Prevention starts with knowing your risk factors. Getting active, losing weight, quitting smoking and lowering your blood pressure are all ways you can help prevent stroke.
Stroke survivors are more likely to have another stroke. The specialists at the UC Comprehensive Stroke Center work with patients and caregivers to stop recurring strokes.
Treatment will depend on a patient’s risk factors, conditions and medical history. The wide-ranging specialists at the Stroke Center have experience preventing and treating strokes and other complex cerebrovascular disorders.
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Tissue Plasminogen Activator (tPA) is a clot-busting drug and is the only drug approved by the U.S. Federal Drug Administration to treat acute ischemic stroke. It works by restoring blood flow in the brain by dissolving brain clots that are causing decreased blood flow (ischemia).
TPA can be delivered either intravenously through an IV or intra-arterially. Treatment with IV tPA is time-sensitive and works best when given as soon as possible at the start of symptoms, but can in some cases be administered up to four and a half hours after symptom onset.
Other mechanical devices may also be used to retrieve intracranial blood clots such as “stentrievers” or the Penumbra device. The devices are attached to a long guide wire that is threaded up from the groin into the brain and attaches to the blood clot. The physician is then able to pull the clot out of the affected artery thus restoring blood flow. When using intra-arterial tPA or mechanical clot retrieval devices, the treatment time window can be extended up to six hours or more from time of symptom onset.
Patients who receive tPA or undergo mechanical clot retrieval are admitted to the Neuroscience Intensive Care Unit (NSICU) for close monitoring of vital signs and symptoms of bleeding. They also undergo frequent neurological exams
There are two types of hemorrhagic stroke: intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH).
Depending on the size, location and the cause of bleeding, ICH can be managed either surgically or medically. The goal of surgery is to remove as much of the blood clot as possible and stop the source of bleeding. If the ICH was caused by an arteriovenous malformation (a tangle of abnormal blood vessels connecting arteries and veins in the brain), a cerebral angiogram with embolization, radiotherapy or surgical resection may be necessary. Medical management for an ICH begins with blood pressure control to help prevent re-bleeding and expansion of the ICH. Follow up with an internal medicine or primary care provider is important to maintain good blood pressure control and prevent future ICH. When the patient’s condition is medically stable, early mobilization with therapy will be initiated to prepare for long-term needs once discharged from the hospital.
Treatment for subarachnoid hemorrhage depends on the cause. If the SAH was caused by an intracranial aneurysm, treatment is typically initiated within 24 to 48 hours via either surgical clipping or endovascular coiling. This is done to prevent re-bleeding of the aneurysm If the SAH was caused by a traumatic injury, the patient will be observed and managed in the Neuroscience Intensive Care Unit (NSICU).
Shortly after a SAH, patients are at risk of vasospasm. Bleeding around the brain and blood vessels may irritate blood vessels and cause them to temporarily narrow, or spasm. When severe, vasospasm can cause an ischemic stroke. Vasospasm can occur three to 30 days after SAH, appearing most commonly between the third and fourteenth day. Patients are monitored in the NSICU and receive periodic ultrasound tests to monitor for vasospasm. Treatment of vasospasm may include increasing the blood pressure to force blood through the narrowed arteries, increasing IV fluids to increase blood volume, or performing an angiogram and injecting medication into the narrow blood vessels to relax them.
Another potential complication after SAH is hydrocephalus. This is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles or cavities in the brain. After SAH, blood may interfere with the normal outflow of CSF from the brain. A CT scan will help diagnose hydrocephalus. Treatment may include a temporary lumbar drain, intraventricular drain or permanent shunt to remove excess CSF.
Sometimes the best treatment is to closely monitor and reduce the risk of rupture by quitting smoking and/or controlling high blood pressure. Small, unruptured aneurysms that are not causing symptoms may be observed with periodic imaging scans unless growth or symptoms necessitate surgery.
One treatment option for an aneurysm is direct surgical clipping. The patient is placed under general anesthesia, and an opening is made in the skull, called a craniotomy. The surgeon locates the aneurysm and places a clip over the “neck” of the aneurysm, occluding it.
Endovascular coiling is another treatment option for some aneurysms. Typically, a catheter is placed into an artery in the groin and advanced to the location of the aneurysm. Small coils are then advanced through the catheter and placed into the aneurysm, with the goal of completely filling the aneurysm. This procedure prevents blood flow into the aneurysm. After this procedure, follow-up angiograms are performed periodically to confirm that the aneurysm is still occluded and not growing larger.
Testing for carotid stenosis includes a doppler ultrasound of the neck, computed tomography angiogram (CTA) scan of the neck, or magnetic resonance angiography (MRA).
Medical treatment is suitable for patients who have a low percentage of stenosis (below 70 percent), are asymptomatic (without symptoms), or have medical conditions that increase the risk of a surgical procedure. Medical treatment for carotid stenosis consists of antiplatelet therapy with aspirin as prescribed by a physician. If aspirin therapy is not well tolerated, another antiplatelet drug, such as ticlopidine or clopidogrel, may be used. Additional medical therapies include regular blood pressure screenings and medications to lower blood pressure, smoking cessation, cholesterol monitoring and cholesterol-lowering medications, and limited alcohol consumption.
Carotid endarterectomy is a surgical procedure that removes the plaque build-up from the inner lining of the carotid artery. This procedure improves blood flow through the artery into the brain and may help prevent future ischemic strokes. A carotid endarterectomy is typically indicated for patients who are symptomatic (have experienced a previous ischemic stroke or transient ischemic attack (TIA) and have greater than 70 percent vessel stenosis. Patients with 50-69 percent stenosis and symptoms may also benefit from surgery, depending on their other medical conditions. Surgery is generally not recommended for carotid stenosis of less than 50 percent.
Carotid stenting is an endovascular procedure performed by a neuro-interventionalist during an angiogram of the affected carotid vessel. This treatment is sometimes indicated for symptomatic patients who have carotid stenosis but are not good candidates for endarterectomy.
Moyamoya disease is characterized by chronic and progressive narrowing internal carotid arteries in the brain that can lead to complete blockage. A brain MRI is used determine the patient’s stroke history, followed by a CT angiogram or conventional cerebral angiogram to identify the characteristic arterial narrowing and collateral blood vessels associated with moyamoya disease. There is no known medication that can reverse the progression of moyamoya disease. Surgery is generally recommended to treat patients with recurrent or progressive ischemic strokes or TIAs and involves directly connecting a donor artery to a recipient artery in the brain. Revascularization through bypass surgery prevents further brain injury by using the external carotid circulation to increase collateral blood flow to underserved areas of the brain. Often, blood vessels are directly connected by a bypass to link the superficial temporal artery (STA) to the middle cerebral artery.
Although stroke is generally regarded as a disease of old age, it also can occur in younger adults, children and even babies. Although the University of Cincinnati Gardner Neuroscience Institute does not typically treat pediatric patients, its internationally recognized research team has studied stroke in children.
Rehabilitation & Recovery
The Stroke Recovery Center at the Daniel Drake Center for Post-Acute Care provides specialized inpatient and outpatient rehabilitative services for patients who have survived a stroke. The center offers a continuum of interdisciplinary care and research. Patients may access one or multiple levels of service based on their medical condition.