Stroke Treatment and Prevention
Neurology / / August 12, 2017
Until recently, treatment of stroke was limited to basic life support during the course of the attack, and rehabilitation.Now, however, the treatment may be useful as soon as possible after the onset of stroke.It is important to get to the hospital and a diagnosis as soon as possible.Getting treatment at an early stage is important in reducing the damage caused by stroke.
Stroke is the fourth leading cause of death.However, death rates reduced.More than 75% of patients survive for a year after the first stroke, and more than half die before 5 years.
People who suffer an ischemic stroke, have a much better chance of survival than those who have a hemorrhagic stroke.The biggest danger comes from an ischemic stroke embolism, seizures, and then - from thrombotic lacunar strokes.
Hemorrhagic stroke is not only destroys brain cells, but also creates other complications, including increased pressure on the brain, or spasms in the blood vessels, which can be very dan
treatment of ischemic stroke
Immediate treatment for ischemic stroke aimed at dissolving the clot.Patients who come to the emergency room with symptoms of acute ischemic stroke is usually prescribed aspirin to thin the blood he helped.Aspirin can be deadly for patients with hemorrhagic stroke, so it is better not to take aspirin alone at home until the doctor will decide which stroke occurred.
If a patient comes to the hospital for 3-4 hours after the stroke (when only the symptoms appear), he may be a candidate for thrombolytic ( "clot Buster") drug therapy.Thrombolytic drugs are used to destroy existing blood clots.Standard thrombolytic drugs - is tissue plasminogen activator (T-PA).They include: alteplase (Aktivazu) and reteplase (Retavazu).
The following steps are crucial before injecting clot Buster: before thrombolytic therapy is performed CT - a doctor must first make sure that the stroke does not hemorrhagic stroke.If it is ischemic, and if the injury is very extensive, it can affect the use of thrombolytics.Thrombolytics should generally be administered within 3-4 hours after a stroke, otherwise they will have no effect.Best results are obtained when patients were administered thrombolytics for 90 minutes after the stroke.
Some patients can experience the benefits of the treatment of thrombolytic therapy after 4.5 hours after the onset of stroke symptoms.These patients include those who are younger than 80 years who have a less severe stroke who have a history of stroke or diabetes and who do not accept blood products (thin anticoagulants).Patients who do not meet these criteria, you should not use thrombolytic therapy after 3 hours.
Thrombolytics dangerous risk of bleeding, so they may not be appropriate for patients with existing risk factors for bleeding.
Treatment of hemorrhagic stroke
Treatment of hemorrhagic stroke depends in part on whether a stroke is caused by bleeding between the brain and skull (subarachnoid hemorrhage) or intracerebral hemorrhage.They can be used as drugs and surgery.
- Medicines. Different types of drugs are prescribed depending on the cause of the bleeding.If the cause is high blood pressure, antihypertensive drugs are administered to reduce it.If the cause is an anticoagulant - such as warfarin (Coumadin), or heparin, they immediately canceled, and other drugs are administered, increases blood clotting.Such drugs are calcium channel blockers Nimodipine (Nimotop), can reduce the risk of ischemic stroke, hemorrhagic stroke following.
- Surgery. operation can be performed for an aneurysm or arteriovenous malformation, which causes bleeding.The operation can be performed via craniotomy, which involves the creation of holes in the skull bone.Less invasive it can be done by introducing the catheter.The catheter extends through a small incision in the groin to the artery and then to the small blood vessels of the brain where the aneurysm.If the aneurysm is a gap, the clip can be placed on it to prevent further leakage of blood to the brain.
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- Hypertension (high blood pressure)
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control and treatment of complications of stroke
In the early days after a stroke, patients are at risk for complications.In this case, the following steps must be done:
- Maintain an adequate supply of oxygen. This is very important.In some cases, you may need to airway ventilation.Also, patients may need extra oxygen when the blood - his lowest level;
- Manage fever. Fever from the beginning and should be monitored intensively treated with medication and, cooling blankets if needed;
- Ensuring swallowing. patient should provide ways of swallowing, before he starts taking food, liquid or medication.Otherwise there is a danger of suffocation;
- supporting electrolyte.Maintaining a healthy electrolyte balance (ratio of sodium, calcium and potassium in the body fluids) is critical;
- Monitor blood pressure. Blood pressure control is important, but difficult.Blood pressure often falls spontaneously within the first 24 hours after stroke.Patients whose blood pressure remains high, it should be used with caution with antihypertensive drugs;
- Monitor the pressure of the brain. Hospital staff should closely monitor the evidence of increased pressure on the brain (cerebral edema), which is a common complication of hemorrhagic stroke.It can also occur in a few days after the ischemic insult.Early symptoms of brain pressure increased drowsiness, confusion, lethargy, weakness and headache.Drugs may be given to reduce the pressure or the risk thereof.Keeping your upper body above the lower - for example, raising the head of the bed, you can reduce the pressure in the brain.It is standard practice for patients with ischemic stroke, but it lowers blood pressure, which can be dangerous for patients with a massive stroke;
- Montoring cardiac activity. Patients should be monitored with the help of electrocardiographic monitoring equipment atrial fibrillation and other heart rhythm problems, especially those who have a stroke, has a high risk of heart attack;
- Control of blood sugar (glucose). Elevated levels of blood sugar (glucose) can occur in severe stroke and can be a serious nuisance.Such patients may require insulin therapy;
- Monitor blood clotting . Regular blood clotting tests are important to ensure that the blood is not "thick";
- Check for deep vein thrombosis. Deep vein thrombosis - a blood clot in the veins of the lower leg or thigh.This can be a serious complication of post-stroke, because there is a risk of detachment of the clot (thrombus) and its movement through the veins in the brain or heart.Deep vein thrombosis can also cause pulmonary embolism.If necessary, it can be provided anticoagulants - for example, heparin, but this increases the risk of bleeding.Stroke patients are also at risk for pulmonary embolism;
- Preventing infections. Patients who have had a stroke are at increased risk of pneumonia, urinary tract infections and other common infections.
complications of stroke and disability
Many patients are left with physical weakness, frequent pain and spasticity (muscle stiffness or spasms).Depending on the severity of the symptoms, these disturbances may affect the ability to walk, get up from a chair, use a computer, drive a car, and many other daily activities.
