Early treatment can help minimize damage to brain tissue and improve the outcome (prognosis). Treatment depends on whether the stroke is ischemic or hemorrhagic and on the underlying cause of the condition. The long-term goals of treatment include rehabilitation and prevention of additional strokes.
Initial treatment for ischemic stroke involves removing the blockage and restoring blood flow. Tissue plasminogen activator (t-PA) is a medication that can break up blood clots and restore blood flow when administered within 3 hours of the event. This medication carries a risk for increased intracranial hemorrhage and is not used for hemorrhagic stroke. Mannitol, a diuretic, may be administered intravenously (through an IV) to reduce intracranial pressure during an ischemic stroke.
Antihypertensives such as labetalol (Normodyne®) and enalapril (Vasotec®) may be used alone or in combination with diuretics to treat high blood pressure. Side effects are usually mild and include dizziness, fatigue, and headache.
Antiplatelet agents such as aspirin, clopidogrel bisulfate, and aspirin with dipyridamole (Aggrenox®) may be prescribed to reduce the risk for recurrent stroke. Aspirin may also improve the outcome of a stroke when administered within 48 hours. Side effects include stomach pain, heartburn, nausea, and gastrointestinal bleeding. Aggrenox is taken orally, twice a day, and may also cause headache.
Clopidogrel bisulfate (Plavix®) is an antiplatelet medication that is taken orally, once a day, to help prevent the formation of blood clots. It is prescribed for patients with atherosclerosis who have had a recent stroke and is used to prevent recurrence. Patients with medical conditions that may cause internal bleeding (e.g., stomach ulcers) should not use clopidogrel.
Side effects include abdominal pain, rash, diarrhea, and headache. Serious side effects (e.g., gastrointestinal hemorrhage) are rare. Physicians and dentists should be informed that a patient is taking clopidogrel before any surgery is scheduled.
Anticonvulsants such as diazepam (Valium®) and lorazepam (Ativan®) may be prescribed for patients who experience recurrent seizures after a stroke. Side effects include drowsiness, fatigue, and weakness.
Anticoagulants such as warfarin (Coumadin®) may be prescribed to prevent the formation of blood clots. Patients taking warfarin may require regular blood tests to monitor coagulation (blood clot formation) and prevent abnormal bleeding.
Hemorrhagic stroke usually requires surgery to relieve intracranial (within the skull) pressure caused by bleeding. Most of the damage caused by this type of stroke results from the physical disruption of brain tissue.
Surgical treatment for hemorrhagic stroke caused by an aneurysm or defective blood vessel can prevent additional strokes. Surgery may be performed to seal off the defective blood vessel and redirect blood flow to other vessels that supply blood to the same region of the brain.
Endovascular treatment involves inserting a long, thin, flexible tube (catheter) into a major artery, usually in the thigh, guiding it to the aneurysm or the defective blood vessel, and inserting tiny platinum coils (called stents) into the blood vessel through the catheter. Stents support the blood vessel to prevent further damage and additional strokes.
Recovery and rehabilitation are import aspects of stroke treatment. In some cases, undamaged areas of the brain may be able to perform functions that were lost when the stroke occurred.
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Speech therapy helps patients regain the ability to speak. Occupational therapy helps patients regain independent function and relearn basic skills (e.g., buttoning a shirt, preparing a meal, bathing).
Prognosis depends on the type of stroke, the degree and duration of obstruction or hemorrhage, and the extent of brain tissue death. Most stroke patients experience some permanent disability that may interfere with walking, speech, vision, understanding, reasoning, or memory.
Approximately 70% of ischemic stroke patients are able to regain their independence and 10% recover almost completely. Approximately 25% of patients die as a result of the stroke. The location of a hemorrhagic stroke is an important factor in the outcome, and this type generally has a worse prognosis than ischemic stroke.
The following measures may help prevent stroke:
- Do not smoke.
- Exercise regularly.
- Limit dietary intake of salt, alcohol, and saturated fat.
- Maintain body weight within an ideal range.
- Use airbags, seatbelts, and child safety seats in automobiles.
- Wear protective helmets when engaging in contact sports, horseback riding, or riding bicycles.
People with hypertension or diabetes can reduce their risk for stroke by controlling their condition through proper medication and appropriate lifestyle modifications (e.g., regular exercise, weight loss).
Carotid endarterectomy is a surgical procedure in which atherosclerotic deposits (plaque) in a carotid artery are removed. This procedure can reduce the risk for stroke.
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