
Stroke is a life-threatening medical emergency that occurs when there is an interruption in blood flow to the brain, resulting in brain cells dying due to oxygen deprivation. It is the second leading cause of death worldwide and the fifth in the United States, with about two-thirds of strokes happening to people over 65 years old. The faster a stroke patient receives treatment, the better their chances of recovery without disability. Stroke patients can improve their chances of survival by recognizing the symptoms and seeking immediate medical attention. Additionally, early rehabilitation, including physical, occupational, and speech therapy, plays a crucial role in improving long-term outcomes and restoring function.
Characteristics | Values |
---|---|
Stroke recognition | Use the BE FAST or FAST acronym to identify stroke symptoms |
Treatment | Clot-busting medication, thrombolysis, thrombectomy, blood pressure management, surgery |
Rehabilitation | Physical therapy, occupational therapy, speech-language therapy, cognitive behavioural therapy, cognitive rehabilitation |
Recovery | Varies from days or weeks to months or years |
What You'll Learn
Immediate medical attention to prevent permanent damage or death
Immediate medical attention is critical to prevent permanent damage or death from a stroke. A stroke is a life-threatening medical emergency that occurs when there is an interruption in blood flow to the brain, causing brain cells to die from a lack of oxygen. The faster a person receives treatment for a stroke, the more likely they are to recover without disability.
If you or someone you know is exhibiting signs of a stroke, it is crucial to call emergency services (911 in the US) right away. Some warning signs to watch out for include:
- Sudden loss of balance
- Sudden loss of vision in one or both eyes, or double vision
- Drooping on one or both sides of the face
- Muscle weakness or paralysis on one side of the body
- Slurred speech or difficulty speaking
Once you arrive at the hospital, the immediate medical attention you receive can include:
- Initial stabilisation of your condition and determination of the type of stroke
- Administration of clot-busting medication to reduce long-term effects, if it is an ischemic stroke caused by a blood clot
- Intensive care or acute care, depending on the severity of the stroke
- Rehabilitation starting within 24 hours, including physical therapy, occupational therapy, and speech-language therapy
- Management of blood pressure to reduce bleeding and improve clotting
- Surgery to relieve pressure on the brain caused by accumulated blood
The specific treatments will depend on the type of stroke and how soon the patient receives treatment. The goal of immediate medical attention is to restore blood flow to the brain, prevent permanent damage, and improve the patient's chances of recovery.
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Thrombolytic drugs to dissolve blood clots
Thrombolytic drugs, also known as clot-busting or clot-dissolving drugs, are used to break up or dissolve blood clots, which are the main cause of strokes and heart attacks. Thrombolytics are approved for the emergency treatment of strokes and can be administered intravenously or intra-arterially.
Thrombolytic therapy is a time-sensitive treatment that should be administered within the first 3 hours of the onset of stroke symptoms. Ideally, patients should receive thrombolytic medicines within the first 30 minutes after arriving at the hospital. The sooner treatment begins, the better the results.
Thrombolytic drugs work by quickly dissolving major clots that block blood flow to the brain, thereby helping to prevent permanent damage to brain cells caused by a lack of oxygen. Ischemic strokes, the most common type of stroke, are caused by blockages in an artery supplying blood to the brain. Thrombolytics can be used to dissolve these clots and improve patient outcomes.
However, thrombolytic therapy is not suitable for all patients. It is not administered to patients with certain medical conditions, such as recent head injuries, uncontrolled high blood pressure, or those taking blood-thinning medications. Additionally, it may cause bleeding, a common side effect that can be life-threatening.
While thrombolytic therapy is a crucial treatment option, it is just one aspect of stroke care. Stroke rehabilitation is also essential and typically involves a team of specialists, including physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses.
