Stroke Treatment

Stroke is a fatal disease that can leave serious aftereffects or even threaten life. However, if it is diagnosed quickly at an early stage and treated appropriately, aftereffects can be greatly reduced and the patient’s life can be saved, so it is a very important disease.

If you or someone around you suddenly complains of a severe headache, develops paralysis, or begins to slur speech, and other symptoms suggestive of a stroke appear, do not simply ignore them. Consider the possibility of a stroke and seek help immediately. Above all, it is important to call 119 right away. Being transported by 119 rather than transporting the patient yourself has the advantage of allowing emergency care during transport and connecting the patient to a medical institution capable of specialized treatment.

The treatment of stroke differs completely depending on whether the cause is ischemic or hemorrhagic.

1. Treatment of Ischemic Stroke

1. Revascularization treatment for acute ischemic stroke

Stroke is an emergency. Time is very important after a stroke occurs. The longer the interruption in blood flow continues, the harder the patient’s recovery becomes and the more severe complications may remain. Ultimately, the main goal of treatment for acute ischemic stroke is to minimize irreversible brain damage through early revascularization. Therefore, if suspicious symptoms appear, it is wise to seek medical care quickly.

To restore blood flow, intravenous administration of a thrombolytic called “tPA” may be attempted. A thrombolytic is a drug that dissolves clots blocking blood vessels. In addition, in addition to thrombolytic injection, endovascular procedures using tools such as catheters and stents may be attempted to physically remove the clot and restore blood flow. However, these revascularization treatments are only possible within a certain early period after ischemic stroke onset, and they can be performed selectively in patients who meet the indications through emergency testing. Revascularization treatment is not always successful, and some patients may develop brain hemorrhage after treatment, which can worsen symptoms. However, compared with such side effects, there are more opportunities for recovery through treatment, and it is known to reduce disability after 3 months. Therefore, a rapid hospital visit and diagnosis are necessary so as not to miss the chance to receive such treatment,

The time window for revascularization treatment may vary depending on the patient’s condition, but it is generally within 3 to 6 hours, and within 3 hours. However, the earlier the treatment, the better the expected effect, and considering the time needed to evaluate and test the patient in the emergency room, it can be said that arriving at the hospital as quickly as possible is important.

2. Antithrombotic drug treatment for acute ischemic stroke

Antithrombotic drugs are medications that inhibit the formation of clots, and by suppressing additional clot formation, they can help prevent worsening of symptoms.

① Antiplatelet agents

② Anticoagulants

3. General supportive care for acute stroke

① Respiratory care

② Temperature reduction

③ Monitoring of cardiac changes

④ Blood pressure control

⑤ Blood sugar control

⑥ Treatment to reduce intracranial pressure

4. Rehabilitation treatment and preventive drug treatment for stroke

After an ischemic stroke occurs, once time has passed and brain tissue has already been damaged, the following treatments become important. First, if stroke is not continuously managed, the risk of recurrence is high, so lifelong lifestyle management and preventive drug treatment are necessary. In addition, early rehabilitation treatment must be actively carried out to minimize residual disability. In general, the effect of rehabilitation treatment decreases after 6 months to 1 year.

• Antithrombotic drug treatment to prevent stroke recurrence

• Active correction of stroke risk factors (blood pressure control, blood sugar control, treatment of hyperlipidemia, lifestyle improvements, etc.)

• Prevention of complications caused by the stroke and disability that have already occurred, and active rehabilitation treatment

2. Treatment of Hemorrhagic Stroke

Patients with intracerebral hemorrhage (brain hemorrhage) undergo CT or MRI to confirm the location and extent of the bleeding, and then surgical treatment is considered or medication is given. If the bleeding is mild, medication is used; if the amount of bleeding is large or consciousness continues to worsen, surgery may be necessary. The principle of drug treatment is to prevent enlargement of the hematoma due to excessive blood pressure rise and to control intracranial pressure, and it is not greatly different from general supportive care for stroke. As for surgical treatment, craniotomy was mainly performed until the early 1990s, but currently the main method used is stereotactically inserting a catheter into the hematoma to aspirate it and removing it by injecting a thrombolytic agent.

Meanwhile, in the case of subarachnoid hemorrhage caused by a ruptured aneurysm, the risk of rebleeding increases considerably over time, so the aneurysm must be eliminated by placing a clip on the neck of the aneurysm through surgery or by closing the dilated aneurysm through an endovascular procedure.

In the case of hemorrhagic stroke, neurological residual disability may remain more severely than in ischemic stroke. Such neurological sequelae (such as hemiplegia) should be minimized through active physical therapy. As time passes after a stroke, residual disability can become fixed, so active rehabilitation treatment is needed early on.

In addition, as with ischemic stroke, prevention of stroke is necessary through active correction of stroke risk factors (blood pressure control, blood sugar control, treatment of hyperlipidemia,

lifestyle improvements, etc.).

So far, I have explained the treatment of stroke.

In the next installment, as the final part of the stroke series, we will look at the prevention of stroke.

Source: National Health Information Portal, Korea Disease Control and Prevention Agency