Stroke Survival: Hospital Visit Or Home Care?

A stroke is a life-threatening condition that occurs when there is an interruption in blood flow to the brain, resulting in brain cells being deprived of oxygen. It is a medical emergency that requires immediate attention to prevent permanent damage or death. While it is possible to survive a stroke, the chances of recovery without medical intervention are slim. The longer a stroke goes untreated, the greater the likelihood of extensive brain damage and disability. Therefore, seeking prompt medical attention is crucial for increasing the chances of survival and reducing the risk of long-term complications.

The importance of immediate medical attention

Immediate medical attention is critical following a stroke to prevent permanent damage or death. A stroke is a life-threatening condition that occurs when there is an interruption in blood circulation in the brain, resulting in a lack of oxygen supply to brain cells. This can lead to brain cell death and severe health complications.

Preventing Brain Damage

The longer a stroke goes untreated, the greater the chance of extensive brain damage and disability. Ischemic strokes, the most common type, unfold over 10 hours, and with every minute of delay, the brain loses two million brain cells. Therefore, every second counts during a stroke, and immediate medical attention is crucial to minimise brain damage and improve the chances of recovery.

Reducing Risk of Disability

Strokes are the number one cause of serious adult disability, and without prompt medical attention, the risk of permanent disability increases. Immediate medical care can help restore blood flow to the brain, preventing or limiting the severity of damage. This can improve the chances of regaining functions affected by the stroke, such as speaking, thinking, or walking.

Lowering Risk of Death

Strokes are highly time-sensitive, and delays in treatment can lead to permanent brain damage and death. With rapid medical help, many people can survive an initial stroke and improve their chances of survival. Immediate medical attention allows for timely interventions, such as drug therapies or surgeries, to treat the underlying cause of the stroke and reduce the risk of fatal complications.

Providing Comprehensive Care

Hospitals are equipped with medical teams that can provide comprehensive care for stroke patients. This includes not only treating the stroke itself but also managing related health issues, such as high blood pressure, diabetes, or cholesterol levels, which can impact recovery and influence the risk of another stroke. Additionally, hospitals can provide supportive care, such as physical therapy, occupational therapy, and speech therapy, to aid in the patient's overall recovery and improve their quality of life.

Monitoring and Preventing Recurrence

Receiving immediate medical attention after a stroke allows for continuous monitoring and management of the patient's condition. This is crucial because the risk of a second stroke is much higher after the first one. Medical teams work to reduce this risk by treating underlying conditions and managing risk factors. They also perform regular checks to identify and treat any complications that may arise, even months or years after the initial stroke.

In summary, immediate medical attention is of utmost importance following a stroke. It can mean the difference between life and death, prevent permanent disability, minimise brain damage, and provide comprehensive care and monitoring to improve the patient's chances of recovery and overall well-being.

The different types of strokes

Strokes can be classified into two main categories: ischemic strokes and hemorrhagic strokes. About 87% of all strokes are ischemic, while 13% are hemorrhagic.

Ischemic Strokes

Ischemic strokes occur when a blood vessel that supplies the brain becomes blocked or "clogged" and impairs blood flow to the brain. Brain cells and tissues begin to die within minutes due to the lack of oxygen and nutrients. Ischemic strokes are further divided into two groups:

• Thrombotic strokes: These are caused by a blood clot that develops in the blood vessels inside the brain, usually in older persons with high cholesterol, atherosclerosis, or diabetes. Thrombotic strokes may be preceded by one or more "mini-strokes," called transient ischemic attacks (TIAs).
• Embolic strokes: These are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain through the bloodstream. Embolic strokes often result from heart disease or heart surgery and occur rapidly without any warning signs.

Hemorrhagic Strokes

Hemorrhagic strokes occur when a weakened blood vessel, such as an aneurysm or an arteriovenous malformation (AVM), ruptures and bleeds. When this happens, brain cells and tissues do not receive oxygen and nutrients, and pressure builds up in the surrounding tissues, causing irritation and swelling, which can lead to further brain damage. Hemorrhagic strokes are also divided into two main categories:

• Intracerebral hemorrhage: Bleeding occurs from the blood vessels within the brain, usually caused by high blood pressure. There are usually no warning signs, and the bleeding can be severe enough to cause a coma or death.
• Subarachnoid hemorrhage: Bleeding occurs in the subarachnoid space, which is the space between the brain and the membranes that cover it. This type of hemorrhage is often due to an aneurysm or an arteriovenous malformation and can also be caused by trauma.

Transient Ischemic Attack (TIA)

Transient ischemic attacks (TIAs) are often referred to as "mini-strokes" and can last up to a few minutes. While TIAs cause significantly less damage than ischemic and hemorrhagic strokes, they should not be taken lightly as they are often warning signs of a future stroke. If you experience a TIA, it is crucial to seek medical attention immediately.

