Definition & Overview

Stroke is one of the leading causes of death and disability in the United States and many parts of the world. It occurs when the blood vessel that carries oxygen and nutrients to a certain part of the brain has ruptured or is blocked leading to the death of brain cells.

Due to its potentially life-threatening consequences, it is crucial for stroke patients to receive emergency treatment to minimize serious risks including death. This is where stroke management, which aims to assess and stabilize patients, becomes crucial. This involves making critical decisions on certain factors such as intubation, blood pressure control, and other forms of emergency intervention to save the patient’s life.

Who Should Undergo and Expected Results

Stroke management is crucial for any patient who suffers from a stroke, which is the third leading cause of death and serious long-term disability in the United States. Although it is more common in people over 65 years of age, about a quarter of stroke cases involves younger individuals.

Stroke may occur due to several causative factors, such as high blood pressure, cigarette smoking, high cholesterol levels, diabetes, cardiovascular disease, obstructive sleep apnea, drug abuse, alcoholism, being overweight or obese, and lack of physical activity. These factors may cause different types of stroke, namely ischemic and hemorrhagic stroke.

An ischemic stroke occurs when blood flow to the brain is reduced or restricted due to narrowed or blocked arteries. A hemorrhagic stroke, on the other hand, is caused by internal bleeding that occurs due to a ruptured blood vessel or artery in the brain. If the hemorrhage originates from a blood vessel in the brain, the condition is referred to as intracerebral hemorrhage, which is associated with high blood pressure (hypertension), blood-thinning medications, and trauma. On the other hand, if the hemorrhage occurs due to a burst artery in the brain or near it, it is known as a subarachnoid hemorrhage, which is often caused by aneurysms or weak spots in the walls of the blood vessels.

Patients who suffer from transient ischemic attacks or mini-strokes also require stroke management. The condition refers to a brief passing period, usually lasting less than five minutes, during which a person experiences symptoms similar to that of a stroke. This occurs when the blood flow to the brain becomes temporarily blocked.

How is the Procedure Performed?

Proper guidelines for stroke management are designed to assist anyone dealing with a stroke emergency, including medical personnel. It begins with emergency procedures performed to stabilize the patient’s condition as quickly as possible to eliminate immediate threat to life.

Stroke Management for Ischemic Strokes

In dealing with an ischemic stroke, emergency stroke management involves:

  • Administering tissue plasminogen activator (TPA) intravenously – TPA is a clot-busting medication with potentially life-saving benefits in the event of a stroke. However, for it to be effective, it has to be administered intravenously within 4.5 hours following the onset of stroke symptoms.

  • Administering aspirin – Aspirin can effectively keep blood clots from forming. It is therefore commonly used to stabilize a patient who has suffered from a stroke, as it helps prevent another one from occurring.

  • Administering medications directly to the brain – Emergency stroke management also involves directly administering medicine into the area of the brain where the stroke originates. The time window within which this has to be performed after a stroke occurs is relatively longer than that for intravenous TPA.

  • Removing the clot – This is done by inserting a catheter into the brain to manually remove the clot.
    However, despite their efficacy, administering medicines directly to the brain and manually removing the clot are not appropriate or safe in some cases. Thus, guidelines in stroke management also aim to help emergency personnel and responders to determine which method is most appropriate to use based on a number of factors involved in each individual case.

Once the immediate threat to the patient’s life has been averted, stroke management focuses on preventing another stroke from occurring. In order to effectively do so, patients are carefully evaluated to determine the factors that caused the stroke. This helps them determine what kinds of treatments are necessary.

Most patients undergo either a carotid endarterectomy or an angioplasty and stenting procedure following a stroke.

  • A carotid endarterectomy aims to remove plaque that has accumulated in the carotid arteries. The procedure is invasive and requires the surgeon to open up the carotid artery to manually remove the plaque.

  • Angioplasty with stenting is a minimally invasive procedure wherein a balloon, which is inserted through a catheter towards the narrowed artery, is used to push the plaque onto the arterial walls to create enough room for the blood to flow freely. A stent is then placed to support the opening and prevent it from collapsing.

Stroke Management for Hemorrhagic Strokes

In dealing with a hemorrhagic stroke, emergency stroke management focuses on:

  • Loosening up the blood clot using anti-platelet drugs
  • Counteracting blood-thinning effects
  • Administering medications to lower blood or intracranial pressure
  • Administering medications to prevent seizures and vasospasm

As the blood clot loosens up and the body slowly absorbs the blood, the patient’s condition will stabilize. At this point, the patient is evaluated to see if further treatments, which are usually aimed towards surgical blood vessel repair, are necessary to prevent a recurrence. Currently, doctors use surgical clipping, endovascular embolization, surgical AVM removal, intracranial bypass, and stereotactic radiosurgery to repair the affected blood vessel.

Stroke management ends with stroke recovery and rehabilitation, which focuses on building up the patient’s strength and recovering as much of his normal functioning as possible. The goal is to ease the patient back into normal, independent living. This may require different methods, depending on which part of the brain was affected and the long-term effects that the patient is suffering from.

Strokes that originate from the right side of the brain may affect movements in the patient’s left side and vice versa. However, strokes that begin on the left side of the brain tend to put patients in greater danger due to their potential effect on patient’s speech and language faculties.

Possible Risks and Complications

Stroke management cannot guarantee the success of the treatment since certain factors, such as the patient’s age and overall health condition, can complicate the process. In some cases, patients experience the following:

  • Brain edema or swelling of the brain
  • Epileptic seizures
  • Infections, such as urinary tract infections and chest infections, among others
  • Mobility-related accidents, which may cause serious injury
  • Thromboembolism
  • Deep venous thrombosis
  • Pneumonia and other breathing problems

References:

  • “Management of patients with stroke or TIA: assessment, investigation, immediate management, and secondary prevention – A national clinical guideline.” Scottish Intercollegiate Guidelines Network. http://www.sign.ac.uk/pdf/sign108.pdf

  • “Stroke and transcient ischaemic attack in over 16s: diagnosis and initial management. (2008). National Institute for Health and Care Excellence. https://www.nice.org.uk

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