Treatment
Aspirin has been shown to be helpful in reducing stroke recurrence. Dipyridamole and Clopidogrel may also reduce the risk of recurrent stroke.
Drugs that reduce blood clotting or dissolve existing clots may be given following ischaemic stroke. The drug tissue plasminogen activator (or t-PA) is a clot-dissolving drug. If given within 3 hours of a stroke, disability may be reduced. The main complication of this drug is bleeding into the brain. Currently t-PA is not widely available in the UK.
Some hospitals have specialist stroke units. These offer a structured programme of rehabilitation and care. This has been shown to improve recovery and function compared to non-stroke unit care.
Rehabilitation following a stroke is best served by a multidisciplinary team approach. Doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists and counsellors all have an important role to play. Assistive equipment such as callipers, splints and braces may be needed to reduce functional limitations arising from paralysis and contractures.
Cognitive rehabilitation is an integral part of stroke rehabilitation. It involves assessment of cognitive function, identification of specific areas of impairment, goal setting and institution of appropriate rehabilitation techniques.
There is evidence that cognitive rehabilitation may improve certain aspects of cognitive function following stroke, for example, Aphasia, apraxia, spatial neglect, attention deficits and memory disorders (by use of appropriate memory aids).
Surgery may be required to remove blood clots from the brain after haemorrhagic stroke, or to remove fatty deposits (atheroma) from the carotid artery. This may involve placing a clip or a platinum coil around an aneurysm (a blood filled balloon formed by the dilatation of the wall of an artery) to stop bleeding (see sub-arachnoid haemorrhage in ‘other types of cerebral accident’), however these procedures are risky in themselves.
Transient Ischaemic Attack (TIA) clinics, by arranging speedy investigations and treatment (if necessary), and focussing on other preventative aspects, such as lifestyle advice, aim to prevent strokes from occurring.
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