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Stroke (cont.)

Treatment Overview

Initial treatment for a stroke happens in the hospital. The sooner you get treatment, the better. The worst damage from a stroke often occurs within the first few hours. The faster you receive treatment, the less damage will occur.

In the hospital

Your treatment will depend on whether the stroke is caused by a blood clot (ischemic) or by bleeding in the brain (hemorrhagic). Treatment focuses on restoring blood flow for an ischemic stroke or controlling bleeding for a hemorrhagic stroke.

Before starting treatment, your doctor will use a computed tomography (CT) scan or magnetic resonance imaging (MRI) of your head to diagnose the type of stroke you've had. For more information about these and other tests, see Exams and Tests.

Ischemic stroke

Emergency treatment for an ischemic stroke depends on the location and cause of the clot. Measures will be taken to stabilize your vital signs, including giving you medicines.

  • If your stroke is diagnosed soon enough after the start of symptoms, you may be given a clot-dissolving medicine called tissue plasminogen activator (t-PA), which can increase your chances of survival and recovery.
  • You may also receive aspirin or another antiplatelet medicine.

Hemorrhagic stroke

Treatment for hemorrhagic stroke includes efforts to control bleeding, reduce pressure in the brain, and stabilize vital signs, especially blood pressure.

  • You will be closely monitored for signs of increased pressure on the brain, such as restlessness, confusion, difficulty following commands, and headache. Other measures will be taken to keep you from straining from excessive coughing, vomiting, or lifting, or straining to pass stool or change position.
  • If the bleeding is due to a ruptured brain aneurysm, surgery to repair the aneurysm may be done. Repair may include:
    • Using a metal clip to clamp off the aneurysm to prevent renewed bleeding.
    • Inserting a small coil into the aneurysm to block it off (endovascular coil embolization).
  • In some cases, medicines may be given to control blood pressure, brain swelling, blood sugar levels, fever, and seizures.
  • If a large amount of bleeding has occurred and the person is rapidly getting worse, surgery may be needed to remove the blood that has built up inside the brain and to lower pressure inside the head.

Preventing another stroke

After emergency treatment for stroke, and when your condition has stabilized, treatment focuses on preventing another stroke. It will be important to control your risk factors for stroke, such as high blood pressure, atrial fibrillation, high cholesterol, and diabetes. Your doctor will probably want you to take one or more medicines to prevent another stroke. For more information on the medicines you may have to take after a stroke, see Medications.

Changes in lifestyle will also be an important part of your treatment to reduce your risk of having another stroke:

Your doctor may also recommend surgery to remove plaque buildup in the carotid arteries. A procedure called carotid artery stenting (CAS) is another option for some people who have blocked carotid arteries. For more information on surgery to prevent a stroke, see Surgery. For more information on CAS, see Other Treatment.

For more information on preventing a stroke, see Prevention.

Rehabilitation

Starting a rehabilitation (rehab) program as soon as possible after a stroke increases your chances of recovering some of the abilities you lost.

It is not possible to predict precisely how much physical ability you will regain. The more ability you retain immediately after a stroke, the more independent you are likely to be when you are discharged from the hospital. After a stroke:

  • People usually show the greatest progress in being able to walk during the first 6 weeks. Most recovery occurs within the first 3 months. But you may continue to improve slowly over the next few years.
  • Speech, balance, and skills needed for day-to-day living return more slowly and may continue to improve for up to a year.
  • About half of the people who suffer a stroke have problems with coordination, communication, judgment, or behavior that affect their work and personal relationships.

Your rehab will be based on the physical abilities that were lost, your general health before the stroke, and your ability to participate. Rehab begins with helping you resume activities of daily living, such as eating, bathing, and dressing. For more information, see the topic Stroke Rehabilitation.

What to think about

After a person has had a stroke, family members can learn ways to provide support and encouragement to their loved one.

If you get worse, your loved one may need to move you to a care facility that can meet your needs, especially if your caregiver has his or her own health problems that make it difficult to properly care for you. It is common for caregivers to neglect their own health when they are caring for a loved one who has had a stroke. If your caregiver's health declines, the risk of injury to you and your caregiver may increase. For more information, see:

Click here to view a Decision Point.Stroke: Should I Move My Loved One Into Long-Term Care?
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