Munson Health
 
Ischemic Stroke

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by Wood D

(Cerebrovascular Accident; CVA; Cerebral Infarct)

 

Risk Factors

Certain factors increase your risk of stroke but can not be changed, such as:
  • Race—People of African American, Hispanic, or Asian/Pacific Islander descent are at increased risk.
  • Age: Older than 55 years of age
  • Family history of stroke
Other factors that may increase your risk can be changed such as:
Certain medical condition that can increase your risk of stroke. Management or prevention of these conditions can significantly decrease your risk. Medical conditions include:
Risk factors specific to women include:
  • Previous pre-eclampsia
  • Use of birth control pills, especially if you are over 35 years old and smoke
  • Long-term use of hormone replacement therapy
  • Menopause
  • Pregnancy—due to increased risk of blood clots
 

Treatment

Immediate treatment is needed to open the blocked blood vessel. This should restore blood flow to the brain tissue and stop further damage.
Treatment after immediate care will aim to:
  • Reduce the chance of later strokes
  • Improve function affected by the stroke
  • Overcome disabilities
Supportive care may also include:

Medications

Certain patients will receive a group of drugs called thrombolytics. These medications can rapidly dissolve blood clots. They are often given by IV but can be delivered directly to the arteries where the blood clot is. These medications need to be given within hours after the start of symptoms to be effective. That is why it is important to get medical help right away if stroke symptoms develop.
Aspirin and other medications that decrease the risk of blood clot formation may be recommended after immediate care is done. These medications may prevent future strokes from occurring.
To help manage other health issues and decrease the risk of future strokes the doctor may recommend medication to:

Surgery

A surgery may be done to allow blood flow back into the affected area such as:
  • Extracranial/intracranial bypass—blood vessel from the scalp is used to reroute blood supply around the blocked artery
  • Embolectomy—a catheter is threaded through blood vessels to the clot. It can remove the clot or deliver clot-dissolving medication directly to the area
A stroke can cause swelling in the brain. A decompressive surgery, such as craniotomy, may be needed to relieve the pressure in the brain to prevent damage.
Other surgeries may be performed following a stroke to prevent a recurrence. These surgical options include:
  • Carotid endarterectomy (CEA)—fatty deposits are removed from major arteries in the neck.
  • Carotid angioplasty and stenting—a procedure to widen and support the major artery in the neck with a mesh tube. The procedure will help open the artery and allow better blood flow.

Rehabilitation

If brain tissue was damaged, rehabilitation can be an important part of your recovery. Rehabilitation may include:
  • Physical therapy—to regain as much movement as possible
  • Occupational therapy—to assist in everyday tasks and self care
  • Speech therapy—to improve swallowing and speech challenges
  • Psychological therapy—to improve mood and decrease depression
 

Prevention

Many of the risk factors for stroke can be changed. Lifestyle changes that can help reduce your chance of getting a stroke include:
  • Exercise regularly.
  • Eat more fruits, vegetables , and whole grains . Limit dietary salt and fat .
  • Stop smoking .
  • Increase your consumption of fish.
  • Drink alcohol only in moderation: no more than 1-2 drinks per day.
  • Maintain a healthy weight.
  • Check blood pressure frequently . Follow your doctor's recommendations for keeping it in a safe range.
  • Take a low dose of aspirin if your doctor says it is safe.
  • Keep chronic medical conditions under control. This includes high cholesterol and diabetes.
  • Talk to your doctor about the use of a statins. These types of drugs may help prevent certain kinds of strokes in some people.
  • Seek medical care if you have symptoms of a stroke, even if symptoms stop.
  • If you abuse drugs, talk to your doctor about rehabilitation programs.
 

RESOURCES

American Heart Association
http://www.heart.org

National Stroke Association
http://www.stroke.org

 

CANADIAN RESOURCES

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

Public Health Agency of Canada
http://www.publichealth.gc.ca

 

References


Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2010 October 21. Available at: http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3181f7d043v1. Updated October 21, 2010. Accessed November 18, 2013.


Ischemic stroke. American Heart Association American Stroke Association website. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots%5FUCM%5F310939%5FArticle.jsp. Updated November 7, 2013. Accessed November 18, 2013.


Long term management of stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 28, 2013. Accessed November 18, 2013.


Neuroimaging for acute stroke. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 15, 2013. Accessed November 18, 2013.


Stroke (acute management). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 24, 2013. Accessed November 18, 2013.


What is stroke? National Stroke Association website. Available at: http://www.stroke.org/site/PageServer?pagename=STROKE. Accessed November 18, 2013.


11/20/06 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1726-1729.


12/16/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Farquhar C, Marjoribanks J, Lethaby A, Suckling J, Lamberts Q. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev. 2008;CD004143.


10/9/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mitchell PH, Veith RC, Becker KJ, et al. Brief psychosocial-behavioral intervention with antidepressant reduces poststroke depression significantly more than usual care with antidepressant: living well with stroke: randomized, controlled trial. Stroke. 2009;40:3073-3078.


3/28/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Park Y, Subar AF, Hollenbeck A, Schatzkin A. Dietary Fiber Intake and Mortality in the NIH-AARP Diet and Health Study. Arch Intern Med. 2011 Feb 14. [Epub ahead of print]


2/7/2014 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Bushnell C, et al. AHA/ASA Guideline for the Prevention of Stroke in Women. Stroke. 2014 Feb 6. [Epub ahead of print]

 

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