How can a stroke be treated?

The treatment of a stroke is two-fold. The first thing to establish is the type of stroke you have had- as in was it caused by a bleed or a blockage. A CT brain will distinguish between these two.

If it was caused by a blockage the sequence is as follows:

  1. When was the onset of the symptoms? If you have come to hospital within 3- 4.5 hours you may be a candidate for a clot busting treatment. Your doctor will be able to identify if you are a candidate for this or not. If you have arrived after the 3- 4.5 hour time window then you will most likely receive a high dose of aspirin.
  2. Your blood pressure is likely to be high right after a stroke- this is a normal physiological response. Within a few days though if your blood pressure is consistently high you will likely need medication- this may turn out to be why you had a stroke.
  3. The next thing that will be done is a series of investigations to try and identify why you may have had a stroke. This will involve a heart rhythm monitor and a scan of your heart and neck at the very least. Blood tests will be done to check for high cholesterol and diabetes. There may be more investigations but this will be done on an individual basis.
  4. Your cholesterol may or may not be high but most patients following a stroke will be treated with medication to reduce cholesterol.
  5. If you have diabetes this will need to be controlled. You may not know you have this but it will form part of the management of your stroke.

If your stroke was caused by a bleed the sequence is as follows:

  1. The most important thing your doctor will do if you have suffered a bleed is to make sure your blood pressure is not too high. High blood pressure is a common cause of a bleed related stroke and control of it is important to prevent it from happening again.
  2. Sometimes after a brain haemorrhage there can be brain swelling. If this happens medication will be given to reduce this swelling.
  3. You will have more brain scans to try and see what kind of bleed it was. There are bleeds that occur from rupture of an aneurysm (which is a blood filled pouch that balloons out from an artery)- this is called a subarachnoid haemorrhage. Here the blood collects in the linings of the brain between brain and skull. In this case you may need to have a surgical procedure to prevent it from happening again. There are also bleeds that occur deep in the brain tissue- these are the ones that are caused by having high blood pressure. Sometimes these bleeds are caused by a cluster of abnormally formed blood vessels which is referred to as an arteriovenous malformation.

The next part of the management of stroke will be rehabilitation. The amount of rehabilitation you need will really depend on what was affected by your stroke. Recovery varies from person to person. People often make a lot of recovery within the first year but recovery can continue long after that. Recovery is a gradual process as the brain takes a lot of time to heal.

The disabilities resulting from a stroke can range from paralysis or problems controlling movement, sensory disturbances including pain, problems with use and understanding of language, problems with thinking and memory and emotional disturbances.

Rehabilitation may involve relearning skills, learning new skills and adapting to the limitation caused by the stroke.

Rehabilitation will involve physiotherapy, occupational therapy, speech therapy and psychological input.

A stroke may have only affected you in a physical sense as in weakness on one side of your body but this can have a huge psychological impact. Simple tasks such as getting up and dressed in the morning may now become a challenge and dealing with the psychological impact of this is as important as dealing with the physical aspect.

Pain following a stroke is a common occurrence. It can stem from both the neurological dysfunction but also the knock-on effect on muscles and joints that can occur following a weakness or paralysis of one side of the body. Early physiotherapy and occupational therapy can be helpful here. However, it is also important for patients to tell their doctors if pain is an issue as there are many different ways of managing this.

Depression following stroke is quite common. Signs of depression include sleep disturbances, changes in eating patterns, weight gain or loss, social withdrawal, irritability, fatigue and in severe cases suicidal thoughts. It is important to acknowledge that having a stroke can have a huge impact on your life and feeling depressed about that is not something to ignore. This can be quite successfully treated through the use of antidepressants and counselling.

Successful rehabilitation will depend upon the extent of the brain injury, the attitude of the patient in terms of being positive and motivated, the level of social (family and friends) support and early time to start rehabilitation.

Overall, when it comes to stroke the important steps to take are those to try and prevent it from happening. Identifying what your risk factors are and then making positive lifestyle changes to address these will significantly reduce your chance of ever having a stroke.

Know your numbers:

Blood Pressure:

Blood Pressure Category Systolic mmHg

(upper number)

Diastolic mmHg

(lower number)

Normal <120                         and <80
Elevated 120-129                   and <80
High Blood Pressure Stage 1 130-139                   or 80-89
High Blood Pressure Stage 2 140 or higher          or 90 or higher
Hypertensive Crisis Higher than 180  and/or Higher than 120

Cholesterol:

Total Cholesterol No more than 5mmol/l
LDL Cholesterol No more than 3mmol/l
HDL Cholesterol More than 1mmol/l
Triglycerides No more than 2mmol/l

Diabetes:

The important number for you to remember if you have diabetes is the HbA1c- this gives an estimation of your blood sugar control over the previous 2-3 months. The number to aim for is <42 mmol or 6.5%.

The HbA1c can also identify people with prediabetes and diabetes:

HbA1c Mmol/mol %
Normal Below 42mmol/mol Below 6%
Prediabetes 42-47 mmol/mol 6.0- 6.4%
Diabetes 48mmol/mol or over 6.5% or over

Body Mass Index:

Body Mass Index (BMI) Weight Status
Below 18.5 Underweight
18.5- 24.9 Normal or Healthy Weight
25.0- 29.9 Overweight
30.0 and above Obese

Resources:

www.ninds.nih.gov

www.strokeassociation.org

www.stroke.org

www.diabetes.co.uk

www.diabetes.ie

www.irishheart.ie