No matter the type of stroke, acting fast and seeking treatment as quickly as possible is key to reducing the risk of permanent brain damage.
Treatment for Ischemic Stroke
Ischemic strokes happen when a blood clot in an artery blocks the flow of blood and oxygen to a portion of the brain. With this type of stroke, the goal is to restore blood flow to the brain as quickly as possible. In most cases, medication is given at the hospital to help break up the clot and prevent the formation of new clots. These drugs may include: Tissue Plasminogen Activator (tPA, Alteplase) Alteplase or tPA is a thrombolytic medication, often referred to as a “clot buster,” which is the gold standard for treating ischemic stroke. This drug must be started within a few hours after stroke symptoms first appear. It will quickly break up or dissolve blood clots that are blocking blood flow to the brain. This type of medicine is given through a catheter or IV tube in the arm. (1) Aspirin While aspirin won’t dissolve existing blood clots, it will help to prevent new clots from forming. Doctors may give aspirin within 48 hours of the start of stroke symptoms. Importantly, the American Heart Association advises not to take aspirin before talking to your doctor. This is because while most strokes are caused by blood clots, not all of them are. Some strokes are caused by ruptured blood vessels, and taking aspirin could potentially make these strokes more severe. Your healthcare provider will be able to tell you if you are a candidate for aspirin therapy. (2) Nonmedication treatments for ischemic stroke include mechanical thrombectomy. This endovascular procedure attempts to remove a large blood clot. A surgeon will insert a wire-caged device (called a stent retriever) through a catheter inserted in the groin to the site of the blocked blood vessel in the brain. The stent then opens and grabs the clot, allowing the doctor to remove the stent along with the trapped clot. (3)
Treatment for Hemorrhagic Stroke
Hemorrhagic strokes happen when blood vessels in or around the brain rupture or leak. This puts too much pressure on the surrounding brain tissue, cutting off circulation and starving the brain of oxygen. Treatment for hemorrhagic stroke will depend on the cause of the bleeding and what part of the brain is affected. Bleeding around the brain is often caused by abnormally formed blood vessels, called arteriovenous malformations (AVMs), and swelling within the vessels, called aneurysms. Bleeding in the brain is often caused by high blood pressure. Nonsurgical treatments for hemorrhagic stroke may include:
Controlling blood pressureStopping any medication that could increase bleeding, such as warfarin (Coumadin) and aspirinBlood transfusions with blood clotting factors to stop ongoing bleeding (1)
Other treatments for hemorrhagic stroke may include:
Endovascular Procedure A long tube is slid into a blood vessel in an arm or leg and passed all the way up to the blood vessels in the brain, where a coil or clip is placed to prevent further bleeding. (1)Surgical Clipping To treat an aneurysm, a surgeon may place a tiny clamp at its base to stop the blood from flowing.Surgical AVM Removal If an AVM is located in an accessible area of the brain, a surgeon may remove it to eliminate the risk of rupture. But this is not always possible, especially if the AVM is too large or is located deep within the brain.Stereotactic Radiosurgery This is an advanced, minimally invasive technique that uses highly focused radiation to repair vascular malformations. (1)
Things That Might Help Rehabilitation
Brain injury due to stroke can change the way you move, feel, think, or speak. The effects are greatest right after the stroke. Over time, most people will make improvements. Stroke rehabilitation programs can help, though these programs will not “cure” or reverse brain damage. The goals of stroke rehabilitation are to help stroke survivors live as independently as possible while adjusting to new limitations. Rehabilitation usually starts in the hospital, within a day or two of the stroke. Stroke rehabilitation may continue for months or even years after leaving the hospital. The types of therapy will depend on what parts of the brain were damaged during the stroke. Stroke survivors may require:
Speech therapyPhysical therapy and strength trainingOccupational therapy (relearning skills required for daily living)Psychological counseling
1. Speech Therapy
Stroke survivors may have trouble speaking, finding words, or understanding what other people are saying. This is called aphasia. Speech-language pathologists help people with aphasia relearn how to use language and communicate. Therapy may include repeating words as well as reading and writing exercises.
2. Physical Therapy
Stroke can cause problems with movement. Paralysis, or loss of muscle function, is common after stroke — especially on one side of the body. Physical therapy can help stroke survivors regain strength, coordination, balance, and control of movement.
3. Occupational Therapy
Occupational therapists or rehabilitation nurses can help stroke survivors relearn some of the skills they will need to care for themselves after a stroke. Rehabilitation nurses may help stroke survivors manage their personal care, such as bathing and washing. They can also help with therapy to regain continence (control of bladder and bowel movements) after a stroke. Occupational therapists may help stroke survivors relearn how to do activities such as preparing meals, cleaning the house, and driving. (5)
4. Psychological Counseling
Stroke can cause chemical changes in the brain that affect the way a person thinks, feels, and behaves. At the same time, stroke rehabilitation can be a long and difficult process. Even after rehabilitation is complete, most stroke survivors will live with some minor to moderate disabilities. Many stroke survivors will require mental health counseling and medication to help address issues such as depression, anxiety, frustration, and anger. It’s important to identify and treat mental health issues, such as depression, early in the recovery process. Stroke survivors that are depressed may be less likely to follow through with stroke rehabilitation and treatment plans. (6)
Where Can a Stroke Patient Get Rehab?
Before you leave the hospital, a hospital social worker will meet with you and your family to assess what type of rehabilitation programs and living situation you will need while recovering from a stroke. Some common types of stroke programs and facilities include:
Inpatient or Nursing Facilities These facilities provide 24-hour rehabilitation and care.Outpatient Facilities Patients often spend several hours a day at a facility for rehabilitation activities but return home at night.Home-Based Programs Therapists come into the home. (7)
Additional reporting by Ashley Welch.
