Stroke treatment depends upon the type of stroke suffered.
Because stroke endangers the brain and life, hospitalization is required for stroke treatment in virtually all cases, and a call for an ambulance should be the immediate action if anyone is suspected of experiencing a stroke. Besides being the fastest route to the emergency room, the ambulance provides one crucial thing -- a team of medical professionals that can supply urgently needed physical care for the patient. The general care, especially keeping blood pressure and blood sugar levels under control, that emergency medical technicians provide in those first minutes is a crucial component of stroke treatment and could actually save brain tissue in stroke patients.
Those stroke survivors who did not receive the needed care immediately -- and even many who did -- will also need long-term care and rehabilitation for stroke after-effects such as paralysis and speech impairment. Doctors may decide to provide treatment to prevent another stroke in the patient's future.
The two basic types of stroke are ischemic and hemorrhagic. With an ischemic stroke, a blood clot blocks a blood vessel in the brain that is already clogged with plaque. In a hemorrhagic stroke, a blood vessel bursts and floods either the brain or the skull with blood. A doctor may recommend preventative treatment when stroke risk factors are high or a patient has had a transient ischemic attack (TIA or mini stroke). One basic instance of this treatment is the use of aspirin or other antiplatelet or anticoagulant medications to reduce the risk of clots forming in the body.
Some surgical methods of ischemic stroke prevention include balloon angioplasty and the implantation of stents (tubes made of metallic mesh). For an angioplasty, surgeons insert a balloon on the end of a catheter into an artery that feeds the brain (usually the carotid artery that runs up the neck to the brain). Upon reaching an area with blockage, the balloon is inflated to push the plaque apart and allow the blood to flow more freely. The surgeon may implant a stent in the artery to prevent the artery from closing up again. A similar type of surgery, intracranial stenting, requires the insertion of a catheter through an incision in the groin, up through the body's arteries and into the brain. This surgical procedure may or may not be preceded by angioplasty.
Alternatively, a surgeon might perform a carotid endarterectomy to remove the fatty plaque blockage from the carotid arteries, where a blood clot could lodge and cause an ischemic stroke. This surgery carries the risk of dislodging a lump of plaque or a blood clot, but the standard procedure is to place filters, called distal protection devices, in the blood vessels to strain out such material.
Either an aneurysm or arteriovenous malformation (AVM) causes a hemorrhagic stroke. An aneurysm is a weak spot in an artery that causes a stroke if it bursts. An AVM is a group of abnormal blood vessels that can also burst and leak into the brain cavity. If an AVM is present and located near the surface of the brain but is not too large, a surgeon may choose to remove those blood vessels surgically from the brain to lessen the risk of a hemorrhagic stroke. A less invasive procedure, sometimes called coiling, involves inserting a catheter through a major artery in the arm or leg. The doctor can then guide the catheter into an aneurysm and place a tiny mechanical coil or other device to keep the vessel from rupturing at that spot. Ironically, the coil works by causing clotting in the aneurysm, which acts as a sealant to separate it from the nearby arteries.
The first order of business for the medical professionals treating a stroke case in a hospital setting is to determine what type of stroke they are dealing with -- ischemic or hemorrhagic. The goal of acute care for an ischemic stroke is to restore the blood flow to the brain to stop the brain damage before it becomes severe. To do this, doctors must remove whatever is blocking the blood's path. One way to do this is through administration of blood-thinning drugs. According to the Mayo Clinic, a likely immediate treatment for an ischemic stroke is a dose of aspirin. However, because this treatment thins the blood, it would have exactly the wrong effect on a hemorrhagic stroke, so an accurate diagnosis is crucial. Alternatively, a doctor may prescribe another type of blood thinner such as warfarin (Coumadin) or heparin.
In some cases, a doctor may decide to use tissue plasminogen activator (tPA), the so-called clot-busting drug, to break up a clot that is causing an ischemic stroke. This drug can be used only within 3 hours of the onset of stroke, but information from the American Stroke Association indicates that only 3 to 5 percent of stroke patients arrive at the hospital within that time frame. Those who do receive this medication are less likely to suffer lasting effects from the stroke.
There are two types of hemorrhagic stroke: subarachnoid and intracerebral. A subarachnoid stroke starts with bleeding in a main artery near the brain's surface. It hemorrhages into the cranium and is characterized by sudden headache. In an intracerebral stroke, a burst blood vessel spills blood into the brain tissue. This type of stroke is usually caused by high blood pressure, according to the Mayo Clinic.
In the case of an aneurysm, doctors will often perform a clipping operation that clamps the base of the aneurysm with a tiny metal clip. This serves to cut off the aneurysm from the blood flow and removes the risk of that aneurysm bleeding into the brain again. Doctors also might use a coiling procedure to stop a hemorrhagic stroke from worsening.
A stroke survivor's doctor may prescribe a daily dose of aspirin to prevent recurrence of stroke. For a patient with particularly bad plaque build-up, other blood thinners may be required.
Long-term stroke treatment usually involves various types of rehabilitation to mitigate or even reverse the effects of a stroke. A team of physical and speech therapists, medical professionals and other specialists work together to provide the care that a stroke survivor needs to recover health and function.