Understanding Stroke
...to protect the brain from injury during stroke. People who survive a stroke should begin stroke rehabilitation as soon as possible to regain as many lost functions (e.g., lack of coordination or strength) as possible. Most recovery occurs during the first few months following a stroke.However, new intensive rehabilitation techniques are offering new hope for recovery even a year or so following a debilitating stroke. Page 3 Diagnosis methods for stroke When a patient shows symptoms of a stroke, the physician will promptly evaluate the patient’s medical history and quickly run tests such as a computed tomography (CT) scan. The CT scan can help the physician determine whether the patient is having a cerebral hemorrhage or cerebral ischemia. This information determines the course of emergency treatment. The CT scan may also help the physician locate the exact position of the damage. Once the patient is stabilized, the complete evaluation of a patient who has had a stroke can take the physician several days. Tests that may be run during this time include the following: Physical examination, during which the carotid artery will be examined with a stethoscope. If the physician hears an abnormal sound (a carotid bruit), there is a higher chance of finding atherosclerosis or carotid artery disease — conditions that increase the risk of stroke. A carotid ultrasound, or Duplex scanning, is a painless strategy for assessing the presence of plaque in the carotid artery. It uses high-frequency sound waves. Magnetic resonance angiography (MRA) is another noninvasive diagnostic test used to assess the degree of blockage in the carotid arteries. The MRA is a variation of the magnetic resonance imagine (MRI) scan, which is also very important in diagnosing a stroke. An electrocard- iogram (EKG) will be done to identify any cardiac problems that may have led to the stroke, such as a prior heart attack. Electroencephalogram (EEG). During this painless test, small metal devices (electrodes) are attached to the scalp. The electrodes are connected by wires (leads) to an electroencephalograph machine that charts the electrical activity of the brain. Treatment options People having symptoms of a stroke should call 9-1-1 immediately. Upon arriving at the hospital, the hospital staff will use strategies as determined by information from an eme- rgency CAT scan. These strategies include the following: Maintaining breathing in patients who may be losing consciousness. This is done through the use of breathing equipment and/or supplemental oxygen. Reducing fever (if present) with medications. Performing a CAT scan to determine whether someone is suffering from an ischemic stroke or a hem- orrhagic stroke. If it is an ischemic stroke, then thrombolytic medications may be given intravenously to dissolve the obstructing blood clots. Page 4 However, giving thrombolytic med- ications to a patient having a hemorrhagic stroke would worsen the existing bleeding in the brain and should be avoided. - Special attention may be given to maintaining nutritional needs intravenously or through the mouth and preventing pneumonia, a common complication after a stroke. People who survive a stroke will often need to undergo treatment (e.g., stroke rehabilitation) to deal with some of the long-term effects of the event. The goal of the treatment is to minimize as much neurological damage as possible, such as impaired movement or speech. The sooner that treatment is begun, the more likely it is that patients will regain significant functions. Individuals may also experience depression, which may be related to the temporary or permanent loss of basic functions. If this should occur, patients are urged to seek the help of a qualified counselor for sup- port and treatment. Future treatment options Scientists are continuously exploring new methods of treating strokes and preventing recurrent strokes. Currently, research is ongoing in several areas, including: Antibiotics. Studies have found that atherosclerotic plaque can harbor bacteria, which, in turn, may increase the tendency for plaque rupture. Researchers are investigating whether antibiotics (specifically, penicillin) can exert any effects against such bacteria, thereby increasing the plaque’s stability and reducing the risk of it breaking off and causing a stroke. Mechanical thrombolysis. These are devices that use catheter-delivered tools to break up or remove blood clots. Currently, clot-busting drugs are currently the only method available to break up an existing blood clot in the brain. However, they can take up to an hour to be effective. Devices currently being tested use lasers, sound waves, suction, spinning blades or snares to remove clots. Neuroprotective agents. Neuro- protective agents represent another avenue of stroke treatment. These agents attempt to rescue brain cells from injury caused by an ischemic stroke. Some agents attempt to increase the flow of blood to the region of brain experiencing stroke.Other agents may prevent damage caused by blood returning to the affected area of the brain. Stem cell transplants. Stem cells are basic cells that have the ability to develop into many dif- ferent types of cells. They start out very similar to each other, but depending on where they develop, the cells become highly specialized to their individual functions. Researchers are investigating a variety of methods in which stem cell transplants could be used as a treatment for stroke damage and other conditions involving damaged brain cells. Hypothermia. Researchers are currently studying whether lowering a patient’s body temperature can decrease the amount of damage that occurs during a severe stroke. Cholesterol-lowering drugs. Page 5 Following stroke survival According to the American Heart Association, up to 30 percent of stroke survivors face permanent disability, making it a leading cause of longterm disability in the United States. Between 50 and 70 percent of stroke survivors recover to the point that they are able to remain independent, according to the data collected through the Framingham Heart Study. Three months after a stroke, about 20 percent of patients require institutional care and 15 to 30 percent of stroke survivors become permanently disabled. About 22 percent of men and 25 percent of women who have suffered a stroke will die within a year and 14 percent of people who have had a stroke or TIA (mini-stroke) will suffer a recurrence within a year. In general, a more severe stroke will require more time in post-stroke rehabilitation to bring back as much of the patient’s functioning as possible. Changes in functioning that may be addressed in rehabilitation include the following: Confusion or dementia , Difficulty swallowing/eating, Drooping on one side of the face/mouth, Lack of balance/coordination ,Pralysis on one side of the body , Trouble controlling one’s bladder or bowels (incontinence) , Trouble seeing or hearing clearly, Trouble speaking clearly, Weakness (e.g., being unable to make a strong fist with both hands), Depression in both the patient and his or her family members is also common after having a stroke. Increasing numbers of people are facing these post-stroke challenges as death rates from stroke drop and survival rates climb. About 10 percent of post-stroke patients will experience pain in those areas that lost sensation following their stroke. The cause of this condition, called central post-stroke pain is unknow...