Treatment:

A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek urgent medical care at the first signs of a stroke.

It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.

Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin.

Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital.

TREATMENT IN THE HOSPITAL

Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. This medicine breaks up blood clots and helps bring back blood flow to the damaged area. However, not everyone can get this type of medicine.

• For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.
• If the stroke is caused by bleeding instead of clotting, clot-busting drugs (thrombolytics) can cause more bleeding.

Other treatments depend on the cause of the stroke:

• Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used.
• Other medicine may be needed to control symptoms such as high blood pressure.
• In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.
• If bleeding occurred, surgery is often needed to remove blood from around the brain and to fix damaged blood vessels.
• Surgery on the carotid artery may be needed.

See also:

• Carotid artery disease
• Carotid artery surgery

Nutrients and fluids may be needed, especially if the person has trouble swallowing. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing trouble may be temporary or permanent.

Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital.

LONG-TERM TREATMENT

The goal of treatment after a stroke is to help the patient recover as much function as possible and prevent future strokes.

The recovery time and need for long-term treatment is different for each person. Problems moving, thinking, and talking often improve in the weeks to months after a stroke. A number of people who have had a stroke will keep improving in the months or years after the stroke.

See: Stroke recovery for information about:

• Bladder and bowel problems
• Living at home instead of a nursing facility
• Muscle and nerve problems
• Speech problems
• Stroke rehabilitation
• Swallowing and eating problems
• Thinking and memory problems

Support Groups:

Support and resources are available from the American Stroke Association -- www.strokeassociation.org.

Expectations (prognosis):

The outlook depends on:

• The type of stroke
• How much brain tissue is damaged
• What body functions have been affected
• How quickly you get treated

You may recover completely, or have some permanent loss of function.

Over half of people who have a stroke are able to function and live at home. Other people are not able to care for themselves.

If treatment with clot-busting drugs is successful, the symptoms of a stroke may go away. However, patients often do not get to the hospital soon enough to receive these drugs, or they cannot take these drugs because of a health condition.

People who have a stroke due to a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke due to bleeding in the brain (hemorrhagic stroke).

The risk for a second stroke is highest during the weeks or months after the first stroke. Then the risk begins to decrease.

Complications:

• Breathing food into the airway (aspiration)
• Dementia
• Falls
• Loss of mobility
• Loss of movement or feeling in one or more parts of the body
• Muscle spasticity
• Poor nutrition
• Pressure sores
• Problems speaking and understanding
• Problems thinking or focusing

Calling your health care provider:

Stroke is a medical emergency that needs to be treated right away. Call your local emergency number (such as 911) if someone has symptoms of a stroke.