What you need to know about stroke and its rehabilitation!

Every day in the world, many people die due to stroke.

A stroke is the closure or rupture of a cerebral artery. If the blood supply to a part of the brain is disrupted and stopped, this part of the brain can no longer function normally, which results in a disruption of blood circulation in the brain area. It causes symptoms such as half-body paralysis, speech disorder, and walking disorder.

What are the general principles of stroke rehabilitation?

A) Basic rehabilitation measures before reaching the hospital

After observing the Early sign s of a sudden stroke in the patient and performing a few simple tests, if you suspect a stroke, keep your cool and contact the emergency medical center; the following measures can help:

1- Write down the time of onset of symptoms.

2- Check the status of pulse and breathing and, if possible, blood pressure and sugar.

3- If the patient is not breathing, if possible, start cardiac massage and mouth breathing.

4- Do not allow the patient to sleep.

5- Do not give any medicine, food, or separate liquids.

6- Preferably, place the patient lying on his side and place a pillow under the patient’s head (to reduce the risk of aspiration in case of vomiting).

7- Keep the patient warm enough (using a blanket or any other suitable device).

b) Diagnostic and therapeutic procedures in the hospital:

After the measures and first aid at home and by the emergency rescue team, the patient should be transferred to the first-equipped medical center as soon as possible.

1- The first step in the hospital is to check the patient’s vital cardiac and respiratory status and stabilize the initial vital signs.

2- In order to diagnose the occurrence of a stroke and its type (hemorrhagic or ischemic), brain imaging is performed, which is usually performed first with a CT scan and then with an MRI.

3- Correction of blood pressure:

In many cases, the occurrence of a stroke (especially of the hemorrhagic type) causes an excessive increase in blood pressure, but the most important thing is that lowering blood pressure must be gradual and calculated. It is recommended that blood pressure above 120/210 should be slowly lowered by 15% in the first 8 to 24 hours. Descending quickly and more than this can lead to reduced blood supply and further damage to the brain.

If the patient is facing a decrease in blood pressure and body fluids, the deficiency should be corrected by using serum (preferably normal saline or saline serum).

4- Correcting the patient’s blood sugar:

Low blood sugar (especially less than 60 mg/dl) must be brought to a higher level, especially in ischemic strokes. Very high sugar levels are also dangerous and sometimes need to be corrected quickly.

5- Prescribing clot-dissolving drugs such as alteplase rt’PA in cases of ischemic stroke caused by clots can help reduce brain damage and mortality by dissolving the clot. The use of this medicine will be useful for up to 4.5 hours (even up to the first 6 hours in some cases), and the sooner it is prescribed, the better the therapeutic effects will be. It should be noted that it is not possible to prescribe this medicine to all patients, and the wrong choice of the patient can cause serious side effects.

6- Removing or dissolving the clot with surgical techniques:

The use of these methods, which directly cause blockage in a certain vessel, also has better results in the first 3 hours, but currently, it is available in a limited way.

7- Aspirin prescription:

In cases of ischemic stroke, oral aspirin is prescribed within the first hours (especially during the first 24 hours). Of course, if the patient has undergone clot-dissolving treatments such as rtPA, its administration will be delayed for 24 hours. The initial dose is usually 325 mg orally.

Other diluting drugs (such as Plavix or Clopidogrel) are used to a lesser extent and only if it is not possible to prescribe aspirin.

8- AnticoagulantsAnticoagulants (heparin and its relatives, LMWH, UFH):

In some cases, the use of heparin and newer drugs for the same family can be useful in reducing the risk of clot development. Other anticoagulantanticoagulant drugs that may be needed later and orally are warfarin, rivaroxaban (Zalerban), dabigatran, and apixaban are examples of these drugs.

9- Reducing intracranial pressure:

Especially in cases where the extent of the damaged area is large, swelling caused by the accumulation of fluids around the site of ischemic stroke, or in cases of progressive or large bleeding that leads to the gradual progression of symptoms, medical or surgical interventions to reduce intracranial pressure and prevent the reduction of the level Vigilance and more damage to adjacent areas of the brain will be required.