Stroke Care

Stroke Care

Understanding the comprehensive approach to stroke prevention involves the critical role of a neurologist who provides a multi-faceted strategy to avert future episodes. This strategy not only manages and treats individuals who have experienced a stroke but also aims to minimize potential damage and foster efficient recovery.  

Before understanding the benefits of Stroke Care, it’s crucial to familiarize ourselves with what a Stroke is and how to identify its early symptoms. This knowledge is essential for timely intervention, which can significantly improve treatment outcomes. 

What is a stroke

What Is a Stroke?

A stroke is a medical condition that occurs when the blood supply to a part of your brain is interrupted or reduced, preventing your brain tissue from getting oxygen and nutrients. This can trigger brain cells to die within minutes. There are primarily three types of strokes: Ischemic stroke (blocked artery), Hemorrhagic stroke (blood vessel leak or rupture), and Transient ischemic attack (temporary or mini stroke). Symptoms can include trouble with speaking or understanding, paralysis, numbness of the face, arm, or leg, trouble seeing in one or both eyes, headache, etc. 

Reference: 

Stroke Care: A Holistic Approach

Stroke care often requires a holistic approach, as patients may be left with physical, mental, or emotional challenges following a stroke. This means addressing not just the immediate physical damage caused by the stroke, but also potential cognitive impairments, emotional health, physical rehabilitation, and lifestyle changes. 

  • Immediate Care: This usually happens in a hospital setting, where immediate medical interventions are provided to help minimize brain damage and prevent further complications. 
  • Rehabilitation: This involves physical, occupational, and speech therapists working with the patient to help regain lost abilities or learn new ways of performing tasks. 
  • Emotional and Psychological Support: A significant part of holistic stroke care, this may involve professional mental health services, counseling, and support groups. 
  • Prevention and Risk Management: This includes lifestyle modifications such as maintaining a healthy diet, regular physical activity, cessation of smoking, and managing underlying health conditions like hypertension or diabetes. 
  • Medication Management: Depending on the cause of the stroke, some patients may be prescribed medications to prevent further strokes. 
  • Social Support: Holistic care also recognizes the essential role of family and community support. 
  • Palliative Care: In some cases, when recovery is not possible, the focus of care might shift towards improving the patient’s quality of life and alleviating symptoms.

References
  • Langhorne, P. (2008). Holistic rehabilitation in stroke. Clinical rehabilitation, 22(10-11), 891-901. https://doi.org/10.1177/0269215508096767 
  • Poltawski, L., Boddy, K., Forster, A., Goodwin, V. A., Pavey, A. C., & Dean, S. (2015). Motivators for uptake and maintenance of exercise: perceptions of long-term stroke survivors and implications for design of exercise programmes. Disability and rehabilitation, 37(9), 795-801. https://doi.org/10.3109/09638288.2014.942000 
  • Lawrence, M., & Kinn, S. (2013). Defining and measuring patient-centred care: an example from a mixed-methods systematic review of the stroke literature. Health expectations, 16(3), 295-326. https://doi.org/10.1111/j.1369-7625.2011.00747.x 
  • Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W. B., . . . Turner, M. B. (2012). Heart disease and stroke statistics – 2012 update: A report from the american heart association. Circulation, 125(1), E2-E220. https://doi.org/10.1161/CIR.0b013e31823ac046 
  • Steiner, V., Pierce, L., & Drahuschak, S. (2008). Building a foundation for a community-based stroke support group program. Rehabilitation Nursing, 33(6), 252-261. https://doi.org/10.1002/j.2048-7940.2008.tb00234.x 
  • Bravata, D. M., Ho, S. Y., Meehan, T. P., Brass, L. M., & Concato, J. (2007). Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the medicare population. Stroke, 38(6), 1899-1904. https://doi.org/10.1161/STROKEAHA.106.481465 

