Stroke Treatment: From the Ambulance to Rehabilitation

If someone shows signs of a stroke, call 9-1-1 right away.

A stroke — sometimes called a brain attack — happens when something blocks the blood supply to part of the brain, or when a blood vessel in the brain bursts. Either way, parts of the brain are damaged or die. A stroke can cause lasting brain damage, long-term disability or death.

Treatment begins the moment emergency medical services (EMS) arrive. At the hospital, a person may receive emergency care, treatment to prevent another stroke, rehabilitation, or all three.

On the way to the hospital

Call an ambulance — don't drive yourself or let someone else drive you. Getting to the hospital fast is the key to treatment and recovery, and people who arrive by ambulance may be diagnosed and treated sooner, because:

• emergency workers begin life-saving care on the way;
• they may take the patient to a specialized stroke center for the fastest possible diagnosis and treatment;
• they gather important information and alert the hospital before arrival, so staff can prepare.

At the hospital

Staff will ask about the person's medical history and exactly when symptoms began. Brain scans show what type of stroke it is. The patient may see a neurologist (a doctor who treats brain disorders), a neurosurgeon (who operates on the brain) or other specialists.

Ischemic stroke

Most strokes are ischemic: blood clots or other particles block blood vessels to the brain, or fatty deposits called plaque build up and cause blockages.

• Clot-busting medicine. Patients who reach the hospital within 3 hours of the first symptoms may receive a thrombolytic — a "clot-busting" drug such as tissue plasminogen activator (tPA). Studies show that ischemic stroke patients given tPA are more likely to recover fully or have less disability, and less likely to need long-term nursing home care.
• Other treatments include medicines such as blood thinners, and surgery to remove the clot.

Hemorrhagic stroke

A hemorrhagic stroke happens when an artery in the brain leaks or bursts. The escaping blood puts pressure on brain cells and damages them. High blood pressure and aneurysms — balloon-like bulges in an artery that can stretch and burst — are among the causes. Medicines, surgery or procedures may be needed to stop the bleeding and save brain tissue:

• Endovascular procedures can repair a weak spot or break in a blood vessel.
• Surgery may be used; if a burst aneurysm is the cause, a metal clip may be placed to stop the bleeding.

After treatment: preventing another stroke

A person who has had a stroke is at high risk of another:

• 1 in 4 stroke survivors has another stroke within 5 years.
• After a transient ischemic attack (TIA), the risk of stroke within 90 days may be as high as 17%, greatest in the first week.

That is why treating the underlying causes matters: heart disease, high blood pressure, atrial fibrillation (a fast, irregular heartbeat), high cholesterol and diabetes. Treatment may include medicine, surgery, and changes to diet, exercise and other habits. Review your plan with your health care team regularly, bring questions to appointments, and take medicines as directed.

Rehabilitation and recovery

Rehabilitation usually starts in the hospital, often within a day or two of the stroke. It eases the move from hospital to home and can help prevent another stroke. Recovery takes weeks, months or even years; some people recover fully, while others have long-term or lifelong disabilities.

People can make great progress toward independence, but some problems may persist:

• paralysis or weakness on one side of the body;
• trouble with thinking, awareness, attention, learning, judgment and memory;
• difficulty understanding or forming speech;
• trouble controlling or expressing emotions;
• numbness or strange sensations;
• pain in the hands and feet that worsens with movement and temperature changes;
• trouble chewing and swallowing;
• bladder and bowel problems;
• depression.

Rehabilitation may include:

• speech therapy, for problems producing or understanding speech;
• physical therapy, with exercises to relearn movement and coordination;
• occupational therapy, to improve everyday activities such as eating, drinking, dressing, bathing, reading and writing.

Therapy and medicine can help with depression and other mental health conditions after a stroke. A support group — ask your health care team or a local medical center — can help with adjusting to life afterward, and family and friends can ease fear and anxiety, especially if you tell them how you feel and how they can help.

Sources

• Centers for Disease Control and Prevention: "Treatment and Intervention for Stroke"; a work of the United States government in the public domain.