Skip to main content
SpringerLink
Log in

Post-Stroke Treatment Strategies, Management, and Rehabilitation: Where We Stand?

  • Chapter
  • First Online:
Advancement in the Pathophysiology of Cerebral Stroke

  • 1037 Accesses

Abstract

Stroke is a medical condition occurring due to the deprivation of blood supply temporarily/permanently to specific area of the brain leading to hypoxia to the brain cells, which eventually causes mortality of the patients. Stroke is categorized into three different types, i.e., transient ischemic attack (shows stroke-like symptoms), acute ischemic strokes (hiccups, nausea, troubles in walking and speaking, numbness of the face, arm, and leg mainly on one side of the body), and hemorrhagic strokes (loss of consciousness and balance, nausea, vomiting, seizures, dizziness). Over the past 20 years, the inhospital and post-discharge management for stroke has been deeply transformed. Their early detection and inhospital therapies can deteriorate short- and long-term outcomes of strokes. Inhospital treatments include thrombolysis, aspirin treatment, antithrombotic therapy, therapeutic hypothermia, blood pressure management, antiplatelet strategies, and surgery for cerebral edema. There are several important aspects which are discussed below in this chapter that should be taken care in order to decrease mortality rate in stroke patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

AA:

Arachidonic acid

ACE:

Angiotensin-converting enzyme

ADP:

Adenosine diphosphate

AF:

Atrial fibrillation

AIS:

Acute ischemic strokes

APA:

Antiplatelet agent

APP:

Amyloid precursor protein

ASA:

American Stroke Association

BBB:

Blood-brain barrier

BP:

Blood pressure

cAMP:

Cyclic adenosine monophosphate

CBF:

Cerebral blood flow

CNS:

Central nervous system

COX:

Cyclooxygenase

CSF:

Cerebrospinal fluid

DAPT:

Dual antiplatelet therapy

GP:

Glycoprotein

HS:

Hemorrhagic strokes

I/R:

Ischemia/reperfusion

MI:

Myocardial infarction

NOACs:

Novel oral anticoagulants

PDE:

Phosphodiesterase

PROACT II:

Prolyse in acute cerebral thromboembolism II

RNS:

Reactive nitrogen species

ROS:

Reactive oxygen species

rtPA:

Recombinant tissue plasminogen activator

T×A2:

Thromboxane A2

TCM:

Traditional Chinese medicine

References

  1. Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., et al. (2017). Heart disease and stroke statistics—2017 update: A report from the American Heart Association. Circulation, 135(10), e146–e603.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693–1702.

    Article  Google Scholar 

  3. Rabinstein, A. A. (2017). Treatment of acute ischemic stroke. CONTINUUM: Lifelong Learning in Neurology, 23(1, Cerebrovascular Disease), 62–81.

    PubMed  Google Scholar 

  4. Wardlaw, J. M., Murray, V., Berge, E., & Del Zoppo, G. J. (2009). Thrombolysis for acute ischaemic stroke. Cochrane Database of Systematic Reviews, 4, CD000213.

    Google Scholar 

  5. Group, S. S. (1995). Tissue plasminogen activator for acute ischemic stroke. The New England Journal of Medicine, 333, 1581–1587.

    Article  Google Scholar 

  6. Hacke, W., Kaste, M., Bluhmki, E., Brozman, M., Dávalos, A., Guidetti, D., et al. (2008). Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. The New England Journal of Medicine, 359(13), 1317–1329.

    Article  CAS  PubMed  Google Scholar 

  7. Wahlgren, N., Ahmed, N., Dávalos, A., Ford, G. A., Grond, M., Hacke, W., et al. (2007). Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): An observational study. The Lancet, 369(9558), 275–282.

    Article  CAS  Google Scholar 

  8. ATLANTIS T. (2004). Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. The Lancet, 363(9411), 768–774.

    Article  Google Scholar 

  9. Saver, J. L. (2004). Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: Novel derivation method and application to thrombolytic therapy for acute stroke. Archives of Neurology, 61(7), 1066–1070.

