Stroke Treatment

What is a Stroke?

Stroke is characterized by brain damage due to bleeding or a loss of blood supply to the brain. This often leads to long-term disability caused by symptoms such as paralysis, trouble swallowing and speaking, and loss of vision.  It is one of the leading causes of death in the United States.  In fact, people with stroke have a very high risk of developing a heart attack.

Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes a Stroke?

A stroke is often caused by an immediate loss of blood supply to the brain. This can occur by a ruptured arterial plaque in your head or neck.  Sometimes blot clots originating from the heart can dislodge and travel to the brain. This is another frequent form of stroke.  These types of strokes are called ischemic strokes.

Strokes may also occur as a result of brain bleeding, which often happens in the setting of high blood pressure or head injury.  These forms of stroke are called hemorrhagic strokes because blood is hemorrhaging, bleeding, into the brain.

The most important risk factors for a stroke include:

  • High blood pressure (hypertension)
  • Elevated cholesterol (hyperlipidemia)
  • Diabetes mellitus
  • Smoking
  • Advanced age
  • History of minor or major heart attack or stroke
  • History of atrial fibrillation

How common is a Stroke?

Stroke is a leading cause of death in the United States and may lead to significant disability - including paralysis and immobility.  It is most frequently seen in the elderly population.  This is likely because this population has a higher prevalence of high blood pressure, heart disease, and falls resulting in head injury.

Approximately 800,000 Americans have a stroke every year.  75% of these strokes occur in people who have never had a prior stroke.  Stroke is considered the 5th leading cause of death in the United States and kills nearly 130,000 people annually.

What are the symptoms and signs of a Stroke?

Symptoms of a stroke often include the sudden development of:

  • Paralysis – one-sided weakness, trouble swallowing/speaking
  • Double vision or loss of vision
  • Confusion
  • One-sided numbness or loss of sensation
  • Headache

Complications of a stroke may consist of:

  • Permanent disability
  • Inability to walk or perform daily activities
  • Pneumonia - problems swallowing and aspirating (choking on food)
  • Memory loss (dementia)
  • Changes in behavior – depression
  • Death

Your doctor will look for abnormal signs on physical examination such as confusion, irregular pupils, increased reflexes, muscle stiffness and weakness, loss of balance, and loss of sensation.

How is a Stroke diagnosed?

Stroke is diagnosed based on symptoms, physical examination, and confirmed with brain imaging tests such as CT scan and MRI. 

Your doctor will also likely order blood tests such as a CMP (comprehensive metabolic panel), CBC (complete blood cell count), and coagulation studies (PT/INR, PTT).  They will also check your cholesterol levels and screen for diabetes.

Another important test is an EKG (electrocardiogram), ultrasound of the neck, and ultrasound of the heart (echocardiogram).

How is a Stroke treated?

The treatment of stroke depends on whether your stroke is caused by brain bleeding (hemorrhagic stroke) or a sudden interruption of blood supply to the brain (ischemic stroke).

Depending on its severity, a hemorrhagic stroke may be managed by closely observing the patients in the hospital and obtaining regular brain scans to evaluate the progression of the bleed.  Significant bleeding often requires brain surgery to stop the bleeding and reduce pressure in the brain cavity.

Strokes caused by a sudden loss of blood supply to the brain are treated differently than brain bleeds.

After a CT scan of the head is obtained to rule out a brain bleed, most patients with ischemic stroke typically receive a medication called Alteplase (tissue plasminogen activator) that rapidly thins the blood and opens up the artery to your brain.

Other important medications that are often prescribed during this type of stroke include:

  • Antiplatelet agents
  • Cholesterol-lowering therapy
    • Lipitor (atorvastatin)
    • Pravachol (pravastatin)
  • Antihypertensive agents
    • Angiotensin converting enzyme (ACE) inhibitors - Zestril (lisinopril)
    • Angiotensin receptor blockers (ARBs) - Cozaar (losartan)

Atrial fibrillation may require treatment with long-term oral blood thinners such as:

Patients with an ischemic stroke are monitored very closely in the hospital because they may develop seizures, brain swelling, and even bleeding into the brain.  As we mentioned, stroke is also frequently associated with heart attacks, which is another reason patients are closely monitored.

After leaving the hospital, patients frequently require physical therapy at a skilled nursing facility. They may also need speech and swallow therapy to help prevent choking on food (aspiration).  Their diet may need to be modified to reduce the risk of aspiration.

Stroke Patient Summary:

  • Stroke is a very common condition characterized by sudden paralysis, confusion, trouble swallowing/speaking, loss of vision, loss of sensation, and headache.
  • It is considered the 5th leading cause of death in the United States
  • Stroke is often caused by a sudden interruption in the blood supply to the brain usually resulting from ruptured arterial plaques or blood clots traveling to the brain.
  • Stroke is also frequently caused by brain bleeds or hemorrhage.
  • Risk factors include high blood pressure, advanced age, high cholesterol, diabetes, smoking, and history of previous stroke or heart attack.
  • Diagnosis is usually confirmed with a head CT or MRI.
  • Complications of a stroke include permanent disability, inability to walk or perform daily activities, pneumonia, memory loss and changes in behavior.
  • Brain bleeds may require immediate surgery to stop the hemorrhage and prevent brain swelling and damage.
  • Ischemic strokes are usually treated with Alteplase.
  • Long-term medical therapy for a stroke and stroke prevention include antiplatelet agents (Aspirin, Plavix), cholesterol-lowering therapy (Lipitor, Pravachol).
  • Blood pressure medications such as Zestril and Cozaar may also be beneficial.
  • Patients may require physical therapy and speech/swallow therapy.

References:

  1. Yew KS, Cheng EM. Diagnosis of acute stroke. Am Fam Physician. 2015 Apr 15;91(8):528-36.
  2. Bernheisel CR, Schlaudecker JD, Leopold K. Subacute management of ischemic stroke. Am Fam Physician. 2011 Dec 15;84(12):1383-8.

 

 

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.