Treatment for Stroke

Medical treatment for stroke:

Specific treatment for stroke will be determined by your physician based on:

• your age, overall health, and medical history
• severity of the stroke
• location of the stroke
• cause of the stroke
• your tolerance for specific medications, procedures, or therapies
• type of stroke
• your opinion or preference

Emergency treatments for stroke at St. John's:

Treatment is most effective when started immediately.

Once in the emergency room, the nurse will obtain vital signs, monitor heart rate and rhythm with EKG monitor, start an intravenous line, perform a physical assessment, and obtain current health and medical history. The emergency room physician will perform a physical assessment, obtain health history, verify time of symptom onset and order a plain CT scan of the head, labs, chest X-ray and EKG.

If the emergency room physician feels that the stroke patient meets criteria for stroke treatment time frames, then he will activate the STAR team (Stroke Treatment Active Responders) which consists of the RN Stroke Coordinator, neurologist, lab personnel, and CT personnel who are available 24 hours a day 7 days a week. The Stroke Coordinator will meet the patient in the ER and perform a stroke assessment using the National Institute of Health Stroke Scale or NIHSS. The Stroke Coordinator will also obtain a medical history including risk factors, and verify time of symptom onset. After obtaining the lab, EKG, and CT results, they will inform the ER physician and the neurologist of the results.

Depending on the severity of stroke symptoms and time of symptom onset, the neurologist and stroke coordinator will review stroke treatment options, review the inclusion and exclusion criteria of the treatment options, and offer the best option to the patient and family. Stroke work-up is started in order to discover the cause of the stroke, start appropriate stroke medications, and initiate appropriate therapies in order to start the road to recovery.

The Stroke Workup:

For those patients whose symptoms have resolved or their symptoms have improved to where it is felt that they are safe for discharge from the ER, their stroke workup can be done in the outpatient setting. After discharge from the emergency room, the stroke / TIA patient will be contacted by a Stroke Coordinator and offered free, personal, one-on-one stroke / TIA education. The emphasis of the class is on signs and symptoms, disease process, risk factor identification and modification, along with medication education.

Emergency treatment following a stroke may also include:

• cerebral angiography
   
• medications used to the dissolve blood clot(s) that cause an ischemic stroke
  Medications that dissolve clots are called thrombolytics or fibrinolytics and are commonly known as "clot busters." These drugs have the ability to help reduce the damage to brain cells caused by the stroke. In order to be most effective, these agents must be given within several hours of a stroke's onset.
   
• medications and therapy to reduce or control brain swelling
  Corticosteroids and special types of intravenous (IV) fluids are often used to help reduce or control brain swelling, especially after a hemorrhagic stroke (a stroke caused by bleeding into the brain).
   
• medications that help protect the brain from damage and ischemia (lack of oxygen)
  Medications of this type are called neuroprotective agents, with some still under investigation in clinical trials.
   
• life support measures including such treatments as ventilators (machines to assist with breathing), IV fluids, adequate nutrition, blood pressure control, and prevention of complications.

Other procedures and medications used to treat or prevent a stroke:

Other medications that may help with recovery following a stroke, or may help to prevent a stroke from occurring, include the following:

• medications to help prevent more blood clots from forming
  Medications that help to prevent additional blood clots from forming are called anticoagulants, as they prevent the coagulation of the blood. Medications of this type include, for example, heparin and warfarin (Coumadin®).
   
• medications that reduce the chance of blood clots by preventing platelets (a type of blood cell) from sticking together
  Examples of this type of medication include aspirin, clopidogrel (Plavix®) or dipyridamole (Aggrenox®).
   
• medications to treat existing medical conditions such as diabetes, heart, or blood pressure problems.

Types of surgery to treat or prevent a stroke:

Several types of surgery may be performed to help treat a stroke, or help to prevent a stroke from occurring, including the following:

• carotid endarterectomy
  Carotid endarterectomy is a procedure used to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help prevent a stroke from occurring.
   
• craniotomy
  A craniotomy is a type of surgery in the brain itself to remove blood clots or repair bleeding in the brain.
   
• surgery to repair aneurysms and arteriovenous malformations (AVMs)
  An aneurysm is a weakened, ballooned area on an artery wall that has a risk for rupturing and bleeding into the brain. An AVM is a congenital (present at birth) or acquired disorder that consists of a disorderly, tangled web of arteries and veins. An AVM also has a risk for rupturing and bleeding into the brain. Surgery may be helpful, in this case, to help prevent a stroke from occurring.

Constraint-Induced Therapy (CIT) for arm and hand paralysis after stroke:

Many individuals who have a stroke are left with paralysis of the upper extremities. CIT is a treatment that encourages the use of the stroke-affected limb by constraining the non-affected limb in a mitt, sling, splint or glove. Intense exercises are done using the stroke-affected arm or hand.

• CIT restraints are worn for up to 90 percent of the waking hours.
• Restraints can be removed for activities such as bathing.
• Small steps are used to break down complex tasks such as making a phone call.
• Verbal and written feedback is used to help motivate and inform persons undergoing CIT.

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Online Resources of Nervous System Disorders