Stroke generally happens suddenly and treatment needs to be administered as quickly as possible. The "time is brain" concept shows the faster you administer medical treatment, the better the outcome. Medical management, or drug therapy, is usually the first course of action, although other treatment options are available.
IV recombinant tissue plasminogen activator (tPA), also called clot-buster, is a thombolytic drug that works by dissolving a clot. Although this is a proven therapy for stroke, only a limited number of patients will receive this therapy because of the short amount of time that it can be safely administered once stroke symptoms have started. To receive this medication intravenously (IV), the patient must be treated within 4.5 hours of acute onset of stroke symptoms.
Research studies have shown that people who arrive in the emergency room quickly enough after stroke to receive the clot-buster have a better chance of functional recovery than those who do not receive it. In addition to the time limit of 4.5 hours, patients must meet other criteria in order to decrease the chance of bleeding after the medication is given. These patients will be closely monitored in the ICU for 24 hours following the administration of the drug to observe for bleeding. A CT or MRI of the brain will be repeated the following day.
Antiplatelet medications work by keeping platelets, a component of blood, from sticking together. When platelets stick together they form clots.
Anticoagulant medications thin the blood by interfering with the production of certain blood components necessary for forming blood clots.
Arteriovenous Malformations (AVM) can be surgically removed through a craniotomy. Small AVMs can be obliterated with a minimally invasive cerebral arteriogram procedure. laser (gamma) knife. Treatment depends on the size and location of the AVM.
Carotid Endarterectomy is surgery that removes harmful fatty deposits (plaque) from your carotid arteries. A cut is made in the side of the neck, and the carotid artery is opened. The plaque is removed, and then the artery is closed up. This surgery depends upon the amount of blockage caused by the plaque. It may or may not be performed during your hospital stay for a stroke. Patients are usually discharged the day after the surgery.
The treatment of a hemorrhagic stroke depends upon the cause of the bleeding. Causes include high blood pressure, use of anticoagulant medications, use of illicit drugs and blood vessel malformation. Most patients are monitored closely in an intensive care unit during and after a hemorrhagic stroke. The initial care of a person with hemorrhagic stroke includes several components:
Surgery may be required in some cases. A surgical procedure may be recommended to prevent or stop bleeding or reduce the pressure inside the skull. Depending upon the stroke severity and the patient's condition, surgery may be done within the first 48 to 72 hours after the hemorrhage, or it may be delayed until one to two weeks later to allow the patient's condition to stabilize.
