Duration of stroke therapy

The duration of the necessary therapy for a stroke depends on the extent of the damage. The more functional areas disappear, the worse the prognosis is and the longer the healing process takes. About half of all stroke patients remain in need of care even after good treatment.

Older patients, in particular, usually recover less well from a stroke. The stay at a stroke unit or a neurological clinic can take one to several weeks (usually 2-4 weeks). Usually a rehabilitation is started afterwards, which again takes 4 to 6 weeks.

The medically supervised healing process therefore takes about 1 to 2 months. Even after this period, patients must continue to practice the unlearned movements and must be monitored by their family doctor or a neurologist in private practice. The duration of the therapy and especially the healing process varies from individual to individual, but often lasts not only a few months but years.

How can a stroke be prevented?

The prevention of a stroke is the best protection against this disease. To prevent an apoplexy, risk factors that cause arteriosclerotic changes in the vessels and promote vascular changes should be eliminated: Adjusting blood pressure, blood sugar and LDL cholesterol (keep LDL cholesterol consistently below 100mg/dl) to normal values reduces the risk of stroke. Diabetics should strive for optimal blood sugar adjustment and low long-term blood sugar values (= HbA1c values).

Regular exercise with increased endurance and weight reduction has a positive effect on health and helps prevent a stroke. Smoking and alcohol consumption should be avoided. A balanced, low-fat diet rich in vegetables and fruit is important.

Smoking
Overweight
High blood pressure.

Drug therapy with acetylsalicylic acid or the platelet aggregation inhibitor clopidogrel should be used on a long-term basis if the patient has vasoconstrictions of the intra- or extracranial vessels. This therapy should also be carried out if the patient does not (yet) have any symptoms. For so-called secondary prevention after a TIA, PRIND or stroke has occurred, the above-mentioned drugs are also given with the aim of preventing the occurrence of a new stroke.

Patients with chronic atrial fibrillation or those who have suffered a stroke as a result of embolism should also receive blood-thinning therapy. This can be done with Marcumar or heparin. Surgery to reopen the narrowed/closed internal carotid artery is indicated if the patient has symptoms of a stroke and the vessel is more than 70% occluded or if there are no symptoms but the vessel is more than 80% occluded.

Patients who have no symptoms but have a severe vasoconstriction (=vascular stenosis) should have an operation, as they have a 10% risk of suffering a stroke within three years. If a so-called aneurysm is present, i.e. a bulging of a vessel, a stroke can be prevented by switching off the aneurysm and thus preventing a rupture with subsequent cerebral hemorrhage. To prevent a first-time stroke, drugs are used for so-called primary prevention.

Here, the aim is to prevent the disease from occurring by treating high-risk underlying diseases. The drugs used are drugs to treat high blood sugar and blood pressure, cardiac arrhythmia (antiarrhythmics), blood thinners to reduce the tendency to form clots (anticoagulants) and blood lipid reducers (statins). After a stroke, the drugs used to prevent recurrence (avoidance of a recurrence of the stroke) are the same.

If a vascular occlusion was the cause of the infarction (ischemic infarction), ASA 100 is prescribed as standard. This drug, also known as Aspirin®, reduces platelet aggregation (thrombocyte aggregation inhibitor) and thus inhibits blood clotting. If ASA is not tolerated, clopidogrel (also an antiplatelet aggregation inhibitor) or another drug from the drug group (prasugrel, ticagrelor) can also be used.

Statins, for example simvastatin, are also administered in the prevention of recurrence if the cholesterol level in the blood is too high. Too high values can promote fatty degeneration and the resulting calcification of the vessels, which can then lead to repeated occlusion. The blood pressure should be set in the target range between 120/70 and 140/90 mmHG.

ACE inhibitors (e.g. ramipril), calcium channel blockers (e.g. amlodipine), beta blockers (e.g. metoprolol) and many other drugs are used for this purpose. If atrial fibrillation of the heart is diagnosed as part of the causal diagnosis, blood thinning with coumarin derivatives (Marcumar® or Falithrom®) or with new anticoagulants such as dabigatran (Pradaxa®) must be carried out.