Medications
If you get to a hospital at the first signs of an ischaemic stroke, you may be given powerful clot-busters called thrombolytics--the only approved drug therapy for an ongoing stroke. Thrombolytics dissolve existing clots, open up blocked arteries and restore blood flow to the brain.
The main thrombolytic medication is called tissue plasminogen activator (tPA), although others are used and several are under investigation. If you arrive within in the first three hours of the start of stroke symptoms, you'll get thrombolytics through a vein; if it's later, within six hours, you may get them infused directly into a brain artery. In experienced hands, thrombolytics can dramatically reduce your risk of permanent disability from a stroke. However, thrombolytics affect blood clotting and so they also increase your risk of bleeding--which in itself can be dangerous. The bottom line is that most people get to the hospital too late for thrombolytic therapy, and only 2 percent of stroke victims ever receive tPA.
If you're among the majority of stroke patients not receiving thrombolytics, you'll be started on an antiplatelet drug to prevent another clot from developing. Aspirin is a top choice. You're far less likely to die or suffer a disability if you start aspirin therapy within 48 hours of an ischaemic stroke. Aspirin affects the blood's ability to form a clot and this has two very positive benefits: first, aspirin will make your current stroke less severe and second, it will definitely reduce your chances of developing another. If you've had a haemorrhagic stroke, take aspirin only on a doctor's recommen-dation because it can increase bleeding.
Your doctor may recommend a drug that combines aspirin with another antiplatelet agent called dipyridamole. Named Persantin, the blend is more effective than aspirin alone for preventing a second stroke, especially if you're at high risk for one. Also slightly more protective against stroke than aspirin alone are thienopyridine drugs such as Ticlid, Plavix and Iscover. All these antiplatelet medications are listed on the PBS for the secondary prevention of stroke or transient ischaemia attacks (mild stroke-like symptoms that resolve within 24 hours). Sometimes the potent anticlothing drug warfarin (Coumadin) is prescribed, but bleeding risk is higher.
Following a stroke, you may also need other medications to treat various complications. Depression is very common and antidepressants, such as Prozac, can really be of benefit. They also help ease any crying episodes and increase your mental sharpness. A brain stimulant such as Ritalin may boost speech and motor skills when combined with physiotherapy. The muscle relaxant baclofen can help with painful muscle spams. When speech difficulties occur, Parlodel, a drug used for Parkinson's disease, can enhance your ability to form sentences and multisyllable words.
PROMISING DEVELOPMENTS
A stroke happens in one of three ways. 1) A thrombus (clot) can build up on a brain artery wall, causing a cerebral thrombosis. 2) An embolus (usually a clot) can make its way to a brain artery and impede the blood flow, causing a cerebral embolism. 3) A blood vessel within or on the surface of the brain can leak or rupture, causing a haemorrhagic stroke. Ischaemic strokes are treated very differently to haemorrhagic strokes.
Haemorrhagic Stroke
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The treatment for haemorrhagic stroke is different to that for ischaemic stroke in two important ways. First, anticoagulants and clot-blusters are not given with a haemorrhagic stroke because they could worsen the bleeding in the brain. Instead, medications focus on lowering blood pressure and minimising blood flow from the ruptured artery. Second, surgery may be done to remove accumulated blood and relieve pressure. (The skull allows little room for tissue to expand so bleeding quickly raises pressure in a dangerous way.) Surgeons may remove blood clots in the damaged area. While surgery may save your life it may also leave you with severe neurological problems.
A common problem with haemorrhagic stroke is that blood vessels near the bleed can spasm and contract, which in turn blocks oxygen to the brain, increasing the potential stroke damage. To prevent this, your doctor may use a calcium channel blocker to relax the blood vessels. A novel means of adminstering the calcium channel blocker drug Cardene involves surgically placing 2 to 10 tiny drug pellets parallel to the affected artery and next to any blood clots. The journal Stroke reported in 2002 that doing this can vitally eliminate vessel spams and their consequences.
>The stroke has made me wobbly. If I fall, will my brittle bones give way?
You're right to be concerned about falling. Talk with your doctor about taking biphosphhonate drugs such as Fosamax, which increase bone density (and strength) and reduce the odds that you'll suffer a fracture if you do fall. Physiotherapy and aids around the house can help prevent treacherous spills during the post-stroke period.
>What about natural treatments? Will they help?
Acupuncture done on points on the sculp that relate to the central nervous system seems to help damaged (but not destroyed) brain cells perk up and get back to work. And when points on affected hands and feet are stimulated, acupuncture may jump-start lost sensation and motion. It can also relieve the pain and stiffness of spastic muscles. Another therapy, the Feldenkralis method of 'body education' for 'relearning' movements, helps with loss of nerve and muscle function or poor joint movement and balance. And hands-on therapies like Rolfing and myopractic can serve to release muscle and nerve tension.
If you get to a hospital at the first signs of an ischaemic stroke, you may be given powerful clot-busters called thrombolytics--the only approved drug therapy for an ongoing stroke. Thrombolytics dissolve existing clots, open up blocked arteries and restore blood flow to the brain.
