mortality in the world. Strokes are ranked third in the world in regards to mortality.
What is Hypertensive Encephalopathy?
Hypertensive encephalopathy is an acute syndrome during which severe hypertension is accompanied by headaches, nausea and vomiting, confusion, convulsions, stupor (somnolence) and coma, and other transitory neurological symptoms.
What is the cause of a stroke?
A stroke due to a hemorrhage occurs more rarely than a cerebral ischemia. The major cause for this type of stroke is arterial hypertension.
What is the difference between a heart attack and a stroke?
A myocardial infarction (MI), commonly known as a heart attack, occurs when a portion of the heart is deprived of oxygen due to blockage of a coronary artery. A stroke is a medical condition medical condition that occurs when the blood supply to part of the brain is cut off.
What types of stroke are there?
There are different types of Stroke, they include: brain stroke of the ischemic type, brain stroke due to hemorrhage (cerebral hemorrhage) and hemorrhages due to the rupture of blood vessels or due to vascular malformation, etc.
Which are the major risk factors for a stroke?
Risk factors for stroke, that are worth mentioning include: Atherosclerosis (Depositing of lipids in the lumen of blood vessels in the form of plaques), High blood pressure, Lack of physical activity, Obesity, Continuous consumption of alcohol, Smoking, etc.
