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Strokes in Women
|How Are Strokes Treated?
If someone suffers a stroke immediately dial 911 for emergency services. While you wait for an ambulance:
1. Lie the person on the floor.
2. Avoid giving them any food or liquids. If vomiting occurs lay their head to the side.
3. If the person show signs of breathing difficulties, raise their head and shoulders. If breathing stops altogether, CPR should be started.
4. When is CPR necessary? or how is hands only CPR performed?
5. Do NOT give them aspirin. While the recommended heart attack treatment advice is to take an aspirin while waiting for emergency services to arrive, this is NOT a good idea for stroke victims. Aspirin can increase bleeding in hemorrhagic stroke patients, worsening the condition. Until a diagnosis of the type of stroke suffered has been established, aspirin should be avoided.
While there is no cure for stroke, early intervention and treatment at hospital will reduce the likelihood permanent damage and effects of stroke as well as lower the risk of a repeat one in the near future. In recent years there have been new advances in stroke treatment, but these therapies need to be started within a few hours of on the onset of symptoms. This is why it is important to recognize the symptoms of stroke (image) early and call your emergency department immediately. There are 2 main emergency treatments: medications and surgical procedures. The type of treatment you receive depends on which type of stroke you have, how serious the stroke was, your age, general health and how soon you arrive in hospital. Treatment will only be given once a stroke diagnosis has been reached and the type of stroke established. After emergency treatment has been given and the patient is stabilized, they will be informed about stroke recovery procedures including stroke rehabilitation and making healthy lifestyle choices to reduce their overall stroke risk factors.
How Is An Ischemic Stroke Treated?
Most strokes are ischemic and early treatment focuses on removing the blood clot which is blocking blood flow to the brain. The most promising treatment for ischemic stroke is a thrombolytic therapy medication called tPA (tissue plasminogen activator). This is the only drug currently approved by the FDA for the treatment of stroke. tPA is a powerful clot-buster and dissolves the clot causing restricted blood flow to the brain. It should be given within 3 hours of the onset of symptoms in order to be effective. Unfortunately only about 3 to 5 percent of people who have strokes get to hospital quick enough to be considered for tPA. However, emerging studies are now showing that tPA could be effective for up to 4.5 hours afterwards. Guidelines are now being updated but it is still up to the attending doctors to determine if tPA administration is appropriate in the situation. If it is too late for tPA, you may be given antiplatelets (such as aspirin or clopidrogrel) and anticoagulant medications such as warfarin to prevent further blood clots. Aspirin therapy and antiplatelets may be prescribed long-term to help prevent future attacks.
In some instances surgery may be necessary to repair damage after a stroke or to prevent another stroke from occurring. The two most common procedures are carotid endarterectomy and angioplasty with stenting. These surgeries remove clots and blockages in the neck (carotid) arteries (where most blockages occur) caused by the long-term build up of atherosclerosis:
During this procedure (image) the blocked area of the carotid artery is opened and the obstruction is removed. The artery is then widened to improve blood flow, repaired and finally closed. This operation may also be given to people with symptoms of stroke or those who suffered a mini stroke (TIA). The vast majority of mini strokes are caused by narrowing of the internal carotid artery.
Angioplasty With Stenting
This is a less invasive procedure which is performed as an alternative if the risk of carotid endarterectomy is too high (where for example the patient is not in general good health). Also called cerebral angioplasty, this procedure is not yet available in all medical centers. It involves threading a long narrow tube into an artery in the groin (or arm) and directing it through the body to the carotid artery. There, a balloon on the end of the tube inflates, squeezing and widening the artery. A small metal stent is left in the artery to keep it permanently open. To read more about the procedure see coronary angioplasty (where the procedure is applied to the heart's arteries - image).
How Is A Hemorrhagic Stroke Treated?
Where ischemic stroke is caused by a blockage, hemorrhagic stroke is caused by a blood vessel rupturing causing internal bleeding in the brain. The treatment is different. Unfortunately there are few medications which can treat hemorrhagic stroke. tPA is not suitable as it may aggravate the situation by causing more bleeding. Instead of treating the bleeding, any medication prescribed is generally aimed at removing the underlying cause of the bleeding. If blood pressure is raised, drug pressure medications will be used. If the patient has been taking anticoagulant medications for a heart condition, these may be stopped if it is suspected they contributed to the stroke. If swelling in the brain (edema) is detected medications called hyperosmotic agents may be given to reduce pressure. Calcium channel blockers may be given to patients suffering a subarachnoid hemorrhage stroke as studies show it can reduce brain cell loss by preventing a complication called vasospasm (blood vessel spasm).
Surgery on hemorrhagic patients is rarely performed due to the high risk of it causing extra bleeding or brain damage. It may be considered for patients with subdural hematomas (where blood collects outside the blood vessels). In such an instance the skull is opened and drained. If an aneurysm is diagnosed (see causes of stroke), either ruptured or unruptured, a neurosurgeon can perform either of the following surgeries:
Clip Ligation: (image) An aneurysm is a blood filled bulge in a blood vessel which can rupture and cause internal bleeding. It is usually present at birth and does not cause symptoms until it bursts. Clip ligation involves clamping the bulge (aneurysm) with a metal clip to separate it from the rest of the blood vessel. To perform the operation, the surgeon must open the skull and expose the brain (a procedure called craniotomy). Different types of clips are available to accommodate different sizes and locations of aneurysms.
Coil Embolization: Also called endovascular coiling (image), this is a less invasive surgery which involves inserting a catheter through an artery where it is then guided to the aneurysm and deposits a coil to seal the aneurysm. A thrombus (blood clot) quickly forms sealing the aneurysm further (or prevents it from rupturing if it has not already). Although this surgery is more desirable because it does not involve opening the skull, how long the treatment lasts is not yet certain. For this reason patients need to be periodically monitored by an MRI scan.
Note: The risk of repeat bleeding from an untreated aneurysm is 35 percent within the first 14 days after the first bleed.
How Are Mini Strokes Treated?
A mini stroke produces symptoms of stroke but it resolves on its own within 24 hours, leaving no lasting damage. It is considered a warning sign that a more serious stroke may soon strike. Treatment will depend on the underlying cause - if a blood clot formed medications to help prevent further clotting may be prescribed. If an aneurysm is discovered, surgery may be performed to prevent it from rupturing. Lifestyle changes such as quitting smoking and improving your diet to help control your stroke risk factors will also be recommended.
See also: Natural Remedies for Stroke