stroke
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TRANSCRIPT
Stroke
Treatment Options
Treatment for Stroke• Medication• Rehabilitation and Therapy• Surgery• Lifestyle Changes
• References
Stroke Medication• Emergency
– Clot-busters:• Thrombolytic medications e.g. tissue Plasminogen Activator (tPA)
(alteplase, Activase; Cathflo Activase)
– Aspirin– Swelling reduction:
• Corticosteroids such as cortisone and hydrocortisone
– Neuroprotective agents (in development)• After stabilization
Stroke Medications
• Anticoagulants (blood thinners) – warfarin (Coumadin), – enoxaparin (Lovenox) and – heparin.
• Antiplatelet (prevent platelets from sticking)– aspirin, – clopidogrel (Plavix) and – dipyridamole (Aggrenox)
Stroke Medications
• Statins (lower cholesterol)– atorvastatin (Lipitor), – rosuvastatin (Crestor), and – simvastatin (Zocor).
• Blood pressure medicines (hypertensives)
Blood Pressure (BP) Medicines• Diuretics • Beta-Blockers• Alpha-Blockers• Calcium Channel Blockers• Angiotensin-Converting-Enzyme (ACE)
Inhibitors• Angiotensin II Receptor Blockers• Vasodilators
BP Medicine (Diuretics)• Thiazide diuretics
– chlorothiazide (Diuril), – chlorthalidone (Hygroton),– indapamide (Lozol), – hydrochlorothiazide (Esidrix, HydroDiuril)– , bendroflumethiazide (Naturen), – methylclothiazide, (Edduran), and – metolazone (Mykrox, Zaroxolyn).
BP Medicine (Diuretics)• Potassium sparing
– amiloride (Midamor), – spironolactone (Aldactone), and – triamterene (Dyrenium).
• Loop diuretics– bumetanide (Bumex), – furosemide (Lasix), – ethacrynic acid (Edecrin), and – torsemide (Demadex).
BP Medicine (Beta Blockers)• atenolol (Tenormin), • metoprolol (Lopressor), • nadolol (Corgard), • propranolol (Inderal), and• timolol (Blocadren
BP Medicine (Alpha Blockers)• Doxazosin (Cardura), • Phentolamine, • Tamsulosin (Flomax), and• Terazosin
BP Medicine (Calcium Channel Blockers)• Amlodipine (Norvasc), • Diltiazem (Cardizem LA, Tiazac), • Felodipine, • Isradipine (DynaCirc CR), • Nicardipine (Cardene SR), • Nifedipine (Procardia, Procardia XL,
Adalat CC), • Nisoldipine (Sular),and • Verapamil (Calan, Verelan, Covera-HS)
BP Medicine (Angiotensin-Converting-Enzyme (ACE) Inhibitors )
• benazepril• captopril• enalapril• fosinopril• lisinopril• moexipril• quinapril• ramipril
BP Medicine (Angiotensin II Receptor Blockers )
• Candesartan (Atacand),• Eprosartan (Teveten),• Irbesartan (Avapro),• Losartan (Cozaar),• Olmesartan (Benicar),• Telmisartan (Micardis), and• Valsartan (Diovan)
BP Medicine (Vasodilators)• Hydralazine HCI (Apresoline)• Minoxidil (Loniten)
Rehabilitation and Therapy• Physical• Occupational• Speech• Mental Health• Other
Physical Rehabilitation & Therapyhelps patients:
• Retrain the brain• Strengthen muscles,• Improve balance and gait, and • Regain as much physical control as
possible.
Occupational Rehabilitation & Therapy helps patients:
• Apply physical skills to activities of daily living
• Relearn eating, dressing, bathing and caring for oneself
• Redevelop cognitive skills such as difficulty with attention, memory or poor judgment.
• Develop new ways to do tasks successfully with new limitations
Occupational Rehabilitation & Therapy helps patients:
• Learn to safely reduce potential injury, • Use prostheses and orthotics and • Adjust to assistive devices
– Canes, – Crutches, – Walkers and – Wheelchairs
Speech Rehabilitation & Therapy helps patients:
• Relearn how to express themselves,• Relearn how to process language input, • Retrain swallowing mechanisms• Develop communication tricks when
typical speech is lost• Improve articulation and enunciation, and• Use devices such as computer-aided
speech technology.
Mental Health Rehabilitation & Therapy helps patients:
• Counseling for depression and anxiety• Retraining in social skills.• Setting short term and long term goals
Other Rehabilitation and Therapy:• Music Therapy. • Mirror Therapy using the unaffected side to
envisioning the affected side moving,• Robotic Therapy (sophisticated exercise
machines),• Virtual Reality, (such as WII Hab - using a
gaming system to practice movement),• Mental Practice envisioning movement• Recreational Therapy
SurgerySurgery for stroke is used in three different ways:• To prevent stroke• Immediately after the stroke• To repair damage after the patient is
stable
Surgeries for ischemic stroke and to prevent future stroke
• Carotid Artery Surgery (Endarterectomy) and
• Carotid Stenting.