    Article  PubMed  Google Scholar 

  10. Furlan, A., Higashida, R., Wechsler, L., Gent, M., Rowley, H., Kase, C., et al. (1999). Intra-arterial prourokinase for acute ischemic stroke: The PROACT II study: A randomized controlled trial. Journal of the American Medical Association, 282(21), 2003–2011.

    Article  CAS  PubMed  Google Scholar 

  11. Dawson, J. (2009). Prevention of stroke: Risk stratification and targeted and novel therapies. University of Glasgow.

    Google Scholar 

  12. Arnold, M., Nedeltchev, K., Schroth, G., Baumgartner, R., Remonda, L., Loher, T., et al. (2004). Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis. Journal of Neurology, Neurosurgery & Psychiatry, 75(6), 857–862.

    Article  CAS  Google Scholar 

  13. Lindsberg, P., & Mattle, H. (2006). Therapy of basilar artery occlusion: A systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke, 37(3), 922–928.

    Article  PubMed  Google Scholar 

  14. Dalen, J. E. (2006). Aspirin to prevent heart attack and stroke: What’s the right dose? The American Journal of Medicine, 119(3), 198–202.

    Article  CAS  PubMed  Google Scholar 

  15. Castillo, J., Davalos, A., Naveiro, J., & Noya, M. (1996). Neuroexcitatory amino acids and their relation to infarct size and neurological deficit in ischemic stroke. Stroke, 27(6), 1060–1065.

    Article  CAS  PubMed  Google Scholar 

  16. Castillo, J., Leira, R., Moro, M. Á., Lizasoain, I., Serena, J. N., & Dávalos, A. (2003). Neuroprotective effects of aspirin in patients with acute cerebral infarction. Neuroscience Letters, 339(3), 248–250.

    Article  CAS  PubMed  Google Scholar 

  17. Ansara, A. J., Nisly, S. A., Arif, S. A., Koehler, J. M., & Nordmeyer, S. T. (2010). Aspirin dosing for the prevention and treatment of ischemic stroke: An indication-specific review of the literature. The Annals of Pharmacotherapy, 44(5), 851–862.

    Article  CAS  PubMed  Google Scholar 

  18. Warner, T. D., Nylander, S., & Whatling, C. (2011). Anti-platelet therapy: Cyclo-oxygenase inhibition and the use of aspirin with particular regard to dual anti-platelet therapy. British Journal of Clinical Pharmacology, 72(4), 619–633.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Diener, H.-C., Sacco, R. L., Yusuf, S., Cotton, D., Ôunpuu, S., Lawton, W. A., et al. (2008). Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: A double-blind, active and placebo-controlled study. The Lancet Neurology, 7(10), 875–884.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Andresen, M., Gazmuri, J. T., Marín, A., Regueira, T., & Rovegno, M. (2015). Therapeutic hypothermia for acute brain injuries. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(1), 42.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Liu, L., & Yenari, M. A. (2009). Clinical application of therapeutic hypothermia in stroke. Neurological Research, 31(4), 331–335.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Karnatovskaia, L. V., Wartenberg, K. E., & Freeman, W. D. (2014). Therapeutic hypothermia for neuroprotection: History, mechanisms, risks, and clinical applications. The Neurohospitalist, 4(3), 153–163.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yokobori, S., Frantzen, J., Bullock, R., Gajavelli, S., Burks, S., Bramlett, H., et al. (2011). The use of hypothermia therapy in traumatic ischemic/reperfusional brain injury: Review of the literatures. Therapeutic Hypothermia and Temperature Management, 1(4), 185–192.

    Article  PubMed  PubMed Central  Google Scholar 

  24. McManus, M., & Liebeskind, D. S. (2016). Blood pressure in acute ischemic stroke. Journal of Clinical Neurology, 12(2), 137–146.