References

  • Langhorne, P. (2008). Holistic rehabilitation in stroke. Clinical rehabilitation, 22(10-11), 891-901. https://doi.org/10.1177/0269215508096767 
  • Poltawski, L., Boddy, K., Forster, A., Goodwin, V. A., Pavey, A. C., & Dean, S. (2015). Motivators for uptake and maintenance of exercise: perceptions of long-term stroke survivors and implications for design of exercise programmes. Disability and rehabilitation, 37(9), 795-801. https://doi.org/10.3109/09638288.2014.942000 
  • Lawrence, M., & Kinn, S. (2013). Defining and measuring patient-centred care: an example from a mixed-methods systematic review of the stroke literature. Health expectations, 16(3), 295-326. https://doi.org/10.1111/j.1369-7625.2011.00747.x 
  • Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W. B., . . . Turner, M. B. (2012). Heart disease and stroke statistics – 2012 update: A report from the american heart association. Circulation, 125(1), E2-E220. https://doi.org/10.1161/CIR.0b013e31823ac046 
  • Steiner, V., Pierce, L., & Drahuschak, S. (2008). Building a foundation for a community-based stroke support group program. Rehabilitation Nursing, 33(6), 252-261. https://doi.org/10.1002/j.2048-7940.2008.tb00234.x 
  • Bravata, D. M., Ho, S. Y., Meehan, T. P., Brass, L. M., & Concato, J. (2007). Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the medicare population. Stroke, 38(6), 1899-1904. https://doi.org/10.1161/STROKEAHA.106.481465 
REFERENCES

1. Emergency Medical Care

That’s accurate. The BEFAST acronym stands for: 

  • B – Balance: Ask the person to walk. Is their balance off? 
  • E – Eyes: Is their vision impaired or lost? Ask them if they see double or have a loss of vision in one or both eyes. 
  • F – Face: Look at the person’s face. Is one side drooping or numb? Ask the person to smile to confirm. 
  • A – Arms: Can the person raise both arms? Does one arm drift downward or is it weak or numb? 
  • S – Speech: Is speech slurred? Do they have trouble speaking or seem confused? Ask the person to say a simple sentence and check if it is correct and understandable. 
  • T – Time: If any of these signs are evident, it’s time to call 9-1-1 immediately. 
REFERENCE

Reference

  • Barsan WG. (2019). Emergency Medical Services and Stroke. JAMA. 321(12):1139–1140. doi:10.1001/jama.2019.2078. 
  • Harbison, J., Hossain, O., Jenkinson, D., Davis, J., Louw, S. J., & Ford, G. A. (2003). Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test. Stroke, 34(1), 71–76. https://doi.org/10.1161/01.str.0000044170.46643.5e 
  • Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., … American Heart Association Stroke Council. (2018). 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 49(3), e46–e110. https://doi.org/10.1161/STR.0000000000000158 

2. Diagnosis and Evaluation

The diagnosis of stroke begins with a detailed neurological exam, followed by the use of imaging techniques to identify the type and location of the stroke. Imaging tests could include a Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). 

A physical examination is typically performed first, where the healthcare provider looks for signs of a stroke and evaluates key vital signs, such as blood pressure and pulse. 

A CT scan is usually the first imaging test. It can help distinguish between ischemic stroke and hemorrhagic stroke and reveal any other brain abnormalities. 

An MRI is more sensitive than a CT for the detection of ischemic stroke, especially in the early stage after stroke onset. 

Other tests could include a cerebral angiogram, echocardiogram, blood tests, and electrocardiogram (ECG). 

A stroke specialist (a neurologist or a geriatrician) will typically conduct a more detailed evaluation, considering physical symptoms, medical history, lifestyle, and the results of these imaging tests. They would also assess crucial aspects such as swallowing ability, nutritional needs, and physical and psychological health. 

References

  • Furie K.L., Jayaraman M.V. (2018). 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke, 49, 509–510. [doi: 10.1161/STROKEAHA.117.019870]. 
  • Powers W.J., Rabinstein A.A., Ackerson T. et al. (2019). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 50(12): e344-e418. [doi: 10.1161/STR.0000000000000211]. 
  • National Institute of Neurological Disorders and Stroke. (2021, May 13). Stroke Information Page. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/disorders/all-disorders/stroke-information-page 
  • National Institute of Neurological Disorders and Stroke. (2022, January 20). Stroke diagnostics. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/stroke-diagnostics-fact-sheet 
REFERENCES1

3. Acute Treatment

Acute treatment for stroke is largely dependent on the type of stroke — ischemic (from a blockage) or hemorrhagic (from a rupture). The faster the treatment, the better the chances of survival and less likelihood of disability. 

