brain, spinal cord, and nerve disorders
Overview of Stroke
Prevention of Stroke
Preventing strokes is preferable to treating them. The main strategy for preventing a first stroke is managing the major risk factors. If people have had a stroke, additional preventive measures are usually needed. Treatment and Smoking and use of amphetamines orcocaineshould be stopped, and alcohol should be limited to no more than two drinks a day. Exercising regularly and, if overweight, losing weight help people control high blood pressure, diabetes, and high cholesterol levels. Having regular checkups enables a doctor to identify risk factors for stroke so that they can be managed promptly. If people have had an ischemic stroke, taking an antiplatelet medication can reduce the risk of another ischemic stroke. Antiplatelet medications make platelets less likely to clump and form clots, a common cause of ischemic stroke. (Platelets are tiny cell-like particles in blood that normally help it clot in response to damaged blood vessels.) Aspirin, one of the most effective antiplatelet medications, is usually prescribed. One adult’s tablet or 1 children’s tablet (which is about one fourth the dose of an adultaspirin) is taken each day. Either dose seems to prevent strokes about equally well. If people have had a TIA or minor stroke, taking a combination of a low dose ofaspirinandclopidogrel(an antiplatelet medication) for a short time (about 3 weeks) is slightly more effective at reducing the risk of future strokes than takingaspirinalone. However, risk is reduced only for the first 3 months after a stroke. After that, the combination has no advantage overaspirinalone. Also, takingclopidogrelplusaspirinfor more than 3 months increases the risk of bleeding by a small amount. Clopidogrelalone may be given to people who cannot tolerateaspirin. Some people are allergic to antiplatelet medications or similar medications and cannot take them. Also, people who have gastrointestinal bleeding should not take antiplatelet medications. If an ischemic stroke or a transient ischemic attack is due to blood clots originating in the heart,warfarin(also called coumadin), an anticoagulant, may be given to inhibit blood clotting. Because takingwarfarinand an antiplatelet medication increases the risk of bleeding, these medications are only occasionally used together for stroke prevention. Dabigatran,apixaban, andrivaroxabanare newer anticoagulants that are often used instead ofwarfarin. After a stroke, older people are more likely to have problems, such as pressure sores, pneumonia, permanent shortening of muscles that limits movement (contractures), and depression. Older people are also more likely to already have disorders that limit treatment of stroke. For example, they may have very high blood pressure or gastrointestinal bleeding that prevents them from taking anticoagulants to reduce the risk of blood clots. Some treatments, such as Carotid artery surgery (surgical removal of fatty deposits in arteries), are more likely to cause complications in older people. Nonetheless, treatment decisions should be based on the person’s health rather than on age itself. Some disorders common among older people can interfere with their recovery after a stroke, as in the following: People with dementia may not understand what is required of them for rehabilitation. People with heart failure or another heart disorder may risk having another stroke or a heart attack triggered by exertion during rehabilitation exercises. A good recovery is more likely when older people have the following: A family member or caregiver to help A living situation that facilitates independence (for example, a first-floor residence and nearby shops) Financial resources to pay for rehabilitation Because recovery after stroke depends on so many medical, social, financial, and lifestyle factors, rehabilitation and care for older people should be individually designed and managed by a team of health care professionals (including nurses, psychologists, and social workers as well as a doctor or therapist). Team members can also provide information about resources and strategies to help people who have had a stroke and their caregivers with daily living. 