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The only emergency treatment for acute stroke is the clot busting drug, tissue plasminogen activator (tPA), that must be started within
three hours of the onset of stroke symptoms to be of maximum benefit for stokes caused by a blood clot. Not every stroke patient should be treated with tPA.
A physician will evaluate if the patient is a candidate for tPA. Remember, stroke is a medical emergency, call 911 to get to the emergency room immediately!
After treatment is given in the emergency room the patient will be admitted for evaluation for the source of the stroke and rehabilitation. The patient may have blood tests and a CT
scan in the emergency room. The patient will usually be admitted to a medical floor that cares for stroke patients. They will continue with the evaluation, which may include:
- Carotid doppler studies (checking for blockage of the neck arteries that supply blood to the brain)
- MRI (looking for brain tissue damage from the stroke)
- CT scan (looking for damage to the brain)
- Echocardiogram (bouncing sound waves off of the heart valves looking for source of blood clot)
- Electrocardiogram (EKG to evaluate heart rhythm)
- Blood work to look at cholesterol, blood count, and clotting factors for the blood
If there is a deficit (weakness or damage) from the stroke you may be evaluated by rehabilitation department therapists.
You could be seen by a speech therapist for swallow ability and language skills. Physical therapy may be ordered to evaluate and treat problems with
gait, stability, and strength. Occupational therapy may be ordered to evaluate problems with strength,
cognitive function and the ability to perform activities of daily living. The therapists may offer therapy throughout
your stay, suggest you spend some time in the inpatient rehab unit, offer discharge therapy exercises or suggest therapy continue to be provided at an
outpatient facility. Obviously, people with the least impairment will benefit the most from rehab therapy. The goal of therapy is to decrease dependence
and improve physical abilities.
Successful recovery depends on many factors, including:
- extent of brain injury
- survivor’s attitude
- skill of the rehab team
- cooperation and involvement
- support of family and friends
The physician will be evaluating the tests to find the source of the stroke.
The health care team will also be looking at your risk factors and lifestyle for clues.
Finding the source of your stroke will influence the treatment provided.
If the carotid artery (blood vessel in the neck) is blocked due to fatty buildup, surgery might be
needed to remove the blockage. The surgery is called carotid endarterectomy.
If the blood pressure is elevated, there are many types of blood pressure medications that can be used. It is important to keep the blood pressure below 140/90, or for diabetics it should be below 130/85.
For ischemic (blood clot) strokes, there are several different medications that may be used to prevent another stroke. Most patients
will have an antiplatelet medication prescribed.
Antiplatelet drugs prevent the blood cells from sticking together and forming a clot. The most effective and least
expensive of these drugs is aspirin, in any strength. Antiplatelets are used for patients who have smaller clots or
vascular disease from plaque on their vessel walls. Two other antiplatelet mediations, Aggrenox or Plavix, may be
used with aspirin, or alone, to prevent clots from forming.
Another drug that may be used to prevent blood clots is Coumadin. The mechanism of action in the blood is different from antiplatelets.
Coumadin will prevent the body from making blood clots instead of preventing the blood cells from sticking together. Coumadin is more likely to be used when a person has had
atrial fibrillation (irregular heartbeat), blood clots in the lungs or legs, or has had a heart valve replacement.
Lifestyle change is another important part of prevention. Compliance with medication, eating a heart healthy diet, positive
attitude, and exercise are all key pieces of rehabilitation from a stroke. The stroke team at Sparrow Health System is eager
to assist you with the care and knowledge necessary to reduce the chances of having a stroke. The family members’ knowledge
is also an important component of education and rehabilitation. Family members need to understand what the
stroke survivor is experiencing and how the disabilities affect the person. Education through Sparrow Health System or support
groups can assist the survivor and family with the healing process.
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