The main thrombolytic medication is called tissue plasminogen activator (tPA), although others are used and several are under investigation. If you arrive within in the first three hours of the start of stroke symptoms, you'll get thrombolytics through a vein; if it's later, within six hours, you may get them infused directly into a brain artery. In experienced hands, thrombolytics can dramatically reduce your risk of permanent disability from a stroke. However, thrombolytics affect blood clotting and so they also increase your risk of bleeding--which in itself can be dangerous. The bottom line is that most people get to the hospital too late for thrombolytic therapy, and only 2 percent of stroke victims ever receive tPA.
If you're among the majority of stroke patients not receiving thrombolytics, you'll be started on an antiplatelet drug to prevent another clot from developing. Aspirin is a top choice. You're far less likely to die or suffer a disability if you start aspirin therapy within 48 hours of an ischaemic stroke. Aspirin affects the blood's ability to form a clot and this has two very positive benefits: first, aspirin will make your current stroke less severe and second, it will definitely reduce your chances of developing another. If you've had a haemorrhagic stroke, take aspirin only on a doctor's recommen-dation because it can increase bleeding.
Your doctor may recommend a drug that combines aspirin with another antiplatelet agent called dipyridamole. Named Persantin, the blend is more effective than aspirin alone for preventing a second stroke, especially if you're at high risk for one. Also slightly more protective against stroke than aspirin alone are thienopyridine drugs such as Ticlid, Plavix and Iscover. All these antiplatelet medications are listed on the PBS for the secondary prevention of stroke or transient ischaemia attacks (mild stroke-like symptoms that resolve within 24 hours). Sometimes the potent anticlothing drug warfarin (Coumadin) is prescribed, but bleeding risk is higher.
Following a stroke, you may also need other medications to treat various complications. Depression is very common and antidepressants, such as Prozac, can really be of benefit. They also help ease any crying episodes and increase your mental sharpness. A brain stimulant such as Ritalin may boost speech and motor skills when combined with physiotherapy. The muscle relaxant baclofen can help with painful muscle spams. When speech difficulties occur, Parlodel, a drug used for Parkinson's disease, can enhance your ability to form sentences and multisyllable words.
PROMISING DEVELOPMENTS
- Surgeons are trying mechanical devices to open up blocked brain arteries in minutes--faster than clot-busting drugs. They're testing saline jets, ultrasound, laser energy and even snares and baskets to disrupt and dissolve clots.
- Much of the brain damage after a stroke is caused by a cascade of harmful chemicals released by dying brain cells, which poison nearby tissues. So-called neuro-protective agents, designed to save the cells from self-destructing, stop the chain reaction by blocking certain brain chemical receptors.
- Scientists have identified a new marker for increased stroke risk: c-reactive protein (CRP). Measuring this chemical, which indicates underlying inflammation, may soon be part of basic blood tests. Drug and healthy living can lower your CRP level.
Haemorrhagic Stroke
------------------------------------------------------------------------------------------------------------------------------
The treatment for haemorrhagic stroke is different to that for ischaemic stroke in two important ways. First, anticoagulants and clot-blusters are not given with a haemorrhagic stroke because they could worsen the bleeding in the brain. Instead, medications focus on lowering blood pressure and minimising blood flow from the ruptured artery. Second, surgery may be done to remove accumulated blood and relieve pressure. (The skull allows little room for tissue to expand so bleeding quickly raises pressure in a dangerous way.) Surgeons may remove blood clots in the damaged area. While surgery may save your life it may also leave you with severe neurological problems.
A common problem with haemorrhagic stroke is that blood vessels near the bleed can spasm and contract, which in turn blocks oxygen to the brain, increasing the potential stroke damage. To prevent this, your doctor may use a calcium channel blocker to relax the blood vessels. A novel means of adminstering the calcium channel blocker drug Cardene involves surgically placing 2 to 10 tiny drug pellets parallel to the affected artery and next to any blood clots. The journal Stroke reported in 2002 that doing this can vitally eliminate vessel spams and their consequences.
>The stroke has made me wobbly. If I fall, will my brittle bones give way?
You're right to be concerned about falling. Talk with your doctor about taking biphosphhonate drugs such as Fosamax, which increase bone density (and strength) and reduce the odds that you'll suffer a fracture if you do fall. Physiotherapy and aids around the house can help prevent treacherous spills during the post-stroke period.
>What about natural treatments? Will they help?
Acupuncture done on points on the sculp that relate to the central nervous system seems to help damaged (but not destroyed) brain cells perk up and get back to work. And when points on affected hands and feet are stimulated, acupuncture may jump-start lost sensation and motion. It can also relieve the pain and stiffness of spastic muscles. Another therapy, the Feldenkralis method of 'body education' for 'relearning' movements, helps with loss of nerve and muscle function or poor joint movement and balance. And hands-on therapies like Rolfing and myopractic can serve to release muscle and nerve tension.
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