Recognising the symptoms of a stroke

F.A.S.T. Warning Signs

F.A.S.T. is an easy acronym to help you remember the signs of a stroke and the importance of acting quickly:

• F = Face Drooping: Does one side of the person's face droop or is it numb? Ask them to smile. Is their smile uneven?
• A = Arm Weakness: Is one of their arms weak or numb? Ask them to raise both arms. Does one arm drift downward?
• S = Speech Difficulty: Is their speech slurred or strange? Are they having trouble speaking or understanding speech?
• T = Time to Call 911/999: Stroke is an emergency. Every minute counts. Call emergency services immediately. Note the time when any of the symptoms first appear, as this information helps healthcare providers determine the best treatment.

Other Stroke Symptoms

• Numbness or weakness in the face, arm, or leg, especially on one side of the body
• Confusion, disorientation, memory problems, or trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Trouble walking, dizziness, loss of balance, or lack of coordination
• A severe headache with no known cause
• Fatigue, nausea, or vomiting

It's important to note that some strokes can be "silent", meaning they occur without any obvious warning signs or symptoms. These "silent strokes" are often undetected until advanced brain imaging techniques are used. However, they have been linked to subtle problems in movement and mental processing, as well as an increased risk for future strokes and dementia.

If you or someone you know is experiencing any of these symptoms, seek medical attention immediately. Do not wait, as every second counts during a stroke. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the hospital.

Treatment options for stroke

Treatment for Ischemic Strokes

The primary treatment for ischemic strokes is tissue plasminogen activator (tPA), a powerful thrombolytic that breaks up blood clots. tPA must be administered within 3 hours of the stroke occurring, and up to 4.5 hours in selected cases. If tPA is not an option, other blood-thinning medications such as clopidogrel or warfarin may be used to prevent new blood clots from forming. In some cases, a thrombectomy may be performed, where a catheter is used to manually remove the clot. This procedure can be done up to 24 hours after the stroke.

Treatment for Hemorrhagic Strokes

Unlike ischemic strokes, treatment for hemorrhagic strokes does not involve blood thinners as this would worsen the bleeding in the brain. Instead, doctors may administer medications to counteract the effects of blood thinners if the patient is already taking them. Other medications that may be used include antihypertensives to lower blood pressure, vitamin K to help stop bleeding in the brain, and antiepileptics if the stroke leads to seizures.

Surgery may be required to repair the damaged blood vessel. There are several surgical options available, including endovascular repair (coiling), aneurysm clipping, arteriovenous malformation (AVM) surgery, and decompressive craniectomy. Endovascular repair involves threading a thin wire and catheter through the blood vessels to the aneurysm and releasing a coil of soft platinum wire to form a net that prevents further bleeding. Aneurysm clipping involves installing a clamp to prevent the aneurysm from bleeding further or bursting. AVM surgery removes or shrinks the tangled blood vessels to restore proper blood flow. Decompressive craniectomy involves temporarily removing part of the skull to relieve pressure caused by swelling.

Supportive Treatments

In addition to emergency treatments, patients may require supportive treatments during the early stages of recovery. These may include a feeding tube, IV fluids, supplemental oxygen, nutritional supplements, and compression stockings to prevent blood clots.

Preventative Treatments

After the initial emergency treatment, doctors will work to prevent another stroke from occurring. This may include evaluating the health of the patient's arteries and recommending lifestyle changes such as regular exercise, a heart-healthy diet, and quitting smoking. Medications such as aspirin may also be prescribed to improve cardiovascular health.

Recovery and rehabilitation from a stroke

A stroke can change your life in an instant. Few are prepared for this sudden, often catastrophic event, but rehabilitation rates are encouraging. The road to recovery is different for everyone, but it is important to start rehabilitation as soon as possible after a stroke. The longer a stroke goes untreated, the greater the chance of extensive brain damage and disability.

In-Hospital Rehabilitation

The typical length of a hospital stay after a stroke is five to seven days. During this time, the stroke care team will evaluate the effects of the stroke, which will determine the rehabilitation plan. The rehabilitation team includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. Therapy sessions are conducted up to six times a day while the patient is in the hospital, helping to evaluate the damage and jump-start the recovery process.

Post-Hospital Rehabilitation

After leaving the hospital, rehabilitation can continue in an inpatient rehabilitation unit, a subacute rehabilitation facility, or at home with outpatient rehabilitation. The choice of facility depends on the level of functional impairment and the intensity of therapy the patient can handle.

1-3 Months Post-Stroke

The first three months after a stroke are critical for recovery, and most improvements will occur during this time. The goal of rehabilitation is to restore function as closely as possible to pre-stroke levels or develop compensation strategies to work around any functional impairments. During this time, setbacks may occur, such as pneumonia, a heart attack, or a second stroke, which can have significant physical, mental, and emotional effects.

6-Month Mark and Beyond

After six months, improvements are still possible but will be much slower. Most stroke patients reach a relatively steady state at this point, with some making a full recovery while others experience ongoing impairments, also known as chronic stroke disease. It is important to continue following up with the care team, including the primary care physician, rehabilitation physician, therapists, neurologist, and rehabilitation psychologist.

Support and Self-Care

Frequently asked questions