What is the Best Treatment for Stroke?

Stroke Recovery & Treatment: From Medication to Rehabilitation

A stroke is a health condition characterized by a reduced or compromised blood supply to a part of the brain, resulting from an inadequate supply of oxygen and nutrients to brain cells. If this condition is not treated immediately, brain cells begin to die within minutes, leading to brain injury, disability, or death.

Types of Stroke

Stroke is primarily classified into three different groups:

• Ischemic Stroke - A plaque buildup that blocks a blood vessel in the brain
• Hemorrhagic Stroke - A blood vessel in the brain ruptures
• Transient Ischemic Attack - A temporary disruption of blood flow to the brain

What is the First-line Treatment for a Stroke?
 

The treatment for stroke depends on its type—ischemic stroke, caused by a blocked blood vessel, or hemorrhagic stroke, caused by intracerebral bleeding. Early intervention is essential, and treatment guidelines vary accordingly. The first-line treatment is mainly for ischemic stroke, which is also the majority of cases, and it includes the following:

1. Emergency Treatment of Ischemic Stroke

Immediate Emergency Care

It involves a quick diagnosis and transfer to a facility that can treat a stroke. This places the treatment within the time frame known as the "golden hour," when it can significantly reduce brain injuries and improve outcomes.

a) Intravenous Thrombolysis (tPA)

The most effective and commonly used treatment for ischemic stroke is tissue plasminogen activator (tPA). It is an intravenous drug that dissolves clots, restoring blood flow.

• Time Window: Ideally, administer within 3 to 4.5 hours of symptom onset.
• Effectiveness: It has been proven to significantly enhance the likelihood of recovery and reduce disability when administered early.
• Limitations: Should not be applied to patients with a higher risk of bleeding or certain medical conditions.

b) Endovascular Thrombectomy

For certain patients with large artery occlusion, doctors will perform a mechanical thrombectomy, which involves inserting a catheter into the artery and manually removing the clot.

• Time Window: Optimal within 6 hours, but under certain conditions, it may be acceptable even after 24 hours since the onset of symptoms.
• Effectiveness: Most effective in patients with large vessel occlusion and severe symptoms.

c) Antiplatelet and Anticoagulant Therapy

After initial emergency treatment, aspirin or other antiplatelet drugs may be used to manage subsequent clotting. In atrial fibrillation or other cardiovascular diseases, anticoagulation with warfarin or newer agents (e.g., apixaban, dabigatran) may be initiated.

Supportive Care and Secondary Prevention

• In addition to their acute treatment, patients receive supportive care to maintain stable blood pressure, blood sugar levels, and other vital signs.
• Secondary prevention includes antiplatelet therapy and anticoagulants, as well as lifestyle modification and control of risk factors (hypertension, diabetes, tobacco use) to prevent recurrence.

Keep reading to learn about the best stroke treatment!

2. Emergency Treatment for Hemorrhagic Stroke

Hemorrhagic strokes occur when a weakened vessel ruptures and bleeds into the brain. The treatment aims to stop the bleeding and decrease pressure in the brain.

a) Blood Pressure Management

Hypertension is a common condition in hemorrhagic stroke and must be controlled carefully to avoid worsening cerebral perfusion while preventing rebleeding.

b) Surgical Intervention

Surgery may be required in some cases to:

• Remove the hematoma (accumulated blood).
• Repair a ruptured aneurysm.
• Remove or block an arteriovenous malformation (AVM).

c) Clotting Factor Administration

In patients taking blood thinners, reversal agents — such as vitamin K, fresh frozen plasma, or an antidote specific to the agent, like idarucizumab for dabigatran — reverse the effects of these medications on normal coagulation.

3. Transient Ischemic Attack (TIA)

TIAs are temporary episodes of neurological impairment caused by a temporary disruption of blood flow to the brain. They do not result in permanent damage but serve as a sinister warning.

• Treatment focuses on preventing future strokes.
• Medications such as antiplatelets (aspirin, clopidogrel), anticoagulants (if due to atrial fibrillation), and statins are used.
• Lifestyle changes and management of risk factors (hypertension, diabetes, and smoking) are essential.

Post-Stroke Care and Rehabilitation for Stroke

Regardless of the type of stroke, rehabilitation is critical for recovery. It usually begins as soon as the patient is stable. The rehabilitation process usually consists of the following:

a) Physical Therapy

Focuses on rehabilitating strength, coordination, and motor function in the weak or paralyzed side of the body.

b) Occupational Therapy

Aids the patient in recovering daily activities such as dressing, eating, and bathing.

c) Speech and Language Therapy

Essential for patients who speak slowly, have difficulty understanding language, or experience trouble swallowing.

d) Cognitive Rehabilitation

Works to reverse impairments in memory, thinking, and judgment that are characteristic of post-stroke.

e) Psychological Support

Depression and anxiety are common after a stroke. Counselling, support groups, and medications can help manage mental illness.

Preventive Measures for Future Stroke

Adopting secondary prevention measures after a stroke is crucial to avoid recurrence. The most important steps are:

• Blood Pressure Control: Maintaining blood pressure within normal limits.
• Cholesterol Management: Statins may be prescribed to lower cholesterol.
• Blood Sugar Control: For diabetic patients, strict glucose control is essential.
• Lifestyle Changes: Stopping smoking, eating a healthy diet, exercising regularly, and limiting alcohol intake.
• Medication Adherence: Long-term use of antiplatelet or anticoagulant medications as prescribed.

Stroke treatment is most effective when accomplished early, utilizing clot-dissolving agents for ischemic stroke and surgical intervention for hemorrhagic stroke. Timely medical intervention, rehabilitation, and preventive measures significantly enhance recovery prospects. Managing risk factors through lifestyle changes and medications is crucial in preventing recurrent strokes. A multidisciplinary care plan can greatly benefit survivors by improving the quality of care.

Star Health provides coverage for extended hospitalization, stroke treatment, and recovery expenses. Our policies apply in emergencies and offer cashless treatment at over 14,000 network hospitals across India.

Also Read:

→ What Causes a Stroke to Happen