Stroke - Treatment - NHS

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Ischaemic strokes can often be treated using injections of a medicine called alteplase, which dissolves blood clots and restores blood flow to the brain. This ... Skiptomaincontent Home HealthAtoZ Stroke BacktoStroke Treatment - Stroke Contents Overview Symptoms Causes Diagnosis Treatment Recovery Prevention Effectivetreatmentofstroke canpreventlong-termdisabilityandsavelives.Thespecifictreatmentsrecommended dependonwhether astroke iscausedby:a bloodclotblockingtheflowofbloodtothebrain(ischaemicstroke)bleedinginoraround thebrain(haemorrhagicstroke)Treatmentusuallyinvolvestaking1ormoredifferentmedicines,althoughsomepeoplemayalsoneedsurgery. TreatingischaemicstrokesIfyouhavehadanischaemicstroke,acombinationofmedicinestotreattheconditionandpreventithappeningagain isusuallyrecommended.Someofthesemedicinesneedtobetakenimmediatelyandonlyforashorttime,whileothersmayonlybestartedoncethestrokehasbeentreatedandmayneedtobetakenlongterm.Thrombolysis–"clotbuster"medicineIschaemicstrokescanoftenbetreatedusinginjectionsofamedicinecalled alteplase,whichdissolvesbloodclotsandrestoresbloodflow tothebrain.Thisuseof"clot-busting"medicineisknownasthrombolysis.Alteplaseis mosteffectiveifstartedassoonaspossibleafterthestrokeoccurs–andcertainlywithin4.5hours.It'snotgenerallyrecommendedifmorethan4.5hourshavepassed,asit'snotclearhowbeneficialitis whenusedafterthistime.Beforealteplasecanbeused,it'sveryimportantthatabrainscanisdonetoconfirmadiagnosisofanischaemicstroke.Thisisbecausethemedicinecanmake thebleedingthatoccursinhaemorrhagicstrokesworse.ThrombectomyAsmall numberofsevereischaemicstrokescanbetreatedbyanemergencyprocedure calledathrombectomy.Thisremovesbloodclotsandhelpsrestorebloodflowtothebrain.Thrombectomyisonlyeffectiveattreatingischaemicstrokescausedbyabloodclotinalargearteryinthebrain. It'smosteffectivewhenstartedassoonaspossibleafterastroke.Theprocedureinvolvesinsertingacatheterintoanartery,ofteninthegroin.Asmalldeviceispassedthroughthecatheterinto thearteryinthebrain.Thebloodclotcanthenberemovedusingthedevice,orthroughsuction.Theprocedurecanbedoneunderlocalorgeneralanaesthetic.AspirinandotherantiplateletsMostpeoplewillbeofferedaregulardoseof aspirin.Aswellasbeingapainkiller,aspirinisanantiplatelet,whichreducesthechancesofanotherclotforming.Otherantiplateletmedicinesmaybeused,suchasclopidogrelanddipyridamole.AnticoagulantsSomepeoplemaybeofferedananticoagulanttohelpreducetheirriskofdevelopingnewbloodclotsinthefuture.Anticoagulantspreventbloodclotsbychangingthechemicalcompositionofthebloodinawaythatpreventsclotsfromforming.Warfarin,apixaban,dabigatran,edoxabanandrivaroxabanareexamplesofanticoagulantsforlong-termuse.Therearealsoanumberofanticoagulantscalledheparins,whichcanonlybegivenbyinjectionandareusedshortterm.Anticoagulantsmaybeofferedifyou:haveatypeofirregularheartbeatcalledatrialfibrillation,whichcancausebloodclotshave ahistoryofbloodclotsdevelopablood clotinyourlegveins(deepveinthrombosis(DVT))becauseastrokehasleftyouunabletomoveoneofyourlegsBloodpressuremedicinesIfyourbloodpressureistoohigh,youmaybeofferedmedicinestolowerit.Medicinesthatarecommonlyusedinclude:thiazidediureticsangiotensin-convertingenzyme(ACE)inhibitorscalciumchannelblockersbetablockersalpha-blockersFindoutmoreabouttreatinghighbloodpressureStatinsIfthelevelofcholesterolinyourbloodistoohigh,you'llbeadvisedtotakeamedicineknownasastatin.Statinsreducethelevelofcholesterolinyourbloodbyblockingachemical(enzyme)intheliverthatproducescholesterol.Youmaybeofferedastatinevenifyourcholesterollevelisnotparticularlyhigh,asitmayhelpreduceyourriskofstrokewhateveryourcholesterollevelis.CarotidendarterectomySomeischaemicstrokesarecausedbynarrowingofanarteryintheneckcalledthecarotidartery,whichcarriesbloodtothebrain.Thenarrowing,knownascarotidstenosis,iscausedbyabuild-upoffattyplaques.Ifthecarotidstenosisisverysevere,surgerymaybeusedtounblocktheartery.Thisiscalledacarotidendarterectomy.Itinvolvesthesurgeonmakingacut(incision)inyournecktoopenupthecarotidarteryandremovethefattydeposits. TreatinghaemorrhagicstrokesAswithischaemicstrokes,somepeoplewhohavehadahaemorrhagicstrokewillalsobeoffered medicinetolowertheirbloodpressure andpreventfurtherstrokes.Ifyouweretakinganticoagulantsbeforeyouhadyourstroke,youmayalsoneedtreatmenttoreversetheeffectsofthemedicineandreduceyourriskoffurtherbleeding.SurgeryOccasionally,emergencysurgerymay beneededtoremoveanybloodfromthebrainandrepairanyburstbloodvessels.Thisisusuallydoneusingasurgicalprocedureknownasacraniotomy.Duringacraniotomy,asectionoftheskullisremovedtoallowthesurgeonaccesstothesourceofthebleeding.Thesurgeonwillrepairanydamagedbloodvesselsandensuretherearenobloodclotspresentthatmayrestrictthebloodflowtothebrain.Afterthebleedinghasbeenstopped,thepieceofboneremovedfromtheskullisreplaced,oftenbyanartificialmetalplate.SurgeryforhydrocephalusSurgerycanalsobedonetotreat acomplicationofhaemorrhagicstrokescalledhydrocephalus.Thisiswheredamage resultingfrom astrokecausescerebrospinalfluidtobuildupinthecavities(ventricles)ofthebrain,causingsymptomssuchasheadaches,sickness,drowsiness,vomitingandlossofbalance.Hydrocephaluscanbetreated byputtingatube,calledashunt,intothebraintoallowthefluidtodrain.Findoutmoreabouttreatinghydrocephalus SupportivetreatmentsYoumayneedfurthershort-termtreatmenttohelpmanagesomeoftheproblemsthat canaffectpeoplewhohavehadastroke.Forexample,youmayrequire:afeedingtubeinsertedintoyourstomachthroughyournose(nasogastrictube)toprovidenutritionifyouhavedifficultyswallowing (dysphagia)nutritionalsupplementsifyou'remalnourishedfluidsgivendirectlyintoavein(intravenously)ifyou'reatriskofdehydrationoxygenthroughanasaltubeorfacemaskifyouhavelowlevelsofoxygeninyourbloodcompressionstockingstopreventbloodclotsinthelegs (DVT)Findoutmoreaboutrecoveringfromastroke Pagelastreviewed:15August2019 Nextreviewdue:15August2022 Previous : Diagnosis Next : Recovery

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