The stroke specialist at the hospital will determine the type of stroke that the person concerned is suffering from. There are two different types of strokes: thrombotic occlusion - a blocked blood vessel and intercerebral hemorrhage, a brain hemorrhage. The thrombotic occlusion is also called ischemic (white) stroke and is the most common type of stroke. This can be caused for example by a vascular calcification (arteriosclerosis) or a blood clot (embolus). Intercerebral haemorrhage, referred to as hemorrhagic (red) stroke, is less common.
In the acute phase of treatment, it's all about limiting the damage, trying to save the person’s life and protecting the brain as much as possible from consequential damage. The treatment afterwards aims to restore the affected person's functions that are impaired by the stroke - this usually happens in the rehabilitation phase.
After the attending physician has checked the vital signs of the person concerned and, has asks, if possible, for the previously occurring symptoms. The responsible neurologist will check the affected person for his ability to coordinate, his ability to speak, to see and to touch as well as the touch sensation to be able to do evaluate the current state.
This is followed by computer tomography of the head or MRI (magnetic resonance imaging), which both provide information about the type of stroke. CT is usually complemented by blood perfusion (CT perfusion) and vessel imaging (CT angiography).
In addition, an electrocardiogram (ECG) will be performed to examine the function and performance of the heart. The examination is completed by blood tests of the electrolyte balance, kidney levels, blood glucose levels, blood coagulation and blood count to confirm the apoplexy.
The most important thing is the immediate treatment of each stroke to minimize the extent of potential consequential damage.
Ideally, the person should be treated by staff with stroke expertise in so-called stroke units.
The two types of stroke require different treatment methods.
In the treatment of a hemorrhagic stroke, which has occurred due to a cerebral hemorrhage, the size of the cerebral hemorrhage is initially evaluated. For smaller cerebral hemorrhages, it may be sufficient to avoid activities that increase the pressure in the head. Larger cerebral hemorrhages must be operated on and removed. During surgery, the skull is opened to remove the hematoma (bruise) and stop the bleeding.
In the treatment of ischemic strokes there are two possible treatments. The most important treatment is the so-called lysis therapy (also called thrombolysis), in which the vascular closure is resolved by clot-dissolving medication and the number of dead nerve cells should be kept as small as possible. The drugs are usually administered by an infusion.
The blood clot is now also additionally removed by a mechanical intervention. In a thrombectomy, a catheter is passed through an artery to the clot and with the help of the finest instruments this is then removed under x-ray supervision.
The last part of treatment is the prevention of new strokes. Once the type of the stroke has been determined and what exactly led to the stroke, measures can be taken to prevent the recurrence of an apoplexy. In the treatment of ischemic stroke caused by vascular occlusion, blood-thinning medications are usually prescribed. A change of lifestyle also contributes to prevention.
For more information on preventing a stroke, click here.
Rehabilitation after a stroke
There are, of course, cases in which the person recovers completely from the stroke, but there are also cases in which the person concerned is permanently care-dependent and in need of a long rehabilitation.
The chance to suffer a stroke without permanent and serious consequential damages is higher the younger the affected person is. Nevertheless, every second stroke patient is in need of care due to the consequential damage, and in about two-thirds of all cases, the affected person suffers physical injury additionally.
An important part of rehabilitation is the so-called early rehabilitation, which contributes significantly to the success. This usually takes place right in the stroke unit and is managed by the nursing team, occupational therapists, physiotherapists and speech therapists. After the early rehabilitation, it is evaluated whether a rehabilitation and what kind of rehabilitation is necessary to be able to regress the consequential damage or symptoms of the apoplexy.
Generally one can say that the rehabilitation consists of different procedures.
Lost abilities can be relearned by healthy parts of the brain taking over the function of the destroyed ones. The side affected by the stroke should not be allowed to atrophy, and the muscles and joints need regular exercise so as not to regress and possibly even regain their function.
The federal working group (BAR) has developed a phase model (phase A - F) with which the neurological rehabilitation can be divided into a different phases:
- Phase A: acute phase in the hospital
- Phase B: early rehabilitation: for the most severely affected patients who are not yet actively involved in treatment
- Phase C: further rehabilitation: the patient must be able to cope with several 30-minute therapy sessions daily
- Phase D: follow-up treatment (AHB): the patient is ready to perform everyday activities almost entirely on his own
- Phase E: aftercare and Occupational Rehabilitation: Patient can live at home
- Phase F: condition-preserving and activating long-term care in case of persistently high need of care (eg, vegetative coma)
What does the rehabilitation consist of?
As mentioned above, early rehabilitation is made up of a mixture of occupational therapy, physiotherapy, speech therapy and neuropsychological training.
The ergotherapists are responsible for making sure the person concerned manages their everyday life. They help the patient to live as independently as possible despite the restrictions with taking the environment and the living situation of the person concerned into account. The occupational therapist can train, for example, the use of various aids together with the patient. Through this training the patient should be able to do as many everyday activities as possible on his own at the end.
Physiotherapists, on the other hand, train the musculoskeletal system of the patient. This includes posture, the sense of balance, muscle building, coordination and the movements, which are trained by a variety of treatments and exercises. Physiotherapy tries to correct bad posture and paralysis in order to counteract complications such as joint pain. At the same time the patient becomes more mobile, more active and more independent.
The speech therapy is responsible for training the ability to speak and is necessary if the stroke has caused a speech disorder in the patient. The speech therapist begins the therapy directly as soon as the patient is responsive. Also, the speech therapist must determine whether the patients suffers from a swallowing disorder and treat this if necessary to prevent pneumonia, for example.
Neurological disorders, such as apraxia, a disorder with the motor planning to perform tasks or movements or a disorder of the visual field (neglect), must also be treated in the long term. Often, these sequelae must continue to be treated as outpatients after inpatient treatment.
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