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Stroke (Treatment)

How stroke is treated?

The first and most crucial step in the treatment of stroke is to identify it and to reach a hospital emergency as early as possible.

Early initiation of treatment can bring a significant difference in the outcome of stroke. It is preferred to use an ambulance service so that the life-saving treatment can begin on the way.

At Hospital:

The person is taken to an emergency department where a quick evaluation is done. The doctor takes clinical history, typically focusing on the duration of the symptom onset.

The vitals of the person such as BP, heart rate, breathing, etc. is taken, and the treatment is started.

The treatment of stroke consists of:

• Acute stroke management- procedures and medical treatment

• Prevention of stroke and its recurrence

• Post-stroke rehabilitation

This article would inform you about the treatment that is immediately started in the hospital when you reach there.

Acute stroke management

Consist of treatment that would begin immediately once you reach the hospital.

The treatment focuses on stopping a stroke from causing any significant damage or preventing further damage.

The cause of stroke determines the treatment:

• Ischemic stroke: consists of removal or dissolution of the blood clot that blocks the artery.

• Hemorrhagic stroke: consists of sealing the blood leakage from the burst artery. For more information, refer to the article Subarachnoid hemorrhage and Intracerebral hemorrhage.

The treatment given below focuses on the more common type of stroke- ischemic stroke or infarct.

Acute Ischemic stroke treatment

Screen Shot 2020 07 11 at 4.36.30 AM

 

1. Thrombolytic Drug (clot-busting medicine)

The treatment involves the use of a drug called Tissue plasminogen activator (tPA), which causes lysis or dissolution of the clot, causing obstruction.

The treatment is for people who are able to reach the hospital within 3 hours of onset of symptoms. Use of tPA within 3 hours of onset of symptoms have shown significantly better outcome. At least 33% of patients are more likely to recover with minimal or no disability after 3 months.

In some patients, the window of drug administration is up to 4.5 hours.

Drug dose: 0.9mg/kg for a maximum dose of 90mg given intravenously.

The drug can also be given at the clot site by using thin tubes called catheters, which are inserted through the artery of your groin. The doctor also pushes the catheter to and fro through the blood clot to break it. This procedure-intra-arterial thrombolysis-is done by a specialized doctor called neuro-interventionalist.

Contraindications:

• Intracranial hemorrhage

• Recent intracranial surgery or

• Severe head trauma

• Bleeding disorder

• Uncontrolled hypertension

• Recent history of stroke

 

2. Clot retrieval procedure

This treatment uses special devices which hold and pull the clot out, unblocking the artery. The procedure is done by neuro-interventionalist by using the catheters.

The procedure is used for larger arteries of the brain, which responds to tPA to a lesser extent. AHA/ASA recommends the use of this treatment for all patients with larger artery blockade, even with the use of tPA.

The procedure uses:

• Stent retriever: wire mesh that sticks to the clot and pulls it out

• Aspiration catheter: a tool that sucks out the clot with the help of a vacuum.

The treatment is considered effective up to 6 hours of symptom onset. In some people, the procedure can be done up to 24 hours.

 

3. Blood pressure monitoring and management

In case you have received tPA for busting the clot, your doctor would give you medicine to keep your blood pressure below 180/105 mmHg.

Drugs: Labetalol 10 to 20 mg, Nicardipine, or Clevidipine given intravenously.

blood-pressure

4. Blood glucose monitoring and maintenance

Glucose is the fuel for the brain, and the lack of glucose can restrict the brain repair. High levels of glucose may also increase the risk of death.

Blood glucose level: is maintained in the range of 140 to 180 in the first 24 hours.

blood-sugar-monitor

5. Temperature monitoring and management

Fever above 100 degrees Fahrenheit in the first 24 hours is associated with an increased risk of death. Thus, it becomes crucial to manage fever. Paracetamol can be given. Any underlying infection has to be ruled out.

 

6. Blood thinners

Aspirin- a blood thinner- is given in the first 24 to 48 hours of development of symptoms. Aspirin is an antiplatelet drug that prevents blood clot formation by restricting the accumulation of the platelet.

It is shown that aspirin given in the first 48 hours, prevents the recurrence of ischemic strokes and improves the outcomes. Moreover, it doesn’t cause any significant risk of intracranial bleeding.

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