Stroke

Treatment Options

Treatment for Stroke• Medication• Rehabilitation and Therapy• Surgery• Lifestyle Changes

• References

Stroke Medication• Emergency

– Clot-busters:• Thrombolytic medications e.g. tissue Plasminogen Activator (tPA)

(alteplase, Activase; Cathflo Activase)

– Aspirin– Swelling reduction:

• Corticosteroids such as cortisone and hydrocortisone

– Neuroprotective agents (in development)• After stabilization

Stroke Medications

• Anticoagulants (blood thinners) – warfarin (Coumadin), – enoxaparin (Lovenox) and – heparin.

• Antiplatelet (prevent platelets from sticking)– aspirin, – clopidogrel (Plavix) and – dipyridamole (Aggrenox) 

Stroke Medications

• Statins (lower cholesterol)– atorvastatin (Lipitor), – rosuvastatin (Crestor), and – simvastatin (Zocor).

• Blood pressure medicines (hypertensives)

Blood Pressure (BP) Medicines• Diuretics • Beta-Blockers• Alpha-Blockers• Calcium Channel Blockers• Angiotensin-Converting-Enzyme (ACE)

Inhibitors• Angiotensin II Receptor Blockers• Vasodilators

BP Medicine (Diuretics)• Thiazide diuretics

– chlorothiazide (Diuril), – chlorthalidone (Hygroton),– indapamide (Lozol), – hydrochlorothiazide (Esidrix, HydroDiuril)– , bendroflumethiazide (Naturen), – methylclothiazide, (Edduran), and – metolazone (Mykrox, Zaroxolyn).

BP Medicine (Diuretics)• Potassium sparing

– amiloride (Midamor), – spironolactone (Aldactone), and – triamterene (Dyrenium).

• Loop diuretics– bumetanide (Bumex), – furosemide (Lasix), – ethacrynic acid (Edecrin), and – torsemide (Demadex).

BP Medicine (Beta Blockers)• atenolol (Tenormin), • metoprolol (Lopressor), • nadolol (Corgard), • propranolol (Inderal), and• timolol (Blocadren

BP Medicine (Alpha Blockers)• Doxazosin (Cardura), • Phentolamine, • Tamsulosin (Flomax), and• Terazosin

BP Medicine (Calcium Channel Blockers)• Amlodipine (Norvasc), • Diltiazem (Cardizem LA, Tiazac), • Felodipine, • Isradipine (DynaCirc CR), • Nicardipine (Cardene SR), • Nifedipine (Procardia, Procardia XL,

Adalat CC), • Nisoldipine (Sular),and • Verapamil (Calan, Verelan, Covera-HS)

BP Medicine (Angiotensin-Converting-Enzyme (ACE) Inhibitors )

• benazepril• captopril• enalapril• fosinopril• lisinopril• moexipril• quinapril• ramipril

BP Medicine (Angiotensin II Receptor Blockers )

• Candesartan (Atacand),• Eprosartan (Teveten),• Irbesartan (Avapro),• Losartan (Cozaar),• Olmesartan (Benicar),• Telmisartan (Micardis), and• Valsartan (Diovan)

BP Medicine (Vasodilators)• Hydralazine HCI (Apresoline)• Minoxidil (Loniten)

Rehabilitation and Therapy• Physical• Occupational• Speech• Mental Health• Other

Physical Rehabilitation & Therapyhelps patients:

• Retrain the brain• Strengthen muscles,• Improve balance and gait, and • Regain as much physical control as

possible.

Occupational Rehabilitation & Therapy helps patients:

• Apply physical skills to activities of daily living

• Relearn eating, dressing, bathing and caring for oneself

• Redevelop cognitive skills such as difficulty with attention, memory or poor judgment.

• Develop new ways to do tasks successfully with new limitations

Occupational Rehabilitation & Therapy helps patients:

• Learn to safely reduce potential injury, • Use prostheses and orthotics and • Adjust to assistive devices

– Canes, – Crutches, – Walkers and – Wheelchairs

Speech Rehabilitation & Therapy helps patients:

• Relearn how to express themselves,• Relearn how to process language input, • Retrain swallowing mechanisms• Develop communication tricks when

typical speech is lost• Improve articulation and enunciation, and• Use devices such as computer-aided

speech technology.