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Mechanical thrombectomy to remove blood clots
Mechanical thrombectomy is a procedure that can be used to improve stroke patients' survival rates. This technique involves removing blood clots from the brain, which is the most common cause of strokes. During a mechanical thrombectomy, doctors make a small incision in the patient's groin or wrist/abdomen and insert a catheter (a thin tube) into an artery. The catheter is then guided through the blood vessels to the clot using real-time X-ray imaging. Once the catheter reaches the clot, a tiny device called a stent retriever is inserted and advanced past the clot. The device then expands to the size of the artery wall, capturing the clot, and the doctor can pull it out.
Mechanical thrombectomy is a minimally invasive technique that is used when other treatments, such as clot-busting medications, are not successful. It is a safe and effective procedure that improves the chances of a good long-term outcome for stroke patients. The procedure is usually performed within 24 hours of the start of stroke symptoms, as this is the optimal window for successful treatment.
The benefits of mechanical thrombectomy include its gentleness on the patient's body compared to surgical thrombectomy, as it avoids large incisions and disruption to the skull. Additionally, patients who undergo mechanical thrombectomy often regain their ability to speak, drive, and return to their favourite activities. This procedure has been proven to be superior to intravenous thrombolytics in recent literature, and it is recommended by the American Heart Association/American Stroke Association for patients meeting certain criteria.
Overall, mechanical thrombectomy is a valuable technique that can improve stroke patients' chances of survival and recovery. It is a safe and effective treatment option that can provide a second chance at life for patients with severe strokes.
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Lowering blood pressure to limit bleeding
Lowering blood pressure is a crucial step in treating hemorrhagic strokes, which are caused by bleeding in or around the brain. This type of stroke can be life-threatening, and immediate medical attention is necessary to prevent permanent damage or death. Reducing blood pressure is a priority in this situation as it helps to limit the bleeding and prevents it from worsening.
Medication
Medications can effectively lower blood pressure and are often prescribed by doctors to manage hypertension. These may include diuretics, beta-blockers, alpha-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), vasodilators, calcium channel blockers, and alpha-2 receptor agonists. It is important to follow the prescribed dosage and not to skip or cut doses.
Dietary Changes
Adopting a healthy diet is crucial in lowering blood pressure. A diet rich in fruits, vegetables, whole grains, lean proteins, low-fat dairy, nuts, seeds, and beans is recommended. The DASH diet (Dietary Approaches to Stop Hypertension) is specifically designed to help manage and lower blood pressure by reducing sodium intake and increasing consumption of foods packed with vitamins like potassium and magnesium.
Exercise
Regular exercise strengthens the heart and improves cardiovascular health, making it easier for the heart to pump blood with less force. Aim for at least 30 minutes of moderate exercise most days of the week, or 150 hours of weekly physical activity. This can include activities such as walking, dancing, jogging, cycling, or swimming.
Weight Loss
Carrying extra body weight increases the risk of hypertension by causing hormonal disruptions and plaque buildup in arteries. Losing weight can help lower blood pressure and improve overall cardiovascular health. A steady mix of healthy eating and exercise is recommended for sustainable weight loss, aiming for 1-2 pounds of weight loss per week.
Stress Reduction
Chronic stress can contribute to elevated blood pressure. Finding healthy ways to manage stress is important, such as mindfulness, meditation, deep breathing, and talking to a mental health professional if needed.
Smoking Cessation
Smoking cigarettes or using smokeless tobacco increases blood pressure by causing blood vessels to constrict. Quitting smoking has immediate and long-term benefits, including lowering blood pressure and reducing the risk of heart disease.
Alcohol and Caffeine Reduction
Consuming excessive alcohol (more than one drink per day for women or two drinks per day for men) can raise blood pressure and interfere with the effectiveness of blood pressure medications. Caffeine can also cause spikes in blood pressure for some individuals, so it is advisable to limit caffeine intake, especially for those with high blood pressure.
Quality Sleep
Getting enough quality sleep is essential for maintaining healthy blood pressure. Aim for at least seven hours of sleep per night and establish a healthy bedtime routine. Avoid daytime naps, limit screen time before bed, and reduce caffeine intake after midday.
