Therapies

Medical Essentials:

Diagnosis

A number of tests may be performed to pinpoint the type of stroke and help the professionals decide on the most appropriate treatment. They may include:

• blood pressure measurement
• blood sampling
• x-rays
• electrocardiogram (ECG) to assess the heart’s rhythm
• echocardiogram, to look at the heart’s structure and ability to function
• brain scans such as magnetic resonance imaging (MRI), computed tomography (CT) to check the kind of stroke and view the extent of damage
• carotid ultrasound scanning or transcranial doppler ultrasonography (a type of ultrasound scan) to assess blood flow to the brain

Treatment

Speed is everything. Fast treatment is essential. Acute stroke therapies try to stop a stroke while it is happening. These treatments try to dissolve the blood clot causing an ischemic stroke or to stop the bleeding of a hemorrhagic stroke. These therapies are most effective when given very soon after the onset of a stroke.

Treatment of a hemorrhagic stroke is very different from that of an ischemic stroke. Anticoagulants, thrombolytic drugs, and antiplatelet drugs (including aspirin) given to dissolve the clot in an ischaemic stroke would increase bleeding and make a haemorrhagic stroke much worse.

With a haemorrhagic stroke, surgery may be life saving. The goal of surgery is to stop and remove blood accumulating in the brain and to relieve the resulting increased pressure.

Post–stroke treatment and rehabilitation are used to lower the risk of another stroke and to help patients overcome disabilities that result from stroke. People who have had a stroke can do things to lower their risk of having another stroke. These include controlling their underlying risk factors.

BBC reports suggest that: Although between 20 and 40 per cent of people who have had strokes are treated at home, research has now conclusively proved that organised stroke care in a dedicated stroke unit saves lives and reduces disability.

Long-term Treatment of Stroke

Long-term treatment after a stroke consists of a variety of therapies, and aims to help you get back as much independence as possible. This process of rehabilitation will be specific to you, depending on your symptoms, and their severity. A team of specialists can be expected to help, including physiotherapists, psychologists, occupational therapists, speech therapists and specialist nurses and doctors.

An essential part of rehabilitation is exercise. The type and amount of exercise depends upon the severity of the stroke, and the parts of the body that have been affected. A common effect of a stroke is weakness in an arm or leg, and without exercise and physiotherapy this can lead to a loss of muscle strength. If the muscles lose strength they begin to contract (shorten), pulling your arm or leg into a curled position, which would make day-to-day tasks difficult. Exercise is also important for your overall health, and reduces the chances of developing heart disease, osteoporosis or another stroke. Your GP and physiotherapist can talk with you about ways of exercising that will suit you and your lifestyle.

Occupational and Speech Therapists have critical roles to play in helping to overcome and work around the effects of a stroke. Physiotherapy, Speech Therapy and Occupational therapy are three pillars of post-stroke progress.

Drug Treatments

The NHS website has explained that: If you have had an ischaemic stroke, a 300mg dose of aspirin will be given as soon as possible. Aspirin prevents the clot from getting bigger and if taken within 2 days of the stroke, improves your chances of making a good recovery. A “thrombolytic” medication to dissolve the blood clot may also be attempted, but this is only currently a possibility in the first three hours after an ischaemic stroke.

If you have had a haemorrhagic stroke, you will not be given aspirin because it can cause further bleeding and make the stroke worse. Drugs to lower blood pressure and prevent further damage are being used experimentally in the case of haemorrhagic strokes.

We note: Do not use aspirin as first-aid for a stroke. It could be a haemorrhagic stroke and you could be making matters much worse.

Drug treatments are designed to tackle the effects of stroke, prevent complications and help treat risk factors in the hope of preventing a further stroke occurring. There are hundreds of drugs that may be used. They may include:

• anti-platelet drugs (such as aspirin) that make the blood less sticky and help reduce its tendency to clot (only if and as advised by your doctor);
• anti-coagulant drugs that reduce clotting factors in the blood so it is less likely to clot. Heparin is a fast-acting anti-coagulant used in hospital. Warfarin is a commonly prescribed anti-coagulant
• cholesterol-lowering drugs to reduce high cholesterol levels
• anti-hypertensive drugs that lower the blood pressure
• drugs designed to limit the extent of damage to the brain tissue

The risk of ischaemic stroke can be significantly reduced with anticoagulant medicines including warfarin, phenindione and acenocoumarol.

