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Treatment of strokes

Tractament de l'ictus a Vall d'Hebron

Early treatment by expert neurologists and admission to specialised units significantly reduces mortality and long-term dependence in people who suffer from acute stroke. It is essential, then, that if you suspect that you or someone else is having a stroke, you call 112 and follow their instructions to get treatment at the appropriate hospital.

It is also important to state as accurately as possible the time of onset of symptoms. If the patient is unable to give this information or has woken up with signs of a possible stroke, the start time will be considered the last hour he was awake and asymptomatic.

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Description

Ischemic strokes

In the case of ischemic strokes, the purpose of treatment is to undo or remove, in the shortest possible time, the clot that is cutting off the natural blood circulation in the brain. There are two ways to do this:

  • Intravenous thrombolysis. This treatment is used to break down clots that close the intracranial artery. It has a time limit on when it can be administered, and is effective in 40% of cases. When the drug has dissolved the clot and the closed artery has been uncovered, the artery is said to have been recanalised.
  • Thrombectomy (neurovascular intervention). This is performed in cases where the drug has not been effective or cannot be administered. In this case, the clot is removed by an invasive intraarterial procedure through the femur.

 

Haemorrhagic strokes

In haemorrhagic strokes, the treatment aims to stop the bleeding that has been caused by the rupture of a vessel and prevent the increase in size of the haemorrhage. Therefore, regular monitoring of the patient is performed to gauge the level of consciousness and any neurological deficits. This is maintained for at least the first 72 hours after suffering a stroke. We also perform intensive monitoring of blood pressure, blood sugar levels and temperature to foresee possible complications.

Brain bleeding can cause inflammation of the surrounding brain tissue (known as oedema). If this happens, it is necessary to administer medication intravenously to reduce it.  In people who are being treated with oral anticoagulants or who have alterations in haemostasis (a process that the body performs to slow down bleeding), it should be corrected as soon as possible.

In more severe cases, specialists may recommend surgery to drain the bleeding. The decision on surgical treatment is made based on factors such as the location and size of the haemorrhage, age, and the patient’s medical history. This is a difficult decision as it is not always possible to access it without causing damage to other areas of the brain. 

 

Rehabilitation

The purpose of neurorehabilitation is to regain lost or diminished neurological functions as a result of a stroke. However, there are phases of recovery:

  • The first three months is when we see the greatest degree of neurological recovery.
  • In the first six months, functional recovery takes place.
  • After approximately a year, there is adaptation to disability and reintegration into the community.
  • Up to two years after the attack, language and balance can continue to improve.

The interdisciplinary team involved throughout the different stages works so that the patient has the maximum independence and adaptation to their environment.  To meet these goals, it is advisable to start recovery as soon as possible and, from the initial stages, foster the participation of patient and caregivers. 

It should be mentioned that there is “Spontaneous recovery”: this is when the brain has the ability to recover from the damage it has suffered on its own. This recovery, however, may not be enough to reduce the sequelae. That is why it is advisable to always follow the instructions of specialists.

 

Interdisciplinary team

An interdisciplinary team deals with the recovery of a patient who has suffered a stroke. Each of the professionals acts according to the evolution of the condition and the needs that arise at any given time:

  • The neuropsychology  staff are involved when behavioural changes occur as a result of damage to the brain. There may also be impairment of memory, language (comprehension and expression), attention and concentration, the speed with which the brain processes information, visual recognition, programming of motor functions, mood changes, etc.
  • Physiotherapy will be involved for people who, after suffering a stroke, have motor deficits such as walking, balance, loss of strength and muscle tone, among others.
  • In the case of a patient with a disability, occupational therapy aims to help the patient carry out their daily tasks independently (dressing, eating, handling money, among others) and supports adaptation to the environment, which sometimes involves adapting the home and providing utensils appropriate for daily activities without assistance from others, or with as little assistance as possible.
  • Cases where problems with language and communication skills are detected will involve speech therapy. These obstacles may manifest as an inability to convey or understand what the person is saying, presenting incoherent language (aphasia), difficulty in articulating words (dysarthria), or an inability to speak at all. It also deals with problems related to dysphagia (inability to swallow), which can lead to changes in diet, incorporating safe eating techniques (to prevent malnutrition, dehydration and food passing into the lungs) or, in more severe cases, having to use a feeding tube.
  • The social care team aims to achieve the maximum social integration of the patient, guiding and providing professional support in the social and family aspects of the people affected. They provide information on benefits, access and use of existing health and social resources, and how to manage them. 

Other professionals such as doctors, nurses and orthopaedic technicians are also involved in the rehabilitation process.

 

 

Author:

Estela Sanjuan
Research nurse. Coordinator of research and clinical trials at the Stroke Research Group at the Vall d'Hebron Research Institute.

 
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