By combining these strategies, individuals can effectively lower their blood pressure, which is crucial in managing and treating hemorrhagic strokes. It is important to seek immediate medical attention if you or someone you know is experiencing stroke symptoms, as timely treatment significantly improves the chances of recovery and reduces the risk of permanent damage.
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Rehabilitation to improve physical, mental, and emotional symptoms
Rehabilitation is a crucial aspect of stroke recovery, addressing the physical, mental, and emotional symptoms that patients experience. The rehabilitation process should begin as soon as possible after the initial treatment, with patients at Johns Hopkins starting their rehabilitation within 24 hours of their stroke. The rehabilitation team consists of physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses, who collaborate daily to assess the patient's condition.
Physical therapy is a key component of stroke rehabilitation, aiding patients in regaining mobility and addressing issues such as balance, muscle weakness, and paralysis. Through physical therapy, patients can improve their ability to use their hands, arms, feet, and legs, enhancing their overall physical function.
Occupational therapy is another important facet of rehabilitation, helping patients retrain their brains and adapt to daily life. This type of therapy is particularly beneficial for improving hand movements and muscle control, enabling patients to perform tasks like brushing their hair or walking.
Speech-language therapy is also incorporated into the rehabilitation process, especially for patients experiencing difficulty swallowing due to the stroke or the aftereffects of a breathing tube. This therapy aids in improving language and speaking abilities, as well as enhancing the patient's ability to control muscles involved in breathing, eating, drinking, and swallowing.
Rehabilitation psychologists and neuropsychologists play a vital role in addressing the cognitive and emotional impacts of stroke. They can screen for challenges such as memory problems, depression, and impulsivity, and develop strategies to improve cognitive function and build resilience in the face of potential permanent lifestyle changes.
The intensity and duration of rehabilitation vary depending on the patient's needs. Some patients may require inpatient rehabilitation with physician monitoring and intensive therapy, while others may opt for subacute rehabilitation with a slower pace. Outpatient rehabilitation clinics are also available for patients who can return home but require ongoing therapy.
The first three months after a stroke are considered the most crucial for recovery, with patients typically making the most significant improvements during this period. However, it's important to note that improvements are still possible after this initial phase, albeit at a slower pace.
In conclusion, rehabilitation plays a pivotal role in improving the physical, mental, and emotional symptoms of stroke patients. By addressing mobility, cognitive function, and emotional well-being, rehabilitation empowers patients to regain their independence and adapt to their new circumstances.
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Frequently asked questions
Call emergency services immediately. Time is critical when it comes to stroke treatment, and the faster the person receives medical attention, the more likely they are to recover without disability. While waiting for emergency services to arrive, you can use the acronym BE FAST to identify stroke symptoms:
- Balance: Watch for a sudden loss of balance.
- Eyes: Look for sudden loss of vision or double vision.
- Face: Ask the person to smile and observe if one side of their face droops.
- Arms: Ask them to raise their arms; if one arm is weaker, it will sag or drop.
- Speech: Strokes often cause difficulty in speaking or understanding speech.
- Time: Act quickly and call for help immediately.
The treatment for stroke depends on the type of stroke: ischemic or hemorrhagic. Ischemic strokes, caused by blocked blood vessels, are treated with thrombolytic drugs to dissolve clots and improve circulation. Mechanical thrombectomy, a catheterization procedure, may also be used. Hemorrhagic strokes, caused by bleeding in or around the brain, are treated by reducing blood pressure and improving clotting to stop the bleeding. Surgery may be required to relieve pressure on the brain from accumulated blood.
The recovery process for stroke patients can vary depending on the severity of the stroke and the area of the brain affected. It typically involves rehabilitation to address physical, cognitive, and emotional symptoms. Rehabilitation may include physical therapy, occupational therapy, and speech-language therapy. The first three months after a stroke are considered the most critical for recovery, but improvements are still possible after this period, albeit at a slower pace. Family and friend support, as well as continued medical care, are important aspects of the recovery process.