stroke disease - Archive - Blueprint To Health And Healing - Dr Chinedu Nkole -

stroke treatment and management

Dr Chinedu Nkole — Thu, 14 May 2020 11:38:32 +0000

Management of Stroke Patients

The treatment modalities for stroke patients depend on the type of stroke they have had. It is therefore very important to get a CT scan of the head as soon as possible to rule out a bleed in the case of Hemorrhagic stroke. Once a bleed is ruled out, the following treatment options are available for ischaemic strokes :

Thrombolysis

… this is the intravenous administration of a clot bursting drug, alteplase within the thrombolysis window of 4.5 hours from onset of symptoms as per current NICE guideline.

Thrombectomy

… is a process where interventional radiologists mechanically extracts blood clots (Thombus) from within the affected artery. Thrombectomy is ideally performed within 6 hours from time of onset (window range is within 6-24 hours) for patients that meet the criteria.

Antiplatelet Therapy

platelets are blood cells that play a very significant role in blood clot formation.

… platelets are blood cells that play a very significant role in blood clot formation. Anti-platelets are used in treating ischaemic stroke patients. High dose aspirin 300mg daily should be started once a CT scan of the head rules out a bleed, for patients that do not meet the criteria for thrombolysis/Thrombectomy. For those that meet the criteria, a repeat CT scan of the head should be done 24 hours post thrombolysis/thrombectomy to rule out Hemorrhagic transformation/complication of the procedure. Once ruled out, 300mg daily of aspirin is given for 2 weeks and then stepped down to clopidogrel 75mg od lifelong.

Statins – given to mitigate hypercholesterolaemia risk factor. Those intolerant to statins can be put on ezetimibe as an alternative. Haemorrhagic Stroke is treated primarily by treating the cause eg optimising bp control in the case of hypertensive aetiology.

STROKE REHABILITATION :

This is a very important aspect of stroke management and is my personal area of interest.

Mismanagement post stroke could lead to avoidable morbidity and mortality. This aspect of stroke management is multidisciplinary, involving a team of doctors, nurses, physiotherapists, speech and language therapists, Dieticians, neuropsychologists / neuropsychiatrists, occupational therapists and healthcare assistants. Everyone in the team (T-together, E-everyone, A-achieves, M-more) is important and all work together to achieve the common goal of best clinical outcome for the patients. Below are some of the complications post stroke that could result in fatalities if not addressed :

Aspiration Pneumonia

depending on the part of brain affected by the stroke, the patient’s ability to swallow safely can be impaired, a condition known as dysphagia. This predisposes him/her to aspiration pneumonia (some of the food/water go into the lungs instead of the food pipe and cause pneumonia). Their management should be guided by the speech and language team after a swallow assessment. They are initially fed via NG (Nasogastric) tube.

Majority of stroke patients will recover the ability for safe swallow. A minority may need a longer term feeding route such as PEG (Percutaneous Endoscopic Gastrostomy), where a PEG tube is inserted into the patients stomach through the abdominal wall. Patients at risk of aspiration pneumonia should be monitored very closely and doctors should have low threshold to start antibiotics if they spike temperature of their inflammatory markers significantly trending up.

Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)

Because most stroke patients are immobile following disability from stroke, they are
quite prone to developing DVT(blood clot in the limbs) and PE (Blood clot in the lungs) -To prevent this from happening it is very important for every stroke patient to be on an intermittent Pneumatic Compression (IPC) device which can be switched to prophylactic blood thinners when appropriate.

Post Stroke Patient Conditions | Major Types Of Stroke

post stroke patient conditions

Dr Chinedu Nkole — Fri, 01 May 2020 11:19:12 +0000

Constipation – again because of their immobility, stroke patients are prone to constipation. If this is not addressed, it could lead to urinary retention necessitating the insertion of urinary / urethral catheter which could in turn increase the risk of urinary tract infection.
Constipation also limits the patient’s ability to engage during physiotherapy sessions.

Pressure ulcers – Also because of their immobility, they are very prone to developing pressure ulcers. Regular turning and in some cases pressure mattress could help prevent pressure ulcers. Infected pressure ulcers could lead to septicaemia and could potentially result in fatality.

Depression

Understandably, many stroke patients go through periods of low mood due to the sudden change in their life circumstance

This impacts negatively on their ability to rehab and should be addressed sooner than later. Conservative management with the guide of a neuropsychologists is advised in the first instance. It is only when conservative management has not helped that the neuropsychiatrists should be involved for consideration of drug treatment.

