Topic: Stroke
Question: What are the treatments for Stroke ?
Answer: Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions.
                
Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts.
                
Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes.
                
Treating an Ischemic Stroke or Transient Ischemic Attack
                
An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs. Treatment for an ischemic stroke or TIA may include medicines and medical procedures.
                
Medicines
                
If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4hours of symptom onset. Ideally, it should be given as soon as possible. The sooner treatment begins, the better your chances of recovery. Thus, its important to know the signs and symptoms of a stroke and to call 911 right away for emergency care.
                
If you cant have tPA for medical reasons, your doctor may give you antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger. Two common medicines are aspirin and clopidogrel.
                
Medical Procedures
                
If you have carotid artery disease, your doctor may recommend a carotid endarterectomy or carotid arteryangioplasty. Both procedures open blocked carotid arteries.
                
Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia (MERCI).
                
In intra-arterial thrombolysis, a long flexible tube called a catheter is put into your groin (upper thigh) and threaded to the tiny arteries of the brain. Your doctor can deliver medicine through this catheter to break up a blood clot in the brain.
                
MERCI is a device that can remove blood clots from an artery. During the procedure, a catheter is threaded through a carotid artery to the affected artery in the brain. The device is then used to pull the blood clot out through the catheter.
                
Treating a Hemorrhagic Stroke
                
A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes arent treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse.
                
If youre taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, youll be taken off the medicine. If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding.
                
Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair.
                
Aneurysm Clipping and Coil Embolization
                
If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization.
                
Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. Youll be given medicine to make you sleep during the surgery. After the surgery, youll need to stay in the hospitals intensive care unit for a few days.
                
Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm.Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from burstingagain.Coil embolization is done in a hospital. Youll be given medicine to make you sleep during thesurgery.
                
Arteriovenous Malformation Repair
                
If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain.
                
Doctors use several methods to repair AVMs. These methods include:
                
Injecting a substance into the blood vessels of the AVM to block blood flow
                
Surgery to remove the AVM
                
Using radiation to shrink the blood vessels of the AVM
                
Treating Stroke Risk Factors
                
After initial treatment for a stroke or TIA, your doctor will treat your risk factors. He or she may recommend heart-healthy lifestyle changes to help control your risk factors.
                
Heart-healthy lifestyle changes may include:
                
heart-healthy eating
                
maintaining a healthy weight
                
managing stress
                
physical activity
                
quitting smoking
                
If lifestyle changes arent enough, you may need medicine to control your risk factors.
                
Heart-Healthy Eating
                
Your doctor may recommend heart-healthy eating, which should include:
                
Fat-free or low-fat dairy products, such as skim milk
                
Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week
                
Fruits, such as apples, bananas, oranges, pears, and prunes
                
Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
                
Vegetables, such as broccoli, cabbage, and carrots
                
Whole grains, such as oatmeal, brown rice, and corn tortillas
                
When following a heart-healthy diet, you should avoid eating:
                
A lot of red meat
                
Palm and coconut oils
                
Sugary foods and beverages
                
Two nutrients in your diet make blood cholesterol levels rise:
                
Saturated fatfound mostly in foods that come from animals
                
Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats.
                
Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples:
                
1,200 calories a day
                
8 grams of saturated fat a day
                
1,500 calories a day
                
10 grams of saturated fat a day
                
1,800 calories a day
                
12 grams of saturated fat a day
                
2,000 calories a day
                
13 grams of saturated fat a day
                
2,500 calories a day
                
17 grams of saturated fat a day
                
Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are:
                
Avocados
                
Corn, sunflower, and soybean oils
                
Nuts and seeds, such as walnuts
                
Olive, canola, peanut, safflower, and sesame oils
                
Peanut butter
                
Salmon and trout
                
Tofu
                
Sodium
                
Try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more.
                
Dietary Approaches to Stop Hypertension
                
Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt.
                
The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH.
                
Alcohol
                
Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain.
                
Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is:
                
12 ounces of beer
                
5 ounces of wine
                
1 ounces of liquor
                
Maintaining a Healthy Weight
                
Maintaining a healthy weight is important for overall health and can lower your risk for stroke. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active.
                
Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI:
                
Below 18.5 is a sign that you are underweight.
                
Between 18.5 and 24.9 is in the normal range.
                
Between 25.0 and 29.9 is considered overweight.
                
Of 30.0 or higher is considered obese.
                
A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal.
                
Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk.
                
If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol.
                
Managing Stress
                
Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as:
                
A stress management program
                
Meditation
                
Physical activity
                
Relaxation therapy
                
Talking things out with friends or family
                
Physical Activity
                
Regular physical activity can lower many risk factors for stroke.
                
Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week.
                
Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you.
                
Read more about physical activity at:
                
Physical Activity and Your Heart
                
U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans
                
Quitting Smoking
                
If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for stroke. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
                
For more information about how to quit smoking, visit Smoking and Your Heart.
(Source: NHLBI)