What's the treatment for a stroke?
A stroke is a medical emergency, regardless of whether it is a major stroke or a short-lasting TIA. A person suffering a stroke should be taken immediately to a hospital emergency department. The ability to pinpoint quickly the precise location of a stroke and determine the extent of damage is critically important in treatment decisions. A stroke caused by a blocked artery
is treated in an entirely different way than a stroke caused by bleeding within the brain.
It is important to identify that a patient is having a stroke as early as possible. Some suggest that we should rename stroke as a "brain attack" to underline the urgency of early assessment and treatment. Emergency services should be contacted so that the patient can be assessed by medical staff as quickly as possible. If the patient has had the stroke symptoms for less than 3 hours then they may need further assessment as they may be suitable for thrombolysis. This is "clot busting" treatment, useful only in those with ischemic stroke. The aim of the therapy is to minimise the size of the stroke and therefore minimise subsequent disability by restoring blood flow to the area of the brain affected as quickly as possible. It can however only be used in selected patients. The patient will need blood tests to be performed urgently as well as a CT scan of the head. If the scan shows no signs of bleeding (haemorrhage) then clot-busting therapy may be given depending on the judgment of the physician involved. Surgery may also be indicated in very selected cases to treat acute stroke.
If the CT scan shows the stroke to be ischaemic then Aspirin 75 mg to 300 mg is given. It is common for the blood pressure to be elevated following a stroke but many clinicians feel this is beneficial allowing better cerebral blood flow, though there is little hard evidence for this. Many clinicians do not treat mildly elevated blood pressures for the first few days at least. In the long term evidence has shown that particular antihypertensive medications reduce the long term risk of stroke.
Good nursing care is fundamental in maintaining skin care, feeding and hydration and positioning as well as the monitoring of vital signs such as temperature, pulse and blood pressure. Stroke rehabilitation begins almost immediately.
Stroke rehabilitation is the process by which patients with disabling strokes undergo treatment to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. It is multidisciplinary in the fact that it involves a team with different skills working together to help the patient. These include nursing staff, physiotherapy, occupational therapy, speech and language therapy and usually a physician trained in rehabiliation medicine. Some teams may also include psychologists and social workers and pharmacists.
For most stroke patients, physical therapy is the cornerstone of the rehabilitation process. Another type of therapy involving relearning daily activities is occupational therapy (OT). OT involves exercise and training to help the stroke patient relearn everyday activities sometimes called the Activities of Daily Living (ADLs) such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and toileting. Speech and language therapy is appropriate for patients who have have problems understanding speech or written words, or problems forming speech.
Patients may have particular problems such as an inability to swallow or a swallow that is not safe such that swallowed material may pass into the lungs and cause an Aspiration Pneumonia. The swallow may improve with time but in the interim a nasogastric tube may be passed which enables liquid food to be given directly into the stomach. If after a week the swallow is still not safe then a PEG tube is passed and this can remain indefinitely.
The team have regular meetings at which the patient and family may be present to discuss the current situation and to set goals and to ensure effective communication. In most cases the desired goal is to enable the patient to return home to independent living though this is not always possible.
Stroke rehabilitation can last anything from a few days up to several months. Most return of function is seen in the first few days and weeks and then falls off. It is unusual that there is complete recovery but not impossible. Most patients will improve to some extent.