- Factors that affect the quality of life in survivors . Many people who have had a stroke can regain functional independence after a stroke.25% remain - with a slight disability and 40% - suffer from moderate to severe disabilities.
- Factors influencing recurrence . risk for recurrent stroke is highest in the first few weeks and months after the previous stroke.But about 25% of the people will continue the first attack, and another stroke can occur within 5 years.Risk factors for relapse include: older age;blocked arteries (history of coronary artery disease, carotid artery disease, peripheral artery disease, ischemic stroke or TIA);hemorrhagic stroke or embolism;diabetes;alcoholism;Valvular Heart Disease;atrial fibrillation.
Patients who have had a first stroke or TIA are at high risk of recurrent stroke.secondary prevention measures are essential to reduce this risk.
- Quit smoking. Smoking is a major risk factor for stroke.Patients should also avoid exposure to second-hand smoke.
- Eat a healthy diet. Patients should follow a diet rich in fruits and vegetables high in potassium and low in saturated fat.Everyone should limit the intake of sodium (salt) to less than 1500 mg / day.This is especially important for people over 50 years and all with high blood pressure.
- Exercise. Exercise helps reduce the risk of atherosclerosis, which can help reduce the risk of stroke.Doctors recommend at least 30 minutes of exercise every day of the week.
- Maintain a healthy weight. obese should try to lose the weight through a healthy diet and regular exercise.
- Avoid alcohol. Drinking alcohol increases the risk of both ischemic and hemorrhagic strokes.
- Control Diabetes .People with diabetes should aim for the level of fasting blood glucose less than 110 mg / dL and hemoglobin A1C 7%.The blood pressure for people with diabetes should be 130/80 mm Hg.Art.or less.
- control blood pressure.Lowering blood pressure is important in the prevention of stroke.Otherwise healthy patients with high blood pressure should aim for blood pressure below 140/90 mm Hg.Art.Patients with diabetes, chronic kidney disease, atherosclerosis or should strive for a BP below 130/80 mm Hg.(However, these recommendations are now overvalued).Drug therapy is recommended for people with hypertension, who can not control their blood pressure through diet and other lifestyle changes.Many different types of drugs used to control blood pressure.
- Reduced cholesterol. Patients who have had an ischemic stroke or TIA should take statin drugs to lower cholesterol.Most patients should be directed at reducing their LDL ( "bad") cholesterol to less than 100 mg / dL.Patients with multiple risk factors, should strive for LDL levels below 70 mg / dL.
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Medications for antiplatelet prophylaxis of stroke
doctor may suggest aspirin or other antiplatelet drugs - such as Clopidogrel (Plavix) to helpprevent blood clots in arteries or the heart.These medications called antiplatelet agents, they make platelets less sticky and therefore reduce the likelihood of clot formation.But you should never take aspirin without first talking to your doctor.
- Primary prevention (to prevent a first stroke) . Antiplatelet drugs are taken to a stroke or TIA.Before deciding whether to take aspirin to prevent stroke caused by clogging the arteries (ischemic stroke), the physician should assess whether the patient is at increased risk of seizures, caused by bleeding into the brain (hemorrhagic stroke), as well as bleeding in other parts of the body.For men and women of any age who have a low risk of stroke, there is no evidence that the mere Aspirin can help prevent an attack.
- Women aged 55-79 years should consider taking low-dose aspirin (81 mg daily), if they have a risk of stroke or heart attack.Risk factors: heart disease, high blood pressure, diabetes, smoking, atrial fibrillation, left ventricular hypertrophy.
- Women younger than 55 years old should not take aspirin for the primary prevention of stroke.
- Men aged 45-79 years should consider taking aspirin if they have an increased risk of heart attack.Aspirin is not recommended for men only for the prevention of stroke.Some risk factors for coronary heart disease and heart attack: heart disease, high blood pressure, diabetes, smoking, atrial fibrillation, left ventricular hypertrophy.
- Men younger than 45 years old should not take aspirin for the primary prevention of stroke.
for women and men aged 80 years and older is not clear whether the benefits outweigh the aspirin for prevention of stroke - bleeding risks in the gastrointestinal tract or the brain.
Daily use of aspirin can cause ulcers and gastrointestinal bleeding.We need to talk to your doctor about these risks.
- Secondary prevention (to prevent recurrent stroke after the first). after an ischemic stroke or TIA aspirin twice a day is recommended to prevent recurrent stroke.Clopidogrel may be used instead of aspirin for patients who have a narrowing of the coronary arteries, or have had a stent.The combination of aspirin and clopidogrel together longer has advantages and increases the risk of bleeding.
Medication-anticoagulants for stroke prevention
anticoagulants - drugs that are also called antisvertyvayuschey or blood thinners.They are used to prevent clot formation and stroke.For most patients with atrial fibrillation, secondary and higher risk of stroke, they are considered the best means for the prevention of stroke.
Warfarin (Coumadin) - the primary anticoagulant used to prevent strokes in high-risk patients with atrial fibrillation.As with all anticoagulants, warfarin increases the risk of bleeding, but for most patients the advantages far outweigh the risks.is a high risk of bleeding when administered Warfarin first time, at higher doses and long periods of use.