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Understanding Stroke -- Diagnosis and Treatment

What Are the Treatments for Stroke? continued...

After the acute situation is managed, most patients with stroke are monitored in the hospital for several days. Upon release, patient and doctor carefully review necessary steps for recovery and prevention of future strokes. Advice will likely involve diet and lifestyle changes, ongoing drug treatment, physical therapy, and possible surgery for critical narrowing of the arteries in the neck (carotid endarterectomy).

People at risk of having strokes need to keep their blood pressure under control through diet and lifestyle changes and, when needed, with medication.

To prevent ischemic strokes, some patients are first advised to take aspirin. If aspirin proves ineffective, the doctor will probably prescribe clopidogrel (Plavix) or Aggrenox, two other blood-thinning drugs, or Warfarin (coumadin) for special situations. Three other blood thinners have been approved to prevent stroke in those with atrial fibrilation -- Xarelto (rivaroxaban), Pradaxa (dabigatran), and Eliquis (apixiban).

People at particularly high risk for clot stroke because of an existing heart condition would be treated with heparin for acute symptoms and warfarin for long-term therapy. Most patients will also be prescribed a drug to lower cholesterol, such as simvastatin or atorvastatin.

In some patients, surgery to prevent future ischemic strokes might be recommended. Carotid endarterectomy removes plaque from the large carotid arteries leading from the neck into the brain. It is recommended when the arteries are narrowed by 70% or more. Another technique called carotid angioplasty can be used to widen clogged brain arteries. A stent can be inserted into the artery with a catheter. When released from the catheter, the stent (a small wire mesh tube) expands to the size of the artery and holds it open.

Another crucial element of stroke treatment, in addition to emergency and follow-up medical care, is rehabilitation. Immediately after a stroke, other parts of the brain can compensate for areas lost to trauma by forming new neurological pathways. Intensive rehabilitative therapy basically aims to enhance the brain's own recovery efforts. A typical program may involve speech, nutritional, physical, and occupational therapy as well as social services.

The psychological well-being of victims, families, and caregivers plays a crucial role in rehabilitation. Successful recovery depends on both the quality of care and the positive mindset of the victim. Antidepressants may be needed to alleviate post-stroke depression. Several stroke associations offer psychological support via hot lines, discussion groups, and literature.

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