Mental Health Rehabilitation & Therapy helps patients:

• Counseling for depression and anxiety• Retraining in social skills.• Setting short term and long term goals

Other Rehabilitation and Therapy:• Music Therapy. • Mirror Therapy using the unaffected side to

envisioning the affected side moving,• Robotic Therapy (sophisticated exercise

machines),• Virtual Reality, (such as WII Hab - using a

gaming system to practice movement),• Mental Practice envisioning movement• Recreational Therapy 

SurgerySurgery for stroke is used in three different ways:• To prevent stroke• Immediately after the stroke• To repair damage after the patient is

stable

Surgeries for ischemic stroke and to prevent future stroke

•  Carotid Artery Surgery (Endarterectomy) and 

• Carotid Stenting.

Surgeries for hemorrhagic stroke• Draining leaking blood• Treating an aneurysm

Clipping Endovascular coil embolization

Lifestyle Changes• Quitting smoking,• Lowering blood pressure,• Losing weight,• Eating right,• Being physically active,• Limiting alcohol to the recommended

consumption, and• Taking medication as prescribed.

Nutritional Changes• Include a variety of foods and foods of

different colors• Eat whole grains, vegetables and fruits.• Foods low in saturated fat and cholesterol.• Foods with limited added sugar.• Foods with limited of salt and sodium.

Why Exercise?• Recover pre-stroke strength and abilities,    • Prevent recurrent stroke,• Improve aerobic fitness, and• Cognitive exercise

– Keep the mind sharp,– Retrain damaged neural – memory practice, puzzle solving, or word

games. 

Referenceshttp://health.nytimes.com/health/guides/disease/hypertension/medications.htmlhttp://www.medicinenet.com/stroke/page7.htm#what_is_the_treatment_of_a_strokehttp://www.baptistneurology.com/health-library/neurology-treatments/drugs/http://www.webmd.com/brain/brain-swelling-brain-edema-intracranial-pressurehttp://strokecenter.stanford.edu/guide-new-drugs.htmlhttp://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htmhttp://www.baptistneurology.com/health-library/neurology-treatments/rehabilitation/http://medicalcenter.osu.edu/patientcare/healthcare_services/nervous_system/about/rehab/Pages/index.aspxhttp://www.neuropt.org/farcry/%20/go/consumer-information/what-is-a-neurologic-physical-therapisthttp://www.stroke.org/site/PageServer?pagename=REHABTThttp://www.nimh.nih.gov/health/publications/depression-and-stroke/depression-and-stroke.pdfhttp://nyp.org/services/rehabmed/stroke-therapies.htmlhttp://www.ninds.nih.gov/disorders/stroke/stroke_rehabilitation.htm

Depression and Other Mental Health Diagnoses after Stroke Increase Inpatient and Outpatient Medical Utilization Three Years PoststrokeSushmita Shoma Ghose, Linda S. Williams and Ralph W. SwindleMedical Care , Vol. 43, No. 12 (Dec., 2005), pp. 1259-1264Published by: Lippincott Williams & WilkinsArticle Stable URL: http://www.jstor.org/stable/3768213 http://www.news-medical.net/health/Music-Therapy-for-Stroke.aspxhttp://www.ucl.ac.uk/dcal/documents/deaf_stroke_resultshttp://deafstroke.salk.edu/http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/treatment.htmlhttp://www.webmd.com/stroke/guide/stroke-surgeryhttp://www.everydayhealth.com/health-center/stroke-surgery.aspxhttp://nihseniorhealth.gov/stroke/surgeryandvascularinterventions/01.htmlhttp://www.aphasiahelp.org/information/stroke/09_surgery/index.phphttp://www.rwjuh.edu/medical_services/vascular_center_carotid_artery_surgery.html

http://www.nhlbi.nih.gov/health//dci/Diseases/carend/carend_risks.htmlhttp://www.webmd.com/brain/tc/brain-aneurysm-endovascular-coil-embolization-topic-overviewhttp://www.webmd.com/hw-popup/arteriovenous-malformationKeith W., M. (n.d). Common medical presentations: Stroke. Medicine, 37(Acute medicine Part 2 of 2), 109-114. doi:10.1016/j.mpmed.2008.11.004http://www.webmd.com/stroke/features/stroke-prevention-lifestyle-tipshttp://www.baptistneurology.com/health-library/neurology-treatments/lifestyle/http://strokefoundation.com.au/prevent-stroke/risk-factors/high-blood-pressure/tips-to-change-your-lifestyle/http://www.livestrong.com/article/300758-diet-plan-for-a-stroke-victim/http://my.clevelandclinic.org/disorders/Stroke/hic_The_Role_of_Nutrition_in_the_Prevention_and_Treatment_of_Stroke.aspxhttp://www.webmd.com/food-recipes/guide/the-mediterranean-diethttp://www.nlm.nih.gov/medlineplus/tutorials/managingstress/hp069103.pdf)

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