Aging Begins at 30

Stroke 2: Treatment And Its Results

Stroke patients require immediate treatment to preserve function and to return them to society. Don't let a stroke victim talk you out of taking them to the hospital. Treatment in a stroke unit reduces mortality by 28%, therefore hospital admission is strongly advised.

The doctor will ask, "Is there a brain problem other than a stroke causing the symptoms? Is the stroke treatable? Where is the major damage and how much function has been lost? What other diseases are present as well as the stroke?"

After a general history and examination, diagnosis involves routine blood tests, an electrocardiogram, a chest x-ray, and Computerized Axial Tomography (as in tomos, a knife) an x-ray showing slices of the brain, often repeated in 4-5 days. Some will have a lumbar puncture to examine the spinal fluid (the water-bed the brain lies in) for blood.

The result of a stroke can be a motor paralysis on one side (hemiparesis), or less severe weakness, or a sensory loss on one side. Sixty percent of patients with right-sided hemiparesis develop the difficulty in speaking known as aphasia (literally no speech). There is also the clumsy-hand, slurred speech group. Confusion and loss of part of the field of vision can occur. These changes may be temporary or permanent. In the very severe stroke, there is loss of consciousness, seizures, or both at onset.

Strokes are caused most frequently by a clot (27%) in a brain artery. In general terms, the brain insult is lack of blood in 80% and bleeding in 20%. Twenty-three percent have small lacunas or lakes of lost brain tissue. A brain embolus from the heart or the carotid vessels in the neck cause 30%. A blow-out hemorrhage from a congenital weakness in a vessel wall (aneurysm) with brain surface bleeding (subarachnoid hemorrhage) occurs in 10%. Survival for 30 days falls progressively from 100% to 45% in the order just stated from clot to subarachnoid bleed.

The aims of medical treatment are to control the high blood pressure, normalize the heart beat, sedate the patient, control brain swelling, prevent further clotting with anticoagulants and antiplatelet drugs, control seizures, control blood vessel spasm, and reduce the extent of the brain damage. In some patients, surgical treatment will control bleeding from a congenital aneurysm, remove the clot, widen the carotid arteries, or decompress a swollen brain.

Deaths are infrequent in patients who are fully conscious on admission to the hospital but one-third of those who are unconscious die within 3-4 weeks. Two-thirds of patients who are able to walk at hospital discharge following a stroke survive for five years or more compared to a quarter of those unable to walk at discharge. Most deaths nowadays are in patients age 75 or older. Thirty-seven percent die of their first stroke, 10% of a subsequent stroke, 10% of coronary artery disease, 10% of heart failure, and 9% of respiratory disease, usually pneumonia.

Overall, one-third of stroke victims die within a month, one-third die within the next two to five years, and one-third survive beyond that time.

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See related Patient Topics Brain and Nervous System, Heart and Circulation, Seniors' Health or Stroke.

See related Provider Topics Brain and Nervous System, Heart and Circulation, Seniors' Health or Stroke.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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