Synonyms
Therapy Apoplex, ischemic stroke, cerebral circulatory disorder, apoplectic insult
- On the basis of the cranial CT a bleeding is excluded.
- The therapy is carried out within a time window of 3 (6 hours at the most) after the onset of symptoms.
- There is no clouding of consciousness in the patient.
- There are no contraindications/restrictions on use of the therapy, such as already started blood thinning therapy with coumarins, surgery in the last 2 weeks, pregnancy, age over 80 years.
Only a few drugs are used for acute stroke. First of all, an adequate oxygen supply to the patient should be ensured by external supply. If high blood pressure (hypertension) exists, it should not be treated if it is only slightly elevated.
This ensures a good blood supply to the brain and the affected tissue has the best chance of recovery. If the blood pressure is too low (hypotension), the blood volume should be increased primarily by infusions, before a drug treatment with catecholamines (dobutamine, nordrenaline) takes place. If there is a brain edema – a swelling of the brain which can under certain circumstances squeeze out vital areas and thus lead to death – it should be treated with so-called osmodiuretics (mannitol, glycerol, sorbitol).
These compounds are supplied via the vein and withdraw fluid from the tissue, while they themselves cannot leave the vascular system. Lysis therapy can be carried out within the first 4.5 hours after the stroke. Tissue plasminogen activator (also rt-PA, recombinant plasminogen activator or tissue plasminogen activator) is usually used for this purpose.
The compound cleaves plasminogen to plasmin and thus promotes the degradation of fibrin. Fibrin forms blood clots, which are responsible for the event in the majority of all strokes. Lysis therapy is designed to dissolve the clot in order to restore the blood supply in this way.
Rehabilitation after a stroke
The time a stroke patient spends in hospital depends largely on the healing process. As soon as the acute clinical symptoms have subsided and a good healing tendency is evident, further care can be provided in another hospital. These are usually special rehabilitation centers that specialize in the follow-up treatment and reintegration of neurological patients.
The stay there again depends on the progress of the patient, but usually lasts 4 to 6 weeks. As soon as basic functions are restored and outpatient therapy is possible, it should be initiated quickly. Outpatient means that the patient already stays at home and only visits the care center for certain applications or exercises.
In this way, the patient can better reintegrate into everyday life and the family and professional environment is also included. In order to achieve the best possible results, all departments must work together in a neurological rehabilitation. It is well known that after a stroke a wide range of functions can be impaired – paralysis and movement disorders, problems with speech or other basic bodily functions.
The medical staff must work closely with physiotherapists, occupational therapists and speech therapists (speech therapists) to restore the lost abilities. Social workers must also be involved because of the far-reaching changes in the patients’ lives. Often not all functions can be regained even through extensive rehabilitation and years of training.
The patient should above all be trained to live with this circumstance and to be able to help himself. This incision often leads to depression, which must be taken seriously and treated. In order to achieve the best possible results, all departments must work together in a neurological rehabilitation.
As is well known, after a stroke a wide variety of functions can be impaired – paralysis and movement disorders, problems with speech or other basic bodily functions. The medical staff must work closely with physiotherapists, occupational therapists and speech therapists (speech therapists) to restore the lost abilities. Social workers must also be involved because of the far-reaching changes in the patients’ lives.Often not all functions can be regained even through extensive rehabilitation and years of training. The patient should above all be trained to live with this circumstance and to be able to help himself. This incision often leads to depression, which must be taken seriously and treated.
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