Stroke: Causes, signs, medical assessment, and remedies explained
In the realm of neurology, treating ischemic and hemorrhagic strokes requires different strategies due to their distinct underlying causes. Ischemic strokes, characterised by blockages in arteries, and hemorrhagic strokes, caused by bleeding, each necessitate unique approaches.
For Ischemic Strokes, the primary focus is on restoring blood flow as swiftly as possible. This is achieved through acute reperfusion therapy, which can involve intravenous administration of recombinant tissue plasminogen activator (rtPA, alteplase) or tenecteplase to dissolve the clot. In cases of large vessel occlusion strokes, a catheter-based procedure known as mechanical thrombectomy (endovascular thrombectomy, EVT) may be employed to physically remove the clot. EVT has become a standard practice since 2015, with strong evidence supporting its use up to 24 hours after stroke onset in selected patients.
Additional medical and surgical treatments for ischemic strokes include antiplatelet therapy (such as aspirin), carotid endarterectomy or stenting if the stroke is caused by significant carotid artery stenosis, anticoagulation depending on stroke etiology (e.g., atrial fibrillation), careful blood pressure management, and neuroprotective drug therapies, which are currently under investigation.
Long-term care for ischemic stroke patients involves controlling vascular risk factors (hypertension, diabetes, lipids) and rehabilitation programs, including physical, occupational, and speech therapy, to improve function and quality of life.
In contrast, standard care for hemorrhagic stroke centres on controlling bleeding and managing intracranial pressure. This often involves careful blood pressure management and supportive care, such as monitoring and managing brain swelling, intracranial pressure, and prevention of complications. Surgical interventions may be necessary to evacuate the hematoma or relieve pressure in specific cases.
The following is a summary table of the treatments for each stroke type:
| Stroke Type | Acute Treatment | Adjunct/Long-term Treatments | |-------------------|---------------------------------------------------|-------------------------------------------------------| | Ischemic Stroke | - IV rtPA or tenecteplase within 4.5 hrs | - Antiplatelets or anticoagulants | | | - Mechanical thrombectomy up to 24 hours | - Carotid endarterectomy or stenting | | | | - Blood pressure control | | | | - Rehabilitation | | Hemorrhagic Stroke| - Blood pressure management | - Neurosurgical evacuation if indicated | | | - Supportive care (ICU monitoring, ICP management) | - Rehabilitation |
Rehabilitation plays a crucial role in the recovery process for both stroke types, particularly within the first three months after stroke onset. It is essential to seek immediate medical attention for stroke symptoms, as the outcome depends on how quickly treatment is received.
Transient Ischemic Attacks (TIAs), which briefly interrupt the flow of blood to the brain and are similar to ischemic strokes, can also be treated with anticoagulant or antiplatelet medications to reduce the risk of experiencing another stroke.
Sources: [1] American Heart Association. (2021). Stroke. https://www.heart.org/en/health-topics/stroke [2] National Institute of Neurological Disorders and Stroke. (2021). Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page [4] World Health Organization. (2021). Stroke. https://www.who.int/news-room/fact-sheets/detail/stroke
- In neurology, distinguishable strategies are used for treating ischemic and hemorrhagic strokes due to their contrasting causes.
- Ischemic strokes, marked by arterial blockages, require swift blood flow restoration through acute reperfusion therapy.
- Recombinant tissue plasminogen activator (rtPA, alteplase) or tenecteplase is administered intravenously for this purpose.
- In large vessel occlusion strokes, mechanical thrombectomy (EVT) may be utilized to physically remove the clot.
- EVT has become standard practice since 2015, backed by evidence up to 24 hours after stroke onset in select patients.
- Additional treatments for ischemic strokes include antiplatelet therapy, carotid endarterectomy or stenting, anticoagulation, careful blood pressure management, and neuroprotective drug therapies.
- Long-term care for ischemic stroke patients involves managing vascular risk factors and rehabilitation programs.
- Hemorrhagic stroke treatment centers on controlling bleeding and managing intracranial pressure, often requiring careful blood pressure management and supportive care.
- Surgical interventions may be necessary for hemorrhagic stroke patients to evacuate the hematoma or relieve pressure.
- A summary table outlines the treatments for each stroke type, with acute treatment for ischemic strokes including IV rtPA or tenecteplase, and mechanical thrombectomy.
- Long-term ischemic stroke treatments include antiplatelets or anticoagulants, carotid endarterectomy or stenting, blood pressure control, and rehabilitation.
- Hemorrhagic stroke treatment consists of blood pressure management and neurosurgical evacuation if necessary, as well as rehabilitation.
- Rehabilitation significantly contributes to the recovery process for both stroke types, primarily within the first three months after stroke onset.
- Immediate medical attention is crucial for stroke symptoms, as the outcome is contingent on the speed of treatment.
- Transient Ischemic Attacks (TIAs), similar to ischemic strokes, can be treated with anticoagulant or antiplatelet medications to minimize the risk of another stroke.
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