Stroke Treatment and Diagnosis

Stroke Treatment Stages

• Stroke treatment consists of three stages: prevention, acute care, and rehabilitation.
• Prevention focuses on managing risk factors like high blood pressure, cholesterol, diabetes, smoking, and maintaining a healthy weight.
• Acute care aims to diagnose the stroke type, support brain circulation, and prevent further complications.
• Rehabilitation focuses on recovery and regaining lost function through specialized therapy.

Diagnosing a Stroke

• Stroke diagnosis involves observation, patient history, a physical examination, including a neurological assessment, and imaging tests.
• The National Institutes of Health Stroke Scale (NIHSS) assesses neurological function and recovery.
• Imaging tests, including CT scans, MRI, and cerebral arteriography, help identify stroke-related changes and differentiate between hemorrhagic and ischemic strokes.
• Blood tests, like the PLAC test, are used to assess the risk for recurrent stroke.

Medications for Stroke Prevention

• Antiplatelet agents like aspirin and clopidogrel are used to reduce the risk of stroke in individuals with a history of TIAs or stroke.
• Anticoagulants like warfarin, rivaroxaban, apixaban, edoxaban, and dabigatran are prescribed to prevent stroke in patients with atrial fibrillation.
• Antihypertensive medications, including thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs, are used to manage high blood pressure and reduce stroke risk.
• Cholesterol-lowering drugs, such as statins and fibric acid agents, are prescribed to manage high cholesterol levels.

Medications for Acute Stroke

• Anticoagulants, platelet inhibitors, and thrombolytic agents are used to treat thrombotic strokes.
• Thrombolytic therapy with alteplase (tPA) is considered the gold standard for treating acute ischemic stroke.
• tPA is most effective when administered intravenously within 3 hours of stroke onset, but can be given up to 4.5 hours in specific cases.
• Aspirin may be used in patients who are contraindicated for tPA.
• Anticoagulants and antiplatelet agents are not used in patients with hemorrhagic stroke.
• Corticosteroids, such as prednisone or dexamethasone, may be prescribed for cerebral edema.
• Osmotic diuretics (mannitol) and loop diuretics (furosemide) may be given for increased intracranial pressure.
• Anticonvulsants, such as phenytoin and barbiturates, may be prescribed for seizures related to increased ICP.

Surgical Interventions

• Carotid endarterectomy is a surgical procedure to remove atherosclerotic plaque from the carotid artery bifurcation to improve blood flow.
• Extracranial-intracranial bypass surgery is performed to re-establish blood flow to the brain in cases of occluded or stenotic vessels.
• Carotid angioplasty with stenting can be used to treat cerebral stenosis.

Rehabilitation Therapies

• Physical therapy focuses on preventing contractures, improving muscle strength, and enhancing coordination.
• Occupational therapy helps patients regain lost motor skills, such as eating, bathing, and dressing.
• Speech and language therapy assists with relearning language and communication skills, as well as improving swallowing.

This quiz covers the three essential stages of stroke treatment: prevention, acute care, and rehabilitation. It also delves into the methods used for diagnosing a stroke, including the importance of imaging tests and neurological assessments. Test your understanding of stroke management and recovery processes.