Furious Doc
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« Reply #3 on: August 31, 2008, 01:44:55 PM » |
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Treatment of Stroke
Treating a stroke depends on where the stroke occurred in your brain and whether it's ischemic or hemorrhagic. The doctor may use a magnetic resonance imaging (MRI) scan, computed tomography (CT) imaging or angiography (injecting dye through a catheter inserted into the suspected blocked blood vessel and taking x-rays of the vessels) to determine the stroke type and location.
Time is critical. Until a few years ago, strokes were regarded as untreatable. Brain cells were thought to die within minutes after a stroke began, so stroke treatment was believed useless. The only onsite medical treatment is stabilization and "wait and see." Now researchers have discovered that some brain cells die immediately after a stroke, but others can survive for as long as several days. It is now clear that treatment following a stroke, especially if begun within three hours of onset, can help preserve brain tissue.
In June 1996 the FDA approved tissue plasminogen activator (t-PA) as the first treatment for strokes caused by arterial blockages. This "clotbuster" is inserted into the femoral artery near the groin and then threaded up into the brain to directly dissolve the blood clot, thereby limiting or stopping the damage to the brain cells. This therapy is used on ischemic strokes and effective within three hours of onset.
The use of t-PA is not recommended after three hours of onset due to the risk of hemorrhaging, thus standard treatment is administered. In an ischemic stroke the goal is to (1) maintain normal blood pressure and (2) improve blood flow by preventing recurrent clots. This is done by administrating anti-hypertensives to reduce blood pressure, platelet-inhibiting drugs such as aspirin, ticlopidine (Ticlid) or an anticoagulant such as heparin, coumadin or warfarin to prevent blood clots from forming or growing.
If unsuccessful, a carotid endarterectomy may be considered. This procedure removes the atherosclerotic plaque and the blood clot from the left or right carotid artery (the major vessels that carry blood through the neck to the brain) thus allowing the blood to flow uninterrupted.
In a hemorrhagic stroke, the goal is to (1) get the blood pressure under control and (2) correct the cause of the hemorrhage and protect the brain from further damage. The hemorrhage causes blood to pool in the brain and thus increases pressure on the brain. The doctor will give diuretic drugs to minimize the temporary swelling of the brain tissue.
Rarely is surgery recommended, but if tests detect an aneurysm, the surgeon may clamp the aneurysm at its base and then remove it. The surgeon now has the option to use a catheter, containing a metal coil, that passes through the blood vessel in the neck. The metal coil causes the aneurysm to clot and seal itself off.
Some people are only slightly affected by strokes. Others recover quickly from what seemed like a severe stroke. Still others may suffer such serious damage that it will take a long time to regain even partial use of their limbs, speech, or whatever faculties that have been affected.
Successful rehabilitation depends on the extent of brain damage, the patient's attitude, the skill of the rehabilitation team, and the cooperation of family and friends. Most stroke patients can benefit from rehabilitation, and today the outlook for stroke patients is more hopeful than ever before. Because of advances in treatment and rehabilitation, many patients are being restored to a fully functional life.
For rehabilitation to be most effective, three points must be kept in mind:
1. Rehabilitation must begin as soon after the stroke as possible
2. The family can be the patient's most important means of support during the rehabilitation process
3. Rehabilitation is a team effort with the physician, nurse, and other specialists working with the patient and their family.
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