Stroke
Alternative names:
cerebrovascular accident; cerebrovascular disease; CVA
Treatment:
A stroke is an acute, serious condition. Immediate treatment is required. Treatment varies depending on the severity of symptoms. For virtually all strokes, there is a need for hospitalization, possibly including intensive care and life support.
There is no known cure for a stroke. The treatment is essentially rehabilitation based on the symptoms presented. The treatment is also aimed at secondary prevention of future strokes. The recovery may occur as other areas of the brain take over functioning for the damaged areas. The goal of treatment is to prevent the spread (extension) of the stroke and to maximize the ability of the person to function.
IMMEDIATE TREATMENT
Life support and treatment of a coma are performed as appropriate to the condition of the person.
Medications are variable. Those that help one kind of stroke may increase damage in another. For example, anticoagulants may be beneficial in stroke caused by emboli, but they may increase damage if stroke is due to hemorrhage.
Analgesics may be needed to control severe headache.
Antihypertensive medication may be needed to control high blood pressure.
Nutrients and fluids may need to be supplemented, especially if swallowing difficulties are present. This may include intravenous nutrients and fluids or feeding through a tube in the stomach (feeding tube or gastrostomy tube). Swallowing difficulties may be temporary or permanent.
Surgery may be appropriate in some cases. This may include surgical removal of blood or blood clots from the brain cavity, repair of the source of the bleeding, or other surgeries.
Carotid endarterectomy, removal of plaque from the carotid arteries, may be indicated for some people to prevent new strokes from occurring.
Positioning, range of motion exercises, speech therapy, occupational therapy, physical therapy, and other interventions may be advised to prevent complications and promote maximum recovery of function.
LONG-TERM TREATMENT
Recovery time and the need for long-term treatment vary depending on each case. Depression and other symptoms should be treated.
Physical therapy may benefit some persons. Activity should be encouraged within the physical limitations. Speech therapy, occupational therapy, or other interventions may benefit some people.
Urinary catheterization or bladder or bowel control programs may be required to control incontinence.
Environmental safety must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show a marked indifference or lack of judgment, which increases the need for safety precautions. Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.
Communication may require alternative forms, such as pictures, verbal cues, demonstration, or others, depending on the type and extent of language deficit.
In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiological needs.
Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety).
Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.
Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with organic brain syndromes such as stroke.
Expectations (prognosis):
Stroke is the third leading cause of death in developed countries. About one-fourth of the sufferers die as a result of the stroke or its complications, about one-half have long-term disabilities, and about one-fourth recover most or all function.
Complications:
Calling your health care provider:
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of a stroke. Stroke requires immediate treatment.
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