Risk and treatment of stroke

Brain damage from a stroke can be temporary or permanent. Early treatment and preventive measures can reduce the impact. Outcomes of strokes depend upon how much of the brain is damaged and how quickly treatment begins – which ideally should be within 4-6 hours of symptoms.

Susan Locke

Know symptoms – and react quickly

• Face drooping on one side or numbness. Ask the person to smile.
• Arm weakness or numbness. Ask the person to raise both arms. Does one drift downward?
• Speech difficulty, slurred or garbled speech. Ask him to say “The sky is blue.”
• Time – Call 911, the faster a patient gets help, the lower his chances of permanent damage.

IN CASES OF A SUSPECTED STROKE, CALL 911 AND PROCEED TO THE NEAREST HOSPITAL, ideally one with a specialized stroke center.

Early diagnosis can save vital tissue

In addition to clinical symptoms, diagnosis is made usually by CT scan or MRI.

With new imaging modalities like CT perfusion, not only can diagnosis be made early but doctors can assess the degree of tissue damage as well as the degree of tissue that can be saved.

Treatment aim is to restore blood flow

For patient with an Ischemic stroke, the goal is to restore blood flow quickly, ideally within the first few hours of symptoms – with either intravenous thrombolytic treatment with the IV medication alteplase; or mechanical intra- arterial thrombectomy to open the blocked artery.

Longterm prevention:

• Antiplatelet medications: aspirin 50-325 mg/ day, Clopidogrel (Plavix), or combination of aspirin and extended-release dipyridamole (Aggrenox)
• Anticoagulant therapy: Coumadin, Pradaxa, Eliquis, Xarelto
• Revascularization by angioplasty and stenting or by carotid endarterectomy (although not in an acute situation) are procedures that open a narrowed carotid artery

For patient with a Hemorrhagic stroke, treatment depends upon cause of bleeding, so it is crucial to identify the cause.

Medical treatment:

• Control blood pressure.
• Stop any medications that could increase bleeding.
• Measure the pressure within the brain with a ventriculostomy tube. If pressure is elevated, cerebrospinal fluid or blood can be drained. This procedure is done in an ICU or in an operating room.

Surgical treatment:

• The goal of surgical treatment is to prevent or stop bleeding and reduce the pressure in the skull.
• If an aneurysm (ballooning) of a blood vessel has caused the bleeding, the aneurism can be clipped surgically. More recently, surgeons are doing a Coil embolization where a tiny flexible tube is guided up through the body into the vessel in the brain at the site of the aneurysm. The coil is advanced into the weakened area and diverts the blood ow to a more normal path.
• Arteriovenous malformation (AVM) treatment depends on the patient’s age, AVM location and size and the abnormalities of the veins that drain. Treatment options include surgery, radiosurgery or embolization.
• Decompressive craniotomy is a procedure where the skull is open to relieve the pressure on the brain.