Contents
Stroke therapy
Treatment of stroke depends on whether it is ischemic or hemorrhagic.
Ischemic stroke
To treat ischemic stroke, the doctor must restore blood flow to the brain in the shortest possible time.
Medication
Therapy with thrombolytic drugs must begin within 4 hours.
Early treatment increases the chances of survival and reduces complications or consequences of the stroke.
The doctor administers:
Aspirin
Aspirin is a medication that is administered immediately by the emergency doctor. It reduces the likelihood of another stroke. Aspirin dissolves the blood coagel and prevents further thrombus formation.
Hydrogen sulfide
This substance is also excreted from rotten eggs and is new in the therapy of stroke and other diseases.
Hydrogen sulfide protects the mitochondria (powerhouses of cells) that fight inflammation and prevents cell death.
Intravenous injection of tissue-specific plasminogen activator (t-PA) or thrombolysis.
The t-PA is given as an injection through an arm vein.
This is a thrombolytic medication and must be injected within 4.5 hours of the onset of stroke symptoms.
The t-PA dissolves the blood clot, restores blood flow and thus prevents major brain damage.
Emergency measures
Doctors usually treat strokes with therapies that need to be used as soon as possible.
They depend on the characteristics of the clot:
Drugs in the brain. Doctors insert a long and thin tube (catheter) into the brain via an inguinal artery. Once there, the t-PA is injected at the place where the stroke takes place.
The possible effective treatment period is longer than with a venous injection.
Mechanical removal of the blood body
Doctors can use a catheter to handle surgical tweezers in the brain and mechanically destroy or remove the blood clot.
Recent studies confirm that for some people, treatment with a thrombolytic drug or surgical removal of the clot did not give a satisfactory result. The scientists are working to find out who can have a real benefit from this procedure.
Other techniques
To reduce the risk of another stroke or TIA, the doctor may perform surgery that opens an artery clogged by fatty deposits. These operations are performed to prevent a stroke.
The surgeries vary depending on the state of health and are:
Carotid endarterectomy
In carotid endarterectomy, the surgeon removes the plaques in the carotid artery (carotid). The doctor makes an incision on the front of the neck and opens the carotids. He then removes the plaques that clog the artery.
The surgeon sutures the artery again or places a vein patch. The procedure reduces the risk of ischemic stroke.
Carotid endarterectomy is a risk for patients with heart disease.
Angioplasty and stent
In an angioplasty, the surgeon inserts a catheter with a mesh-like wire (stent) and a balloon at the tip of the catheter from the inguinal artery to the neck. The surgeon inflates the balloon in the artery and positions the stent, which remains in the artery and keeps the artery open after the procedure.
Hemorrhagic stroke
Treatment of hemorrhagic stroke involves controlling bleeding and reducing intracranial pressure. Surgery can be done to reduce the risk of further relapses.
If warfarin (Coumadin) or other antiplatelet drugs (clopidogrel, Plavix) are taken to prevent blood clots from forming, the doctor will prescribe other medications to counteract the side effects of the “fluidizers” of the blood. These drugs reduce intracranial pressure (intracranial pressure), lower blood pressure, prevent vasospasm and prevent epileptic seizures.
If the cerebral hemorrhage stops, bed rest must be observed and medical treatment must be carried out. The healing is similar to that of bruising. If a lot of blood has leaked, the doctor may perform surgery to remove the blood and reduce the pressure of the fluid on the brain.
Surgical restoration of blood vessels
Surgery can be done to restore blood vessels and block bleeding.
The doctor may perform one of the following surgeries if the stroke is caused by:
- Aneurysm
- arteriovenous malformation (AVM),
- vascular malformation of a different type.
Possible surgical techniques:
Surgical clipping
The surgeon inserts a small vascular clamp (similar to surgical heaviness) to the base of the aneurysm (interruption of blood flow). The clamp prevents the blood from flowing through the aneurysm, thus avoiding re-bleeding.
Endovascular embolization
The surgeon inserts a catheter through the inguinal artery and thus reaches the brain. The doctor inserts small metal spirals into the aneurysm. The IUDs fill the aneurysm, blocking blood flow to the aneurysm.
Surgical removal of an AVM
The surgeon removes small malformations in the central nervous system if they are located in a surgically accessible place. In this way, the risk of rupture of a blood vessel is eliminated and the likelihood of hemorrhagic stroke is reduced. It is not always possible to eliminate an AVM if it is very large or located in a deep and inaccessible area of the brain.
Rehabilitation after a stroke
Tests for sensitive, motor and cognitive functioning are carried out immediately.
The recovery process improves when motor activities are voluntary and repetitive and special tasks are performed.
Rehabilitation after stroke includes the following activities to restore the paralyzed side of the body.
Physical activity:
- Exercises to improve muscle strength and coordination.
- Increasing the mobility of the joints.
- Restriction of the use of the healthy limb.
- Exercises to increase the range of motion.
Physiotherapy:
- Electrical stimulation to stimulate the weakened muscles.
- Robotic technology to support the affected limbs in their movement.
- Wireless technology to interact with a monitor.
- Non-invasive cerebral stimulation.
Cognitive and emotional activity:
- Therapy for communication disorders.
- Psychological examination and treatment.
When is the patient out of danger? Prognosis
For the first days after the stroke, the prognosis is poor, because the possibility of dying is high.
Mortality after one month is 20-30%, while after one year it is 30-40%.
When should rehabilitation after a stroke begin?
Rehabilitation is started in the post-acute period, an early start increases the likelihood of recovery to resume the previous activities.
Priority is given to stabilizing the patient’s condition.
Subsequently, neurological rehabilitation must begin.
How long does rehabilitation take?
The duration of rehabilitation depends on the severity of the stroke and its complications. Some people recover quickly, even if most are accompanied by physiotherapy for months or years.
Prevention
The best prevention of stroke is a healthy diet, physical exercise, no smoking and no alcohol abuse.
Nutrition
A poor diet is a risk factor for stroke. High-fat foods lead to an accumulation of fatty plaques in the arteries. Excess weight leads to arterial hypertension.
Recommended are foods with low fat content, plenty of fiber, fresh seasonal fruits, lots of vegetables (five servings a day) and whole grains.
You should not eat too much salt (no more than 6 g a day), because salt increases blood pressure. 6 grams is about a teaspoonful.
A balanced diet should contain a small amount of unsaturated fatty acids, which lower cholesterol.
Foods rich in unsaturated fatty acids:
- Oily fish
- Avocado
- Nuts and seeds
- Sunflower products
- Rapeseed
- Olives
- Vegetable oils
Sports and physical activities
Everyone should engage in moderate-intensity aerobic activity for at least 150 minutes (2 hours and 30 minutes) a week.
The best activities are cycling and quick walking.
Normally, the resumption of competitive sports is prohibited and should be discussed with the doctor in any case.