If you have had an ischaemic stroke, you may be advised to take anti-platelet or anti-coagulant medicines to help prevent another stroke occurring. Aspirin is the anti-platelet medication most commonly prescribed. Once aspirin is started, it is currently likely that you will be told to go on taking it. Dipyridamole is used in combination with aspirin in certain people after a stroke. Aspirin and dipyridamole are not normally used together for more than 2 years after the last stroke. After 2 years, you would continue on aspirin alone. Anti-platelet medications may not be useable if you have certain allergies, and it is very important to follow your doctor’s instructions and cautionary advice carefully when using them.

Regardless of whether you’ve had a haemorrhagic or ischaemic stroke, medicines may also be prescribed to reduce the risk factors of having further strokes. These may include medicines to control high blood pressure, high cholesterol, diabetes (high blood sugar) or atrial fibrillation (fast and irregular heart beat). People with atrial fibrillation require full anticoagulation to stop the blood from clotting. Atrial fibrillation causes blood clots to form on the heart valves. If a blood clot breaks off and is carried in the bloodstream to the brain, it may cause an ischaemic stroke.

The Cochrane Reviews tell us that: Stroke is the third most common cause of death and the most common cause of disability in the western world. The development of drugs to limit the effects of brain damage caused by stroke continues, but no routine effective treatment has yet been identified. There are a large number of treatments being tried. Searching “Stroke” on the Cochrane Collaboration website will give you most of them, with high level reviews.

We note again: There seems to be a general awareness that a daily dose of Aspirin can reduce the likelihood of stroke. DON’T DO IT without carefully consulting your doctor. For certain heart, venous and other conditions it might be the right medication, and if it could help you your doctor will tell you. It might also cause a haemorrhagic stroke or other problems. A study published on 1 May 2007 in The Lancet Neurological emphasises this danger.

Surgery

Surgery for a haemorrhagic stroke can be absolutely life saving and improve the outlook for healing immensely. The goal of surgery is to remove blood that has accumulated in the brain and to relieve the resulting increased pressure. Surgery may also deal with an aneurysm, and may prevent recurrence of some haemorrhagic strokes, but it does carry risks and may or may not be suitable.

Some people who have had a transient ischaemic attack (TIA) or minor stroke that has been caused by blockage in the carotid artery in the neck may benefit from an operation called carotid endartectomy to remove the blockage, or insertion of a stent (a short stainless steel mesh tube) into the artery to help keep the artery open. This may significantly reduce the risk of having a full-blown stroke.

Rehabilitation

Many people who survive a stroke are left with some significant disability. Having said that, the brain is remarkably adaptable, and in the months or years after a stroke many cells that have sustained damage recover some of their function. At the same time other areas of the brain take over the functions performed by the cells that have died. The time it takes to recover is extremely variable. However, commonly people have a surge of recovery in the weeks following a stroke followed by a slower recovery over the next year to 18 months or so. The aim of rehabilitation is to encourage and enhance this process.

Rehabilitation helps stroke victims relearn skills that may be lost when the brain is damaged. Rehabilitation is likely to include:

• Physiotherapy – Physical therapy to help restore movement, balance, and coordination
• Occupational Therapy to help the patient relearn everyday activities such as eating, drinking, dressing, bathing, cooking, reading and writing
• Speech Therapy to help stroke patients relearn language and speaking skills, including swallowing, or to learn other forms of communication
• Psychological or Psychiatric Help. Psychological problems, such as depression, anxiety, frustration, and anger, can be common after a stroke

In general the objectives of rehabilitation and medical follow-up are to help aid physical recovery, manage the physical, emotional and social effects of stroke, encourage you become as independent as possible, prevent potential medical or psychological complications, and reduce the likelihood of further strokes. Starting rehabilitation as early as possible can substantially improve recovery and reduce the effects of disability.