1. Stroke
Treatment Options

2. Treatment for Stroke
• Medication
• Rehabilitation and Therapy
• Surgery
• Lifestyle Changes
• References

3. 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

4. Stroke Medications
• Anticoagulants (blood thinners)
– warfarin (Coumadin),
– enoxaparin (Lovenox) and
– heparin.
• Antiplatelet (prevent platelets from sticking)
– aspirin,
– clopidogrel (Plavix) and
– dipyridamole (Aggrenox)

5. Stroke Medications
• Statins (lower cholesterol)
– atorvastatin (Lipitor),
– rosuvastatin (Crestor), and
– simvastatin (Zocor).
• Blood pressure medicines
(hypertensives)

6. Blood Pressure (BP) Medicines
• Diuretics
• Beta-Blockers
• Alpha-Blockers
• Calcium Channel Blockers
• Angiotensin-Converting-Enzyme (ACE)
Inhibitors
• Angiotensin II Receptor Blockers
• Vasodilators

7. BP Medicine (Diuretics)
• Thiazide diuretics
– chlorothiazide (Diuril),
– chlorthalidone (Hygroton),
– indapamide (Lozol),
– hydrochlorothiazide (Esidrix, HydroDiuril)
– , bendroflumethiazide (Naturen),
– methylclothiazide, (Edduran), and
– metolazone (Mykrox, Zaroxolyn).

8. BP Medicine (Diuretics)
• Potassium sparing
– amiloride (Midamor),
– spironolactone (Aldactone), and
– triamterene (Dyrenium).
• Loop diuretics
– bumetanide (Bumex),
– furosemide (Lasix),
– ethacrynic acid (Edecrin), and
– torsemide (Demadex).

9. BP Medicine (Beta Blockers)
• atenolol (Tenormin),
• metoprolol (Lopressor),
• nadolol (Corgard),
• propranolol (Inderal), and
• timolol (Blocadren

10. BP Medicine (Alpha Blockers)
• Doxazosin (Cardura),
• Phentolamine,
• Tamsulosin (Flomax), and
• Terazosin

11. 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)

12. BP Medicine (Angiotensin-Converting-
Enzyme (ACE) Inhibitors )
• benazepril
• captopril
• enalapril
• fosinopril
• lisinopril
• moexipril
• quinapril
• ramipril

13. BP Medicine
(Angiotensin II Receptor Blockers )
• Candesartan (Atacand),
• Eprosartan (Teveten),
• Irbesartan (Avapro),
• Losartan (Cozaar),
• Olmesartan (Benicar),
• Telmisartan (Micardis), and
• Valsartan (Diovan)

14. BP Medicine (Vasodilators)
• Hydralazine HCI (Apresoline)
• Minoxidil (Loniten)

15. Rehabilitation and Therapy
• Physical
• Occupational
• Speech
• Mental Health
• Other

16. Physical Rehabilitation & Therapy
helps patients:
• Retrain the brain
• Strengthen muscles,
• Improve balance and gait, and
• Regain as much physical control as
possible.

17. 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

18. 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

19. 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.

20. Mental Health Rehabilitation &
Therapy helps patients:
• Counseling for depression and anxiety
• Retraining in social skills.
• Setting short term and long term goals

21. 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

22. Surgery
Surgery for stroke is used in three
different ways:
• To prevent stroke
• Immediately after the stroke
• To repair damage after the patient is
stable

23. Surgeries for ischemic stroke
and to prevent future stroke
• Carotid Artery Surgery
(Endarterectomy) and
• Carotid Stenting.

24. Surgeries for hemorrhagic stroke
• Draining leaking blood
• Treating an aneurysm
Endovascular coil
Clipping
embolization

25. 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.

26. 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.

27. 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.

28. References
http://health.nytimes.com/health/guides/disease/hypertension/medications.html
http://www.medicinenet.com/stroke/page7.htm#what_is_the_treatment_of_a_stroke
http://www.baptistneurology.com/health-library/neurology-treatments/drugs/
http://www.webmd.com/brain/brain-swelling-brain-edema-intracranial-pressure
http://strokecenter.stanford.edu/guide-new-drugs.html
http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm
http://www.baptistneurology.com/health-library/neurology-treatments/rehabilitation/
http://medicalcenter.osu.edu/patientcare/healthcare_services/nervous_system/abou
t/rehab/Pages/index.aspx
http://www.neuropt.org/farcry/%20/go/consumer-information/what-is-a-neurologic-
physical-therapist
http://www.stroke.org/site/PageServer?pagename=REHABTT
http://www.nimh.nih.gov/health/publications/depression-and-stroke/depression-and-
stroke.pdf
http://nyp.org/services/rehabmed/stroke-therapies.html
http://www.ninds.nih.gov/disorders/stroke/stroke_rehabilitation.htm

29. Depression and Other Mental Health Diagnoses after Stroke Increase Inpatient
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Sushmita Shoma Ghose, Linda S. Williams and Ralph W. Swindle
Medical Care , Vol. 43, No. 12 (Dec., 2005), pp. 1259-1264
Published by: Lippincott Williams & Wilkins
Article Stable URL: http://www.jstor.org/stable/3768213
http://www.news-medical.net/health/Music-Therapy-for-Stroke.aspx
http://www.ucl.ac.uk/dcal/documents/deaf_stroke_results
http://deafstroke.salk.edu/
http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/treatment.html
http://www.webmd.com/stroke/guide/stroke-surgery
http://www.everydayhealth.com/health-center/stroke-surgery.aspx
http://nihseniorhealth.gov/stroke/surgeryandvascularinterventions/01.html
http://www.aphasiahelp.org/information/stroke/09_surgery/index.php
http://www.rwjuh.edu/medical_services/vascular_center_carotid_artery_surgery.html

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http://www.webmd.com/brain/tc/brain-aneurysm-endovascular-coil-embolization-
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