  • Ischemic Stroke: These strokes are caused by clots obstructing blood flow to the brain. Acute treatment aims to restore blood flow. Intravenous administration of tissue plasminogen activator (tPA), a clot-busting drug, is the standard treatment given within 4.5 hours from when symptoms started. Another strategy is endovascular procedures or mechanical thrombectomy, where doctors thread a catheter through an artery in the groin up to the blocked artery in the brain, remove the clot or deliver medication directly to the site of the blocked artery. 
  • Hemorrhagic Stroke: This type of stroke is caused by bleeding into brain tissue when a blood vessel bursts. Acute treatment focuses on controlling bleeding and reducing pressure on the brain and may include medications to control blood pressure and prevent seizures. Surgery may also be needed to repair blood vessel abnormalities associated with it. 

Stroke treatment guidelines strongly suggest hospitalization in a stroke unit, which has been shown to improve patient outcomes. 

REFERENCES

References

  • Powers W.J., Rabinstein A.A., Ackerson T. et al. (2019). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 50(12): e344-e418. [doi: 10.1161/STR.0000000000000211]. 
  • Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, et al. (2015). Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 46(7):2032-60. [doi: 10.1161/STR.0000000000000069]. 
  • Mayo Clinic Staff. (2020, October 28). Stroke: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119. 

4. Neurologist Involvement

Neurologists play a crucial role in the management of stroke patients. Their involvement ranges from the acute treatment phase to the recovery and rehabilitation phases. 

During the initial or acute phase, a neurologist is essential in diagnosing the type of stroke, its location, and severity. They assess the patient’s neurological condition, interpret neuroimaging studies, and determine the most appropriate treatment, be it thrombolytic therapy, surgery, or a combination. 

The neurologist continues to monitor and manage the patient’s neurological status in the hospital, preventing and managing complications, and addressing any additional cerebrovascular risk factors to prevent recurrent strokes. 

During the recovery and rehabilitation phase, the neurologist, usually in a team with other healthcare professionals, oversees the person’s recovery and rehabilitation program, recommending therapies like physical, occupational, or speech therapy as needed. 

References

  • Xian Y., Holloway R.G., Pan W., Peterson E.D. (2017). The Association between Stroke Center Hospitalization for Acute Ischemic Stroke and Postacute Care and Outcomes. JAMA, 318 (23), 2375-2383. 
  • Gropen, T. I., Gagliano, P. J., Blake, C. A., Sacco, R. L., Kwiatkowski, T., Richmond, N. J., … & Group, N. Y. P. D. S. W. (2006). Quality improvement in acute stroke: the New York State stroke center designation project. Neurology, 67(1), 88-93. 
  • Foley, N., Salter, K., Teasell, R. (2007). Specialized stroke services: a meta-analysis comparing three models of care. Cerebrovascular Diseases, 23(2-3),194-201. 
Stroke care

6. Rehabilitation

Rehabilitation is a crucial part of recovery after a stroke. The goal of rehabilitation is to help the stroke survivor become as independent as possible and to attain the best possible quality of life. Rehabilitation may include working with speech therapists, occupational therapists, and physical therapists, among others, to regain lost functions or learn new ways to perform tasks. 

  • Physical Therapy: Works on problems with movement, balance, and coordination. The goals are to strengthen the body, improve balance, and relearn skills like sitting, standing, and walking. 
  • Occupational Therapy: Helps people regain the ability to carry out daily activities such as eating, dressing, bathing, and using the bathroom. 
  • Speech and Language Therapy: Works to address problems with language and swallowing. Communication issues are addressed, as well as problems understanding speech and written words. 
  • Psychological Therapy: Helps in dealing with emotional and mental health issues, such as depression, anxiety, and frustration.  

Rehabilitation should start as soon as the patient is medically stable, often within 24 to 48 hours after the stroke. 

