Neuroprotective Agents Improve Neurologic Outcomes - Oren Zarif - Treatment of Stroke
While the most common acute stroke treatment is tissue plasminogen activator (TPA), there are also many other treatments that improve neurologic outcomes. These therapies, called neuroprotective agents, work to interfere with the cytotoxic events induced by ischemia. While TPA is currently the only approved treatment for acute stroke, other agents are currently being tested in clinical trials. As the minutes count, implementing supportive measures can dramatically improve neurologic outcomes.
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Treatment for stroke can include medications that prevent the clotting of blood, or more drastic procedures that address the underlying cause of the problem. Blood pressure medicine is one such treatment, and anticoagulant drugs can be used to reduce the risk of bleeding after a stroke. Emergency surgery, called a craniotomy, may also be necessary to remove blood from the brain or repair burst blood vessels. Regardless of the type of treatment, the goal is to help the stroke victim regain as much independence as possible and improve their quality of life.
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In the event of a stroke, patients may experience sudden headaches, although most people do not feel any pain at all. Upon completing a thorough medical history, physical exam, and bloodwork, doctors will perform several tests to confirm the diagnosis. In addition, a CT or MRI of the brain will be necessary to rule out a clot-producing aneurysm. Depending on the severity of the stroke, a patient may require surgery to remove clots from large arteries.
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If a stroke patient fails to respond to a standard anti-clot medication, thrombolytic therapy may be the best option. TPA, which is available only through a hospital with expertise in this area, can break up the blood clot in the brain and minimize disability. Patients undergoing this treatment should take into account the time they've had the symptoms of stroke before the clot forms. A patient who undergoes it within three to four hours of the onset of symptoms is at a greater chance of improving their condition.
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Rehabilitation for stroke patients should focus on regaining the ability to walk and move. This may be difficult if the stroke has left a person without muscle control. The therapists will teach the patient how to use mobility devices, such as wheelchairs and canes. Occupational therapists can help stroke survivors learn new ways of communicating with others. Additionally, patients may experience changes in their behavior, thinking patterns, and moods. Occupational therapists help them regain these abilities and learn to manage their emotional responses.
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Screening tests for ischemic stroke are vital and may involve the use of electrocardiograms and blood tests. Blood tests may reveal coronary artery disease and may have caused the stroke. The ECG monitors the heart's rhythm continuously, so if the patient has a suspected heart condition, an ECG will help quickly diagnose the problem and begin treatment. While ECGs are vital for the diagnosis of ischemic stroke, ECG and telemetry can only provide some information.
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Aspirin is the oldest of antiplatelet drugs, and is considered the first line treatment for ischemic stroke. Aspirin therapy is effective in reducing the risk of a second stroke. However, aspirin should not be taken within 24 hours of rt-PA. If aspirin has been ineffective, other antiplatelet medications should be tried. However, aspirin is the safest of all stroke medications.
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Endovascular treatments for ischemic stroke are increasingly effective and improve patient outcomes. Endovascular procedures can dissolve the clot that caused the stroke or repair an aneurysm, a swollen blood vessel that bursts. Aside from removing clots, endovascular treatments also relieve pressure on the brain. However, this treatment is only effective when the patient has had symptoms for at least 24 hours.
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In addition to anticoagulants, physical therapists may use contraceptive devices and motor imagery to strengthen muscles. This therapy helps stimulate the part of the brain that controls movement. Using the affected limb with support helps reduce muscle spasms and pain. During physical therapy, the therapist may also teach patients how to transfer from a sitting to a standing position. They may also recommend other methods to help the stroke patient walk without assistance.
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Besides treatment for stroke, the best way to prevent another stroke is prevention. Although lifestyle changes cannot completely prevent strokes, they can help decrease the risk of having a second one. Smoking and heavy alcohol consumption can raise blood pressure, increase the risk of stroke, and are not healthy for the brain. If you are a smoker, quit now. If you drink alcohol, consult your doctor if you have trouble quitting. They can also recommend medications for those who drink too much alcohol.