Acute therapy
In order to reduce the damage that a stroke causes to the brain and improve the chances of a complete recovery of brain function, it is necessary to start diagnosis and treatment as early as possible.
The treatment options depend on the type of stroke. The attending physician must tailor the treatment to the individual patient. The following therapeutic principles are observed:
In addition to basic internal therapy, intensive medical treatment may be indicated for the acute treatment of a stroke, which follows four therapeutic principles:
Vital functions
Breathing should guarantee a sufficient oxygen content in the blood and blood pressure and blood sugar should be set neither too high nor too low. The body temperature should be lowered with calf compresses or medication if the patient develops a fever.
Reopening vascular occlusions
If the stroke is caused by a blood clot blocking a blood vessel, in some cases this clot can be dissolved with a drug (known as lysis therapy). The medication is injected into the bloodstream via a blood vessel. This treatment is only permitted within the first three hours after the onset of a stroke. However, following the publication of the results of a new study(ECASS III study, New England Journal of Medicine 2008; 359 (13): 1217-29), it is recommended that the time window for lytotherapy be extended to up to four and a half hours after the onset of symptoms. However, the following still applies: the earlier lysis can be started, the greater the success. In addition, treatment is reserved for highly specialized clinics such as university hospitals.
Prevention of a recurrent stroke
A patient who has suffered a stroke has an increased risk of suffering another stroke. Even if the first stroke was only minor, the damage caused by a subsequent stroke can be extensive. A thorough examination is therefore always advisable to find out the possible causes of the stroke. Sometimes the treating doctor will then recommend a medication that thins the blood in order to prevent a further stroke.
Reduction of consequential damage
If the brain swells as a result of a stroke and is hindered in this swelling by the skull bone, it may be necessary to remove a piece of bone to give the brain space and room for further expansion. The bone can be re-implanted later. Sometimes patients can also have seizures after a stroke, which should be treated quickly.
There are hospitals that specialize in the treatment of strokes. These usually have a so-called stroke unit. Reasons for admitting a patient to a stroke unit include
- a recent stroke that occurred within 72 hours
- an increasing deterioration in the patient’s condition
- Unstable vital signs with disturbances in blood pressure, heart rhythm, body temperature or blood sugar levels
- the possibility of reopening a vascular occlusion
Patients who are so severely affected that they fall into a coma or need to be ventilated should not be treated in a stroke unit, but in an intensive care unit.
