Treatment:

A stroke is a medical emergency. Immediate treatment can save lives and reduce disability.

It is important to get the person to the emergency room immediately to determine if the stroke is due to bleeding or a blood clot so appropriate treatment can be started within 3 hours of when the stroke began.

Treatment depends on the severity and cause of the stroke. A hospital stay is required for most strokes.

TREATMENT IN THE HOSPITAL

Thrombolytics, such as tPA, may be given if the stroke is caused by a blood clot. Such medicine breaks up blood clots and helps restore blood flow to the damaged area. Persons who receive thrombolytics are less likely to have long-term stroke-related problems. However, not everyone can receive this type of medicine. The most important rule is that the person be examined and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, thrombolytics can make the damage worse -- so care is needed to diagnose the cause before giving treatment.

In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes due to blood clots. Aspirin may also be used.

Other medications may be needed to control other symptoms, including high blood pressure. Painkillers may be given to control severe headache.

In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.

Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. These may be given through a vein ( intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.

LONG-TERM TREATMENT

The goal of long-term treatment is to help the patient recover as much function as possible and prevent future strokes. The recovery time and need for long-term treatment differs from person to person. Depending on the symptoms, rehabilitation may include:

• Occupational therapy
• Physical therapy
• Speech therapy

Therapies such as repositioning and range-of-motion exercises can help prevent complications related to stroke, such as infection and bed sores. Those who have had a stroke should try to remain as active as physically possible.

Alternative forms of communication such as pictures, verbal cues, and other techniques may be needed in some cases.

Sometimes, urinary catheterization or bladder and bowel control programs may be needed to control incontinence.

A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show indifference or lack of judgment, which increases the need for safety precautions.

Caregivers may need to show the person pictures, repeatedly demonstrate how to perform tasks, or use other communication strategies, depending on the type and extent of the language problems.

In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet medical needs.

Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety).

Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.

Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.

Support Groups:

Additional support and resources are available from the American Stroke Association -- www.strokeassociation.org.

Expectations (prognosis):

The outlook depends on the type of stroke and how quickly treatment is received. Recovery may occur completely, or there may be some permanent loss of function.

Complications:

• Breathing in a food into the airway (aspiration)
• Decreased life span
• Difficulty communicating
• Permanent loss of brain functions
• Permanent loss of movement or sensation in one or more parts of the body
• Problems due to loss of mobility, including joint contractures and pressure sores
• Fractures
• Malnutrition
• Muscle spasticity
• Reduced ability to function or care for self
• Reduced social interactions
• Side effects of medications

Calling your health care provider:

Stroke is a medical emergency that requires immediate treatment. Call your local emergency number (such as 911) if someone has symptoms of a stroke.