Stroke

  • Alternative Names

    Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident; Stroke - hemorrhagic


    Treatment

    A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek immediate medical care at the first signs of a stroke.

    It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.

    Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin.

    Treatment depends on the severity and cause of the stroke. A hospital stay is required for most strokes.

    TREATMENT IN THE HOSPITAL

    Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. However, not everyone can receive this type of medicine.

    • For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.
    • If the stroke is caused by bleeding rather than clotting, clot-busting drugs (thrombolytics) can cause more bleeding.

    Other treatments depend on the cause of the stroke:

    • Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used.
    • Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.
    • In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.
    • For hemorrhagic stroke, surgery is often required to remove blood from around the brain and to repair damaged blood vessels.
    • Surgery on the carotid artery may be needed.

    See also:

    • Carotid artery disease
    • Carotid artery surgery

    Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

    Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital.

    LONG-TERM TREATMENT

    The goal of treatment after a stroke is to help the patient recover as much function as possible and prevent future strokes.

    The recovery time and need for long-term treatment differs from person to person. Problems moving, thinking, and talking often improve in the weeks to months after a stroke. A number of people who have had a stroke will still continue to improve in the months or years after the stroke.

    See: Stroke recovery for information about:

    • Bladder and bowel problems
    • Living at home rather than a nursing facility
    • Muscle and nerve problems
    • Speech problems
    • Stroke rehabilitation
    • Swallowing and eating problems
    • Thinking and memory problems

    Support Groups

    Additional support and resources are available from the American Stroke Association -- www.strokeassociation.org.


    Expectations (prognosis)

    The outlook depends on the type of stroke, how much brain tissue is damaged, what body functions have been affected, and how quickly treatment is received. Recovery may occur completely, or there may be some permanent loss of function.

    Over half of the people who have a stroke are able to function independently at home.

    If treatment with clot-busting drugs is successful, the symptoms of a stroke may completely go away. However, patients do not often arrive at the hospital soon enough to receive these drugs, or there are complicating medical conditions that prevent their use.

    People who have an ischemic stroke (stroke due to a blood clot) have a better chance of surviving than those who have a hemorrhagic stroke (stroke due bleeding in the brain).

    The risk for a second stroke is highest over the first few weeks or months after the first stroke and then begins to lessen.


    Complications
    • Breathing food into the airway (aspiration)
    • Decreased life span
    • Difficulty communicating
    • Fractures
    • Malnutrition
    • Muscle spasticity
    • Permanent loss of brain functions
    • Permanent loss of movement or sensation in one or more parts of the body
    • Problems due to loss of mobility, including joint contractures and pressure sores
    • Reduced ability to function or care for self
    • Reduced social interactions
    • Side effects of medications

    Calling your health care provider

    Stroke is a medical emergency that requires immediate treatment. Call your local emergency number (such as 911) if someone has symptoms of a stroke.