Symptoms & Treatments

Stroke Therapy

Strokes are a leading cause of preventable disability and death in the United States. They are the third most common cause of death in the United States (150,000 per year) and the second most common cause of death for those older then sixty-five years of age.

There are 500,000 strokes in the United States each year. Of these, ten to eighteen percent will re-stroke within one year and thirty-three percent will re-stroke within five years. The numbers, however, are declining. Since 1980, mortality from stroke has declined by one percent per year. Since 1960, mortality due to stoke has declined more then sixty percent. Declining mortality is attributed to increased survival after stroke, decreased severity of strokes, and improved risk-factor control.

Important modifiable risk factors

• Hypertension
• Hypercholesterolemia and Hyperlipidemia
• Cigarette smoking
• Excessive use of alcohol, more than one to two drinks per day
• Obesity
• Arrhythmia such as atrial fibrillation
• Transient ischemic attack (TIA)
• Carotid stenosis

Important non-modifiable risk factors

• Age more than sixty-five
• Male
• Race
  — Blacks are two times more likely than whites to stroke
  — Hispanics are less likely to stroke than whites age sixty-five
  — Asians are more likely to stroke than whites
• Diabetes
• Prior stroke
• A first-degree relative with a stroke
• A carotid bruit

Current therapy for stroke has improved, both for acute stroke treatments and further stroke prevention. Individuals who suspect they are having a stroke should call 911 immediately. Arriving in the emergency room quickly can make a difference in stroke outcome. Recognizing a stroke is the first step in the process. Symptoms to watch for are:

• Sudden weakness or numbness in the face, arm, or leg
• Sudden loss of vision
• Sudden loss of speech
• Sudden onset of severe headache
• Unexplained dizziness, unsteadiness, or un-coordination
• Nausea
• Vertigo

Individuals who present to the emergency room within three hours may be candidates for thrombolysis. Thrombolysis is the administration of tissue plasminogen activator (TPA), a medicine which breaks blood clots. Patients receiving this drug can have some of their symptoms revolve. Patients who do not qualify will still benefit by acute care in a hospital by doctors trained in acute stroke care.

Some of the complications occurring after a stroke, such as cardiac arrhythmias, cerebral edema, blood pressure instability, and seizures can be effectively managed and should be addressed immediately. Tests which will diagnose the etiology of the stroke, such as carotid doppler, echocardiogram, and imaging studies of the head such as computed tomography (CT) scan and magnetic resonance imaging (MRI) scan will also aid in management.

Patients with signs of thrombosis, who do not qualify for TPA, can be anticoagulated with heparin to stop the progression of their stroke and prevent further damage.

Complications occurring after a stroke, such as seizures, muscle contractions, impaired ability to speak, or the loss of use of an extremity can respond to treatment.

Seizures after stroke occur in four to ten percent of patients. More than half will occur on the first day. Another twenty-five percent will occur by the end of the first month.

An impaired ability to speak or understand the spoken word can be improved with therapy by a trained speech therapist.

An occupational and physical therapist can improve a patient's ability to resume their normal activities of daily living and to ambulate. Methods of stroke identification, treatment, and rehabilitation continue to improve. Educating the public is a key to improving stroke care.