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Stroke Treatment

Treatment for stroke starts in the hospital and lasts for a long time afterward.

Immediate treatment is necessary to prevent permanent brain damage. A lot of the treatment is determined by the type of stroke and what caused it.

When the stroke is caused by the carotid artery in the neck being partially blocked by a fatty buildup, called plaque, surgery called carotid endarterectomy may be used to remove the accumulated plaque.

Bypass surgery can also be done to go around the carotid artery when it is too impaired to be cleared.

When the problem is in the brain’s veins and arteries, cerebral angioplasty is another technique used where balloons, stents and coils are used to treat some types of problems with the brain’s blood vessels; either creating openings for blood flow or propping open narrowed passages.

When a vessel actually bursts in the brain causing a stroke (aneurysm); surgery may require clipping the damaged section so it will no longer leak; removing the damaged section; or placing a catheter or stent through the damaged section to restore blood flow.

The U.S. Food and Drug Administration (FDA) has approved the clot-dissolving drug tissue plasminogen activator (tPA) to treat strokes caused by blood clots (80% of strokes are caused by blood clots). This treatment must be given intravenously within 3 hours of the stroke or injected by a neurologist directly to the site of the clot after that time. If clots are being formed by a hemorrhage in the brain, the brain may start bleeding again and cause further damage. This is a risk that the physician is in the best position to evaluate.

Anticoagulants, often called blood thinners, may be prescribed by physicians following a stroke. By reducing the ability of the blood to clot, they may help to keep blood vessels open and delivering oxygen and nutrients to brain cells.

Antiplatelet drugs may be administered during or immediately after a stroke to help prevent clot formation. While they work differently from anticoagulants, the result is similar. They help to keep blood vessels open and delivering oxygen and nutrients to brain cells.

If high blood pressure causes a hemorrhagic stroke, antihypertensive drugs are administered to bring blood pressure down.

Brain bleeding may cause swelling of surrounding brain tissue, and this may require therapy with drugs called hyperosmotic agents (mannitol, glycerol, and hypertonic saline solutions).

If the stroke resulted from the use of anticoagulants, such as Coumadin or heparin, these medications are discontinued immediately. Medications may be given to reverse the effects of these anticoagulants to reduce bleeding.

Pain relievers and antianxiety medications may relieve the headache that often accompanies hemorrhagic stroke. Medications may be needed to prevent or treat seizures.

Once things are under control, the underlying cause of the stroke may need to be treated. This can include treatment for heart disease, high blood pressure, high cholesterol, stress, peripheral artery disease (PAD), and many other problems.

Once the person who had the stroke has been stabilized and is starting to recover; physical therapy and speech therapy are integral parts of their treatment. Nutrition and diet counseling are also key factors to a full recovery.

In addition, acupuncture therapy for stroke-caused conditions such as paralysis, speech and swallowing problems, and depression is commonly used in the Orient.
There are two schools of thought about when to start acupuncture after a stroke. One is that it should be started as soon as possible, while another school of thought believes a 2 week delay is best. The basis for both schools of thought is the recognized fact that acupuncture does increase the flow of blood and decrease clotting and inflammation. The decision of when to start should be based on the type of stroke. If the brain was bleeding, treatment should be delayed and if it was due to clotting and or plaque in the arteries; the sooner treatment is started the better.

There are also new experimental drugs which are being tested. Whether they will prove useful or not is anyone’s guess; but research into stroke prevention and treatment is ongoing.