    Article  PubMed  Google Scholar 

  25. Appleton, J. P., Sprigg, N., & Bath, P. M. (2016). Blood pressure management in acute stroke. Stroke and Vascular Neurology, 1, e000020.

    Article  Google Scholar 

  26. Bowry, R., Navalkele, D. D., & Gonzales, N. R. (2014). Blood pressure management in stroke five new things. Neurology: Clinical Practice, 4(5), 419–426.

    Google Scholar 

  27. Martin-Schild, S., Hallevi, H., Albright, K. C., Khaja, A. M., Barreto, A. D., Gonzales, N. R., et al. (2008). Aggressive blood pressure–lowering treatment before intravenous tissue plasminogen activator therapy in acute ischemic stroke. Archives of Neurology, 65(9), 1174–1178.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fontana, P., & Reny, J.-L. (2007). New antiplatelet strategies in atherothrombosis and their indications. European Journal of Vascular and Endovascular Surgery, 34(1), 10–17.

    Article  CAS  PubMed  Google Scholar 

  29. Gurbel, P. A., & Tantry, U. S. (2010). Combination antithrombotic therapies. Circulation, 121(4), 569–583.

    Article  PubMed  Google Scholar 

  30. Schneider, D. J. (2011). Anti-platelet therapy: Glycoprotein IIb-IIIa antagonists. British Journal of Clinical Pharmacology, 72(4), 672–682.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Yip, S., & Benavente, O. (2011). Antiplatelet agents for stroke prevention. Neurotherapeutics, 8(3), 475.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Jha, S. (2003). Cerebral edema and its management. Medical Journal, Armed Forces India, 59(4), 326.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Park, J.-O., Park, D.-H., Kim, S.-D., Lim, D.-J., & Park, J.-Y. (2007). Surgical treatment for acute, severe brain infarction. Journal of Korean Neurosurgical Society, 42(4), 326–330.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Broderick, J. P., Bonomo, J. B., Kissela, B. M., Khoury, J. C., Moomaw, C. J., Alwell, K., et al. (2011). Withdrawal of antithrombotic agents and its impact on ischemic stroke occurrence. Stroke, 42(9), 2509–2514.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Guo, Y., Wang, H., Tian, Y., Wang, Y., & Lip, G. Y. (2015). Time trends of aspirin and warfarin use on stroke and bleeding events in Chinese patients with new-onset atrial fibrillation. CHEST Journal, 148(1), 62–72.

    Article  Google Scholar 

  36. Rybak, I., Ehle, M., Buckley, L., & Fanikos, J. (2011). Efficacy and safety of novel anticoagulants compared with established agents. Therapeutic Advances in Hematology, 2(3), 175–195.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Molteni, M., & Cimminiello, C. (2014). Warfarin and atrial fibrillation: From ideal to real the warfarin affaire. Thrombosis Journal, 12(1), 5.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Bajorek, B. (2011). A review of the safety of anticoagulants in older people using the medicines management pathway: Weighing the benefits against the risks. Therapeutic Advances in Drug Safety, 2(2), 45–58.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Fonarow, G. C., Smith, E. E., Reeves, M. J., Pan, W., Olson, D., Hernandez, A. F., et al. (2011). Hospital-level variation in mortality and rehospitalization for medicare beneficiaries with acute ischemic stroke. Stroke, 42(1), 159–166.

    Article  PubMed  Google Scholar 

  40. Casella, G., Caponnetto, P., & Polosa, R. (2010). Therapeutic advances in the treatment of nicotine addiction: Present and future. Therapeutic Advances in Chronic Disease, 1(3), 95–106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Goldstein, L. B., Bushnell, C. D., Adams, R. J., Appel, L. J., Braun, L. T., & Chaturvedi, S., et al. (2010). Guidelines for the primary prevention of stroke. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke.

    Google Scholar 

  42. Ding, E. L., & Mozaffarian, D. (Eds.). (2006). Optimal dietary habits for the prevention of stroke. Seminars in neurology. New York: Copyright© 2006 by Thieme Medical Publishers.

