Ischemic stroke

Pharma
 Intravenous injection of tissue plasminogen activator (tPA). This injection of
recombinant tissue plasminogen activator (tPA), also called alteplase, is
considered the gold standard treatment for ischemic stroke. An injection of tPA is
usually given through a vein in the arm. This potent clot-busting drug ideally is
given within three hours. In some instances, tPA can be given up to 4.5 hours
after stroke symptoms begin. This drug restores blood flow by dissolving the
blood clot causing your stroke, and it may help people who have had strokes
recover more fully.
Surgical
 Mechanical embolectomy minimally invasive surgical treatment designed to
remove a blockage in the blood vessel. a surgeon inserts a microcatheter (a
small plastic tube) into an artery in the patient’s upper leg and threads it (under
X-ray guidance) into the blocked artery of the brain. The surgeon then slips a
device inside the plastic tube and advances it to the site of the clot to either
aspirate it or retrieve it.
2 types of device used in mechanical embolectomy
1. Penumbra works by macerating the blockage (basically chewing it up
into pieces) and then removing the pieces.
2. Stentrievers (such as the Solitaire and the Trevo) are designed to
remove the blood clot as a whole.
 Cerebral revascularization, also called bypass surgery provides new blood
supply that can help prevent strokes and TIAs. The surgery connects a blood
vessel from outside the brain to a vessel inside the brain to reroute blood flow
around a damaged or blocked artery. The goal of bypass surgery is to restore
blood supply to the brain and prevent strokes.

Hemorrhagic Stroke

Pharma
Medications used in the treatment of acute stroke include:
 Anticonvulsants such as diazepam, to prevent seizure recurrence because
hemorrhagic strokes could result from a rupturing blood vessel caused by
seizure.
 Antihypertensive agents such as labetalol, to reduce blood pressure (BP)

 Mannitol pulls brain fluid into the bloodstream to decrease intracranial pressure
in the sub arachnoid space.
  Mechanical ventilator frequently is used to hyperventilate the stroke patient
because this can lead to a lower, safer pressure.

Surgical
 Decompressive craniotomy procedure a part of the skull may be removed to
reduce pressure on the brain. During the operation, a surgeon removes the
portion of the skull that is causing the pressure on the brain. This is usually the
area of the skull that covers the injury.

 Craniotomy with open surgery: The neurosurgeon removes a portion of the

skull and conducts open surgery to drain the hematoma and repair the ruptured
blood vessel. This is a major surgical procedure that is typically used when the
hematoma is very large, or when it’s compressing the brain stem, where critical
functions are controlled.

 Simple aspiration: The surgeon drills a small hole in the skull and drains the
hematoma using a needle. This is a relatively noninvasive procedure, but it can
be difficult to locate the exact location of the bleed and it doesn’t always allow the
surgeon to drain the hematoma completely.
 Endoscopic evacuation is similar to simple aspiration in that it involves drilling a
hole in the skull, but instead of traditional surgical instruments a highly skilled
neurosurgeon can reach and drain the hematoma using an endoscope (a tiny
camera-guided instrument).

 Stereotactic aspiration uses computed tomography (CT) to locate the

hematoma and a specially developed suction tool to drain it. The patient is
immobilized in a stereotactic head frame that allows a greater degree of precision
and accuracy than otherwise possible.