Delirium – also known as acute confusional state, is a condition of acutely disturbed state of mind characterised by acute confusion, restlessness, illusions and incoherence. Some patients experience some period of delirium post stroke. Some other causes include infection and constipation. Conservative management is the advised 1st line of management. If organic causes are ruled out or treated and delirium persists, the neuropsychiatrists should then be involved for consideration of drug treatment.

Upper Gastrointestinal Bleed (UGIB)

is a major complication post stroke.

This is because of the high dose of aspirin 300mg daily, ischaemic stroke patients are started on. To prevent this it is advisable to start them on a proton pump inhibitor at least for the initial 2 weeks they are on high dose aspirin.

The multidisciplinary team should look out for the above possible post stroke complications. If identified and addressed sooner, most stroke patients generally have good clinical outcome. Patients’ families should be regularly updated on the progress of their loved ones and discharge destination and planning started as soon as possible as it takes quite a long time to put the right equipment and care package in place before discharge. There is so much job satisfaction that comes from treating and rehabilitating stroke patients back to as close to their pre-stroke baseline as possible.

Different Types Of Stroke | Management And Treatment Of Stroke

major types of strokes

Dr Chinedu Nkole — Wed, 01 Apr 2020 09:57:41 +0000

A stroke is a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off. A brief note on the pathophysiology can be found in my book : Blueprint to Health and Healing. Types of stroke :-

There are 2 major types of stroke Ischaemic and Haemorrhagic strokes :-

Ischaemic Strokes

… are caused by a blood clot within the artery resulting in blockage that cuts off the
blood supply to the area of brain supplied by the affected artery.

It can be thrombotic (where the blood clot, a thrombus, forms within the artery) or embolic (where the blood clot, an embolus, comes from another part of the body).

This is the most common type of stroke, other types include the “Transient Ischaemic Attack” also known as a mini stroke.

Haemorrhagic strokes

… are caused by bleeding into the brain, mostly due to uncontrolled high blood pressure.

Transient Ischaemic Attack (TIA) ...

… also known as mini stroke is a type of ischaemic stroke. As the name implies, the blockage that stops the blood getting to your brain is temporary and as a result, the symptoms only last for a short amount of time. However, it is a warning that the risk factors should be mitigated to prevent a major stroke.

Cryptogenic stroke (CS) is a form of ischaemic stroke of obscure or unknown cause. One third of ischaemic
strokes are cryptogenic.

Risk Factors For Stroke ...

… Lifestyle-related factors that increase your risk of stroke include

High blood pressure.

Cigarette smoking.

Diabetes.

High blood cholesterol levels.

Heavy drinking.

A diet high in fat (particularly saturated) and salt, but low in fibre, fruit & vegetables.

Lack of regular exercise.

Obesity.

I addressed how the above risk factors can be mitigated in my book : Blueprint to Health and Healing (available on Amazon).

Other Risk Factors For Ischaemic Stroke

Irregular heart Beat, atrial fibrillation- People with this condition need to be on blood thinners to prevent stroke.

Heriditary / Genetic risk factors

Below are some hereditary / genetic stroke risk factors (This list is not exhaustive) :- Antiphospholipid Antibody Syndrome (APS). CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy). CARASIL (cerebral autosomal recessive arteriopathy with subcortical infarcts and leucoencephalopathy) Cerebrotendinous xanthomatosis. Ehlers-Danlos syndrome. Fabry disease Vasculitis Giant cell arteritis (GCA) Sickle Cell Disease.

Causes of Hemorrhagic Strokes :

High blood pressure.
Injury. Bleeding disorders.
Cocaine use. Abnormal blood vessels (AVMs-arterovenous malformations) Aneurysm (a weak area in a blood vessel that breaks open) Amyloid angiopathy

Signs and symptoms of stroke : Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance, or lack of coordination. Sudden severe headache with no known cause.

If you think someone may be having a stroke, act F.A.S.T.

… and do the following simple tests:
F—Face : Ask the person to smile. Does one side of the face droop?
A—Arms : Ask the person to raise both arms. Does one arm drift downward?
S—Speech : Ask the person to repeat a simple phrase. Is the speech slurred or strange?
T—Time : If you see any of these signs, call an ambulance right away. Please it is very important to note the time of onset of symptoms as this will guide the choice of treatment modality.

Stroke Treatment And Management | Post Stroke Patient Conditions