Surgeries for hemorrhagic stroke• Draining leaking blood• Treating an aneurysm
Clipping Endovascular coil embolization
Lifestyle Changes• Quitting smoking,• Lowering blood pressure,• Losing weight,• Eating right,• Being physically active,• Limiting alcohol to the recommended
consumption, and• Taking medication as prescribed.
Nutritional Changes• Include a variety of foods and foods of
different colors• Eat whole grains, vegetables and fruits.• Foods low in saturated fat and cholesterol.• Foods with limited added sugar.• Foods with limited of salt and sodium.
Why Exercise?• Recover pre-stroke strength and abilities, • Prevent recurrent stroke,• Improve aerobic fitness, and• Cognitive exercise
– Keep the mind sharp,– Retrain damaged neural – memory practice, puzzle solving, or word
games.
Referenceshttp://health.nytimes.com/health/guides/disease/hypertension/medications.htmlhttp://www.medicinenet.com/stroke/page7.htm#what_is_the_treatment_of_a_strokehttp://www.baptistneurology.com/health-library/neurology-treatments/drugs/http://www.webmd.com/brain/brain-swelling-brain-edema-intracranial-pressurehttp://strokecenter.stanford.edu/guide-new-drugs.htmlhttp://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htmhttp://www.baptistneurology.com/health-library/neurology-treatments/rehabilitation/http://medicalcenter.osu.edu/patientcare/healthcare_services/nervous_system/about/rehab/Pages/index.aspxhttp://www.neuropt.org/farcry/%20/go/consumer-information/what-is-a-neurologic-physical-therapisthttp://www.stroke.org/site/PageServer?pagename=REHABTThttp://www.nimh.nih.gov/health/publications/depression-and-stroke/depression-and-stroke.pdfhttp://nyp.org/services/rehabmed/stroke-therapies.htmlhttp://www.ninds.nih.gov/disorders/stroke/stroke_rehabilitation.htm
Depression and Other Mental Health Diagnoses after Stroke Increase Inpatient and Outpatient Medical Utilization Three Years PoststrokeSushmita Shoma Ghose, Linda S. Williams and Ralph W. SwindleMedical Care , Vol. 43, No. 12 (Dec., 2005), pp. 1259-1264Published by: Lippincott Williams & WilkinsArticle Stable URL: http://www.jstor.org/stable/3768213 http://www.news-medical.net/health/Music-Therapy-for-Stroke.aspxhttp://www.ucl.ac.uk/dcal/documents/deaf_stroke_resultshttp://deafstroke.salk.edu/http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/treatment.htmlhttp://www.webmd.com/stroke/guide/stroke-surgeryhttp://www.everydayhealth.com/health-center/stroke-surgery.aspxhttp://nihseniorhealth.gov/stroke/surgeryandvascularinterventions/01.htmlhttp://www.aphasiahelp.org/information/stroke/09_surgery/index.phphttp://www.rwjuh.edu/medical_services/vascular_center_carotid_artery_surgery.html
http://www.nhlbi.nih.gov/health//dci/Diseases/carend/carend_risks.htmlhttp://www.webmd.com/brain/tc/brain-aneurysm-endovascular-coil-embolization-topic-overviewhttp://www.webmd.com/hw-popup/arteriovenous-malformationKeith W., M. (n.d). Common medical presentations: Stroke. Medicine, 37(Acute medicine Part 2 of 2), 109-114. doi:10.1016/j.mpmed.2008.11.004http://www.webmd.com/stroke/features/stroke-prevention-lifestyle-tipshttp://www.baptistneurology.com/health-library/neurology-treatments/lifestyle/http://strokefoundation.com.au/prevent-stroke/risk-factors/high-blood-pressure/tips-to-change-your-lifestyle/http://www.livestrong.com/article/300758-diet-plan-for-a-stroke-victim/http://my.clevelandclinic.org/disorders/Stroke/hic_The_Role_of_Nutrition_in_the_Prevention_and_Treatment_of_Stroke.aspxhttp://www.webmd.com/food-recipes/guide/the-mediterranean-diethttp://www.nlm.nih.gov/medlineplus/tutorials/managingstress/hp069103.pdf)
Fisher M, Lees K, Spence JD. Nutrition and stroke prevention. Stroke.2006;37:2430–5. Published online before print July 27, 2006,doi: 10.1161/ 01.STR.0000236633.40160.ee Gordon NF,Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, et al.Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council.Circulation 2004;109(16):2031-41. Surtees PG, Wainwright NWJ, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Psychological distress, major depressive disorder, and risk of stroke.Neurology. March 4, 2008;70(10):788-794. (http://www.neurology.org/content/70/10/788.short)