    Google Scholar 

  43. Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., et al. (2014). Physical activity and exercise recommendations for stroke survivors. Stroke, 45(8), 2532–2553.

    Article  PubMed  Google Scholar 

  44. Freire, F. R., Coelho, F., Lacerda, J. R., Silva, M. F. D., Gonçalves, V. T., Machado, S., et al. (2011). Cognitive rehabilitation following traumatic brain injury. Dementia & Neuropsychologia, 5(1), 17–25.

    Article  Google Scholar 

  45. Kernan, W. N., Viscoli, C. M., Inzucchi, S. E., Brass, L. M., Bravata, D. M., Shulman, G. I., et al. (2005). Prevalence of abnormal glucose tolerance following a transient ischemic attack or ischemic stroke. Archives of Internal Medicine, 165(2), 227–233.

    Article  PubMed  Google Scholar 

  46. Bruno, A., Kent, T. A., Coull, B. M., Shankar, R. R., Saha, C., Becker, K. J., et al. (2008). Treatment of hyperglycemia in ischemic stroke (THIS). Stroke, 39(2), 384–389.

    Article  CAS  PubMed  Google Scholar 

  47. Foroughi, M., Akhavanzanjani, M., Maghsoudi, Z., Ghiasvand, R., Khorvash, F., & Askari, G. (2013). Stroke and nutrition: A review of studies. International Journal of Preventive Medicine, 4(Suppl 2), S165.

    PubMed  PubMed Central  Google Scholar 

  48. Michota, F. (2013). Transitions of care in anticoagulated patients. Journal of Multidisciplinary Healthcare, 6, 215.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Goto, K., Nakai, K., Shizuta, S., Morimoto, T., Shiomi, H., Natsuaki, M., et al. (2014). Anticoagulant and antiplatelet therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention. The American Journal of Cardiology, 114(1), 70–78.

    Article  CAS  PubMed  Google Scholar 

  50. Fung, F. Y., & Linn, Y. C. (2015). Developing traditional Chinese medicine in the era of evidence-based medicine: Current evidences and challenges. Evidence-Based Complementary and Alternative Medicine, 2015, 425037.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Birks, J., & Grimley, E. J. (2007). Ginkgo biloba for cognitive impairment and dementia.

    Google Scholar 

  52. Iriti, M., Vitalini, S., Fico, G., & Faoro, F. (2010). Neuroprotective herbs and foods from different traditional medicines and diets. Molecules (Basel, Switzerland), 15(5), 3517–3555.

    Article  CAS  Google Scholar 

  53. Rhoda, A., Cunningham, N., Azaria, S., & Urimubenshi, G. (2015). Provision of inpatient rehabilitation and challenges experienced with participation post discharge: Quantitative and qualitative inquiry of African stroke patients. BMC Health Services Research, 15(1), 423.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Urimubenshi, G. (2015). Activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda. African Health Sciences, 15(3), 917–924.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India

    Mallikarjuna Rao Gedda & Kulsoom Zahra

  2. Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India

    Surya Prakash Pandey & Prasoon Madhukar

  3. Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

    Abhishek Pathak

Authors
  1. Mallikarjuna Rao Gedda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Surya Prakash Pandey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kulsoom Zahra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Prasoon Madhukar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abhishek Pathak
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. School of Biomedical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India

    Ranjana Patnaik

  2. School of Biomedical Engineering, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India

    Amit Kumar Tripathi

  3. Department of Zoology, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Ashish Dwivedi

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gedda, M.R., Pandey, S.P., Zahra, K., Madhukar, P., Pathak, A. (2019). Post-Stroke Treatment Strategies, Management, and Rehabilitation: Where We Stand?. In: Patnaik, R., Tripathi, A., Dwivedi, A. (eds) Advancement in the Pathophysiology of Cerebral Stroke. Springer, Singapore. https://doi.org/10.1007/978-981-13-1453-7_13

Download citation

Publish with us

Policies and ethics

Search

Navigation