Stroke

A stroke is caused when blood flow in the brain is blocked, depriving the brain of oxygen and causing the death of cells. Blood flow is disrupted in two ways.

Clot

In an ischemic stroke, a blood clot slows or stops blood flow to the brain. A clot can originate in the brain, or it can travel from another part of the body, such as from the heart. Clots are responsible for about 90 percent of all strokes.

Blood clots can be formed by atherosclerosis, a condition where the walls of arteries become hardened and

clogged by deposits of plaques. Plaques are an accumulation of cholesterol, fat, inflammatory ells, and other substances in the blood. These are caused by high cholesterol, obesity, poor diet, and other reasons.

Blood clots compromised of platelets can also form in other parts of the body, typically the heart, and become lodged in the narrow vessels in the brain. These are formed in the heart as a result of abnormal heartbeats like atrial fibrillation or because of structural abnormalities in the valves or heart chambers that disrupt normal blood flow.

Hemorrhaging

Hemorrhaging involves leaking or ruptured vessels in the brain. The hemorrhaging can come from hypertension, or high blood pressure, which causes a weak wall of the artery to rupture. This weak spot is known as an aneurysm.

Treatments for Stroke

Treatment for a stroke should begin as soon as possible. The quicker emergency treatment begins, the greater the chance of preventing any lasting damage. Treatment depends on the type of stroke a person is having.

Emergency Treatment for Ischemic Stroke

Emergency treatment for ischemic stroke must start within 4.5 hours of the event. Ischemic stroke is the most common kind of stroke that involves a blood clot in the brain. Treatment will be used to break up the clot that is blocking or disrupting blood flow in the brain.

Aspirin

One of the most common treatments doctors use during stroke emergencies is aspirin. Proven effective for thinning the blood, aspirin can help get blood to the affected area. You or a family member should inform your emergency room doctor if you're already taking aspirin for heart disease or other conditions.

Stroke Medications

Your doctor may also administer other drugs designed to break up clots. These drugs can be injected through a thin tube (catheter) in your arteries. The most common medication used to treat stroke is known as tissue plasminogen activator (TPA). It will help break up a clot that has formed in the brain. Other oral drugs that may eventually be used to thin the blood and reduce risk of future stroke include clopidogrel and warfarin. Statins have also been shown to reduce the incidence of stroke.

Catheter Embolectomy

If drugs don’t adequately break up the clot, and if the stroke is localized to one area (acute), your doctor may use a catheter to access the clot and remove it manually using specialized tools. The catheter is threaded through blood vessels towards the area where the clot is lodged. The clot is either removed by a corkscrew-like device attached to the catheter, or by clot-busting agents administered through the catheter directly to the clot.

Decompressive Craniotomy

A large stroke may lead to serious swelling in the brain in some cases. Surgical intervention can become necessary if drugs don’t adequately relieve this swelling. The goal of decompressive craniotomy is to prevent the pressure inside the skull from building up to dangerous levels. In the procedure, the surgeon will open up a flap of bone in the skull that is in the area of the swelling. Once the pressure is relieved, the flap will be returned. 

Preventive Treatments for Ischemic Stroke

After emergency procedures, your doctor will evaluate the health of your arteries and determine what needs to be done to prevent another stroke.

Lifestyle Changes

Post-stroke preventative treatment mainly focuses on improvement of cardiovascular health. This might mean lowering blood pressure or better managing cholesterol and fatty acids (lipids). It’s likely to include some combination of improved exercise, healthier diet, or medications to help.

Carotid Endarterectomy

Carotid endarterectomy is typically ordered for patients who have shown stroke-like symptoms like a transient ischemic stroke. During this procedure, a surgeon removes plaques and blood clots from the arteries in your neck. This surgery carries the risks associated with any surgery, but also that it may trigger another stroke if plaques or blood clots are released during the surgery. Protective measures are used to help reduce these risks.

Treatment for Hemorrhagic Stroke

Unlike ischemic strokes, treatments for hemorrhagic strokes don’t involve blood thinners. Thinning the blood would increase the amount of blood being lost in the brain. If you’re already taking blood-thinning medications your doctor may administer drugs to combat these effects or lower your blood pressure to allow the bleeding in the brain to slow.

Surgery

Depending on the damage to the vessel in the brain, surgery may be required after a hemorrhagic stroke. Surgery not only repairs damage, but also helps prevent future problems. However, the problem must be close enough to the brain's surface so a surgeon can access the vessel.
If a surgeon can easily access the affected artery, they may surgically remove it. This can reduce the risk of future rupture. Depending on the location of the aneurysm, surgical removal may not be possible.

Coiling

If the damaged artery is not easily accessible for surgery, catheterization is an option. Using a catheter, a surgeon may use a technique called coiling or aneurysm embolization. Once a surgeon finds the ruptured vessel, they release a coil into the area. The coil is made of soft platinum wire narrower than a strand of hair. This provides a type of net where blood can clot and seal off the hole from other arteries.

Aneurysm Clipping

Your doctor may recommend clipping the aneurysm by permanently installing a clamp to prevent it from bleeding further or bursting. Aneurysm clipping is a surgical procedure and is usually only recommended when coiling is deemed unlikely to be effective. Clipping is significantly more invasive than coiling.

Part 5 of 5: Rehabilitation

Rehabilitation After a Stroke

Rehabilitation following a stroke depends on the extent of the damage and what part of the brain was affected. For instance, if the stroke occurred in the right side of your brain you may need more physical rehabilitation focusing on walking up and down stairs, getting dressed, or bringing food to your mouth as the right side of the brain controls visual-spatial functions.
You may need rehabilitation or corrective measures to help with breathing, vision, bowel or bladder control, speech, or other problems.