Prompt treatment of stroke and medical problems related to stroke, such as high blood sugar and pressure on the brain, may minimize brain damage and improve the chances of survival. Starting a rehabilitation program as soon as possible after a stroke increases your chances of recovering some of the abilities you lost.
Initial Treatment for Stroke
Initial treatment for a stroke varies depending on whether the stroke was caused by a blood clot (ischemic) or bleeding in the brain (hemorrhagic). Before starting treatment, your doctor will use a computed tomography (CT) scan of your head and possibly magnetic resonance imaging (MRI) to diagnose the type of stroke you've had. Further tests may be done to determine the location of the clot or bleeding and to assess the amount of brain damage. While treatment options are being determined, your blood pressure and breathing ability will be closely monitored, and you may receive oxygen.
Initial treatment focuses on restoring blood flow (ischemic stroke) or controlling bleeding (hemorrhagic stroke). As with a heart attack, permanent damage from a stroke often develops within the first few hours. The more quickly you receive treatment, the less damage will occur.
- Emergency treatment for an ischemic stroke depends on the location and cause of the clot. Measures will be taken to stabilize your vital signs, including administering medications.
- If your stroke is diagnosed within three hours of the initial symptoms, you may be given a clot-dissolving medication called tissue plasminogen activator (t-PA), which can increase your chances of survival and recovery. However, t-PA is not safe for everyone. If you have had a hemorrhagic stroke, use of t-PA would be life-threatening. Your eligibility for t-PA will be quickly assessed in the emergency room.
- You also may receive aspirin or aspirin combined with another antiplatelet medication. However, aspirin is not recommended within 24 hours of treatment with t-PA. Other medications may be given to control blood sugar levels, fever, and seizures. In general, high blood pressure won't be treated immediately unless systolic pressure is over 220 millimeters of mercury (mm Hg) and diastolic is more than 120 mm Hg (220 over 120).
Initial treatment for hemorrhagic stroke is difficult. Efforts are made to control bleeding, reduce pressure in the brain and stabilize vital signs such as blood pressure.
- There are few medications available to treat hemorrhagic stroke. In some cases, medications may be given to control blood pressure, brain swelling, blood sugar levels, fever and seizures. You will be closely monitored for signs of increased pressure on the brain, such as restlessness, confusion, difficulty following commands and headache. Other measures will be taken to keep you from straining from excessive coughing, vomiting or lifting, or straining to pass stool or change position.
- Surgery generally is not used to control mild to moderate bleeding resulting from a hemorrhagic stroke. However, if a large amount of bleeding has occurred and the person is rapidly getting worse, surgery may be needed to remove the blood that has built up inside the brain and to lower pressure inside the head.
If the bleeding is due to a ruptured brain aneurysm, surgery may be initiated to repair the aneurysm. The procedure used to repair a brain aneurysm is called endovascular coil embolization. It involves inserting a small coil into the aneurysm to block it off. Whether this surgery can be done depends on the location of the aneurysm and your condition following the stroke.
Stroke Treatment: Ongoing
After emergency treatment for stroke and once your condition has stabilized, treatment focuses on rehabilitation and preventing another stroke. It will be important to control risk factors for stroke such as high blood pressure, atrial fibrillation, high cholesterol or diabetes.
Your doctor will probably want you to take aspirin or other antiplatelet medications. If you had an ischemic stroke (caused by a blood clot), you may need to take anticoagulants to prevent another stroke. You may also need to take medications such as statins, to lower high cholesterol or medications to control your blood pressure.
Your doctor also may recommend carotid endarterectomy surgery to remove plaque buildup in the carotid arteries.
Early aggressive rehabilitation may help you regain some normal functioning. Rehabilitation will be based on physical abilities that were lost, general health before the stroke and your ability to participate. Rehabilitation begins with helping the patient resume activities of daily living such as eating, bathing and dressing.
Changes in lifestyle also may be an important part of your ongoing treatment to reduce your risk of having another stroke. It will be important for you to exercise to the greatest extent possible, eat a balanced diet and quit smoking. Your doctor may suggest that you follow the Dietary Approaches to Stop Hypertension (DASH) diet if you have high blood pressure. If you have high cholesterol, you may need to follow the Therapeutic Lifestyle Changes (TLC) diet. These diets are low in fat (notably saturated fat) and contain more whole grains, fruits, vegetables and low-fat dairy products.
Stroke Treatment: Declining Condition
Depression is common in people who have had a stroke. You may need medications for depression and pain to help you cope.
If your condition worsens, it may be necessary to move to a care facility that can meet your needs, specifically if your caregiver has his or her own health problems that make it difficult to properly care for you. It is common for caregivers to neglect their own health when they are caring for a loved one who has had a stroke. If your caregiver's health declines, the risk of injury to you and your caregiver may increase.