Stroke Treatment

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Stroke treatment

As indicated above, stabilization is the most important step such as giving oxygen by mask, starting a mannitol drip to minimize the pressure effect onto the brain from the swelling of the brain tissue around the stroke area. In the unconscious patient an airway has to be maintained and the patient has to be protected from vomiting and possible aspiration. Intensive one-on one nursing is required.

In this type of stroke there is either a closure of a narrowed blood vessel or else an embolus from somewhere else that got caught in a narrowed blood vessel and suddenly lead to a closure of it. In about half of the patients there might be an indication to attempt to dissolve this clot through the use of an infusion of tPA as mentioned above. Ref. 1 explains that this can be safely given 3 to 7 hours after the stroke started without fear of ending up with a worse scenario, a hemorrhagic stroke. A German study (Ref. 2) has shown that if thrombolytic therapy is done in strict accordance with the American Heart Association guidelines, a good outcome is achieved with ischemic stroke patients. When rechecked one year after the stroke, complete or almost complete neurological recovery was achieved in 41%.

Only 6.6% had another stroke, 3.3% had transient ischemic attacks and 4% died from other causes than a stroke. The authors felt encouraged to continue using thrombolytic therapy for selected ischemic stroke patients. Another study from England (Ref. 3) describes that 49% of severely disabled stroke patients aged 47 to 60 can learn how to walk again, even 3 to 11 months following the stroke. This had a profound positive effect on them and their families as they maintained a degree of independence. This in turn affected further speech- and other neurorehabilitation positively with better than average results.

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Strokes

Ischemic stroke

References:

1. KH Lee et al. Arch Neurol 2000 Jul 57(7): 1000-1008.

2. S Schmulling et al. Stroke 2000 Jul 31(7): 1552-1554.

3. D Jackson et al. Clin Rehabil 2000 Oct 14(5): 538-547.

4. ML Hackett et al. Neurology 2000 Sep 12; 55 (5): 658-662.

5. K Tsutsumi et al. J Neurosurg 2000 Oct 93( 4): 550-553.

6. IS Spetzler Surg Neurol 2000 Jun 53(6): 530-540.

7. G Lot et al. Acta Neurochir (Wien) 1999; 141(6): 557-562.

8. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 174.