The first objective is to minimize damage to the brain by restoring blood circulation in the event of an ischemic attack diagnosed by an MRI or by reducing the effusion of blood in the event of a hemorrhagic accident. If the stroke is severe, the person will remain in hospital for observation for a few days. A period of rehabilitation, at home or in a specialized center, is sometimes necessary. In addition, the cause of the stroke should be investigated and treated (for example, correcting too high blood pressure or cardiac arrhythmia).

pharmaceuticals

If an artery is blocked

Only one drug to reduce the risk of irreversible brain damage is approved. It is indicated for stroke caused by thrombosis or embolism. This is a tissue plasminogen activator, a protein in the blood that helps dissolve clots quickly (over an hour or two). To be effective, the drug must be injected intravenously within 3 to 4,5 hours of stroke, which greatly limits its use.

A few hours after a non-hemorrhagic stroke, medication is often given anticoagulant ou antiplaquettaire. This helps prevent new blood clots from forming in the arteries. In addition, it prevents the enlargement of already formed clots. Once the stroke has stabilized, the doctor will usually suggest a lighter medication, such asaspirine, to be taken daily over the long term.

During the rehabilitation period, other drugs may be helpful. For example, antispasmodic drugs can help relieve muscle spasms.

If there is a hemorrhage

In the hours following this type of vascular accident, drugs to lower blood pressure are usually administered to limit the bleeding and the risk of resumption of bleeding. Sometimes the bleeding triggers epileptic seizures. They will then be treated with drugs from the benzodiazepine class.

surgery

If an artery is blocked

Once the stroke has stabilized, the doctor offers various tests to find out if other arteries are weakened by atherosclerosis. He may offer one of the following preventive surgeries:

• carotid endarterectomy. This procedure consists of “cleaning” the wall of the carotid artery affected by atherosclerosis. It has been practiced for forty years and is intended to prevent the recurrence of strokes;
• an angioplasty. A balloon is placed in the artery affected by atherosclerosis to prevent its blockage. A small metal rod is also inserted into the artery to prevent it from narrowing. This procedure carries more risk than the previous one, because when the atherosclerotic plaque is crushed by the balloon, fragments of the plaque may be released and cause another blockage further in the cerebral artery.

If there is a hemorrhage

Brain surgery may be necessary to remove the accumulated blood. If the surgeon finds an aneurysm at the time of surgery, they treat it to prevent it from rupturing and another stroke. Treatment most often involves placing a platinum filament in the aneurysm. A blood clot will then form around it and fill in the dilation of the blood vessel.

Note. Occasionally, a medical examination may reveal the presence of an unruptured aneurysm in the brain. Depending on the context, the doctor may or may not recommend preventive surgery. If the patient is under 55, the doctor will usually suggest this preventive surgery. If the patient is older, a choice must be made taking into account the benefits and risks of the operation. Indeed, the latter exposes the patient to a risk of neurological sequelae ranging from 1% to 2%, and to a risk of mortality of approximately 1%.². In addition, more studies are needed to know the real effect of such an intervention on stroke prevention.

readjustment

One of the goals of rehabilitation is to train nerve cells in an unaffected part of the brain to perform functions that were performed before the stroke by other nerve cells. Depending on the needs, the services of various therapists are required: a nurse, a dietitian, a physiotherapist, a speech therapist, an occupational therapist, a psychologist, a psychiatrist, a social worker, etc.