REFERENCES5

References

  • Winstein C.J., Stein J., Arena R., et al. (2016) Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 47(6):e98-e169. [doi: 10.1161/STR.0000000000000098]. 
  • Veerbeek, J.M., Kwakkel, G., van Wegen, E.E.H., Ket, J.C.F., Heymans, M.W. (2014). Early Prediction of Outcome of Activities of Daily Living After Stroke: A Systematic Review. Stroke, 45(5): 1482-1488. DOI: 10.1161/STROKEAHA.113.003 predicting. 
  • Miller E.L., Murray L., Richards L., et al. (2010) Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke, 41(10):2402-2448. [doi: 10.1161/STR.0b013e3181e7512b]. 

7. Medication Management

Medication management following a stroke is crucial to prevent further strokes and to manage emerging and pre-existing conditions that could complicate recovery. 

There are a few categories of medication that are commonly used in the management and prevention of stroke: 

  • Anticoagulants and antiplatelets: These helps reduce blood clots, which are the cause of ischemic strokes. Medications can include aspirin, clopidogrel, and warfarin. 
  • Blood pressure medications: High blood pressure is a significant risk factor for stroke. Various classes of drugs, like ACE inhibitors, beta-blockers, and diuretics, are used to manage blood pressure. 
  • Cholesterol medications: Statins are often prescribed to reduce LDL (“bad”) cholesterol, another risk factor for stroke. 
  • Antidepressants: Depression is common after a stroke, and selective serotonin reuptake inhibitors (SSRIs) may be used. 
  • Medications to control blood sugar: Diabetes increases stroke risk. Insulin and other medications may be necessary to control blood sugar levels. 

It’s important to continually review and manage these medications collaboratively with healthcare providers. Improper use of medications can lead to preventable hospital readmissions or even more severe health problems.  

References: 

  • Kernan W.N., Ovbiagele B., Black H.R., et al. (2014). Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 45:2150-2236. [doi: 10.1161/STR.0000000000000024]. 
  • Meschia J.F., Bushnell C., Boden-Albala B., et al. (2014). Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 45:3754-3832. [doi: 10.1161/STR.0000000000000046]. 
  • Winstein C.J., Stein J., Arena R., et al. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 47: e98-e169. [doi: 10.1161/STR.0000000000000098]. 
  • Hackett M.L., Anderson C.S., House A., Xia J. (2008). Interventions for treating depression after stroke. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD003437. DOI: 10.1002/14651858.CD003437.pub3. 
  • Powers W.J., Rabinstein A.A., Ackerson T. et al. (2019). Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 50:e344-e418. [doi: 10.1161/STR.0000000000000211]. 

8. Lifestyle Changes

Lifestyle changes are important to prevent future strokes and improve overall health after a stroke. Here are some of the recommended modifications: 

  • Regular Physical Exercise: Regular physical activity can reduce the risk of stroke by controlling blood pressure, and weight, eventually reducing the risk of other chronic diseases. 
  • Healthy Diet: Consuming a diet that’s low in saturated and trans fats, and rich in fruits, vegetables, whole grains, lean proteins, and cholesterol can help control blood pressure and cholesterol levels. 
  • Avoiding Tobacco: Smoking or exposure to secondhand smoke raises the risk of stroke. Seeking help to quit smoking is strongly advised. 
  • Limiting Alcohol: Heavy drinking increases the risk of high blood pressure, ischemic strokes, and hemorrhagic strokes. It’s recommended to limit it to no more than one drink a day for women or two drinks a day for men. 
  • Weight Management: Being overweight or obese increases your risk of stroke. Losing excess weight through diet and exercise can decrease these risks. 
  • Regular Medical Check-ups: Regular medical check-ups to control pre-existing conditions such as diabetes and heart disease are essential. 
REFERENCES

References

Reference

https://www.nhlbi.nih.gov/health/stroke 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142760/ 

https://www.stroke.org/en/about-stroke/types-of-stroke/common-diagnosis-methods 

httheps://www.nhlbi.nih.gov/health/stroke/treatment#: 

https://www.cdc.gov/stroke/treatments.htm#: 

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Disclaimer: The content presented in these articles is intended solely for informational purposes. It is not designed to replace the guidance, expertise, or advice given by licensed healthcare professionals or physicians. The information provided should not be perceived as medical advice or therapeutic suggestions. Before initiating any treatment or altering your healthcare routine, please consult with suitable physicians or healthcare providers for accurate diagnosis and proper therapeutic solutions.