Management of stroke focuses on acute treatment, secondary prevention, and rehabilitation

Stroke: Overview

A stroke occurs when blood flow to the brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients, leading to cell death. It is a medical emergency and a major cause of disability and death worldwide.

Etiology

Strokes are classified into three main types based on their cause:

• Ischemic Stroke (87% of cases):

  Caused by a blockage in a blood vessel supplying the brain.
  Common causes:

  • Atherosclerosis: Build-up of fatty deposits in blood vessels.
  • Embolism: A clot or debris formed elsewhere in the body travels to the brain.
  • Thrombosis: A clot forms in a brain artery.
• Hemorrhagic Stroke:
  • Caused by bleeding into or around the brain.
  • Common causes:
    • Hypertension: Chronic high blood pressure weakens blood vessels.
    • Aneurysm: A bulging weak spot in a blood vessel that ruptures.
    • Arteriovenous Malformation (AVM): Congenital tangle of abnormal blood vessels.
• Transient Ischemic Attack (TIA) or Mini-Stroke:
  • Temporary blockage of blood flow to the brain, resolving within minutes to hours without causing lasting damage.
  • Often a warning sign of a future major stroke.

Progression

Stroke progression varies by type and severity:

• Acute Phase:
  • Minutes to hours after onset.
  • Tissue damage begins in the “ischemic core” with surrounding “penumbra” (salvageable tissue).
• Subacute Phase:
  • Days to weeks after stroke.
  • Brain edema and secondary injury processes can exacerbate damage.
• Chronic Phase:
  • Weeks to months after stroke.
  • Focus shifts to recovery, plasticity, and adaptation.

Management

Management of stroke focuses on acute treatment, secondary prevention, and rehabilitation:

• Acute Treatment:
  • Ischemic Stroke:
    • Thrombolysis: Administration of tissue plasminogen activator (tPA) within 4.5 hours of symptom onset to dissolve clots.
    • Mechanical Thrombectomy: Removing the clot using a catheter for eligible patients.
  • Hemorrhagic Stroke:
    • Blood Pressure Control: Immediate reduction to prevent further bleeding.
    • Surgery: Repairing aneurysms or AVMs, or relieving pressure from hematomas.
• Secondary Prevention:
  • Medications:
    • Antiplatelets: Aspirin or clopidogrel to prevent clots.
    • Anticoagulants: For patients with atrial fibrillation (e.g., warfarin, DOACs).
    • Statins: Lower cholesterol to reduce atherosclerosis risk.
  • Lifestyle Changes:
    • Quit smoking, maintain a healthy diet, and exercise regularly.
    • Manage chronic conditions like hypertension, diabetes, and obesity.
• Rehabilitation:
  • Physical Therapy: Restores mobility and strength.
  • Occupational Therapy: Improves skills for daily living.
  • Speech Therapy: Helps with communication and swallowing difficulties.
  • Psychological Support: Addresses depression, anxiety, and cognitive challenges.

Can Stroke Progression Be Stopped?

Stroke progression can sometimes be halted or its impact minimized with early intervention. Key strategies include:

1. Emergency Response:

   Recognize stroke symptoms using BE FAST (Balance, Eyes, Face, Arms, Speech, Time).
   Immediate medical attention can save brain tissue and prevent further damage.

2. Neuroprotective Therapies (Experimental):

   Research on neuroprotective agents aims to limit damage in the penumbra by reducing inflammation, oxidative stress, or excitotoxicity. 

3. Secondary Prevention:

   Aggressive control of modifiable risk factors can prevent recurrent strokes.

Conclusion

Stroke is a life-altering event, but timely treatment and preventive measures can significantly reduce its impact. With advances in acute therapies like thrombolysis and thrombectomy, coupled with long-term rehabilitation and risk management, the outlook for stroke survivors continues to improve. Early recognition and rapid action remain critical to halting progression and optimizing recovery.