Draft:Original research/Stroke management

A stroke is a brain attack or cerebrovascular accident. The medical effort with respect to strokes is sometimes referred to as stroke management.

Prevention
"In the larger Heart Protection Study [2002], the reduction in the event rate under simvastatin was significant even in those with low-density lipoprotein cholesterol below 3.0 mmol/l (116 mg/dl) or total cholesterol below 5.0 mmol/l (193 mg/dl). The annual excess of myopathies was 1 per 10,000 patients treated [Heart Protection Study, 2002]."

"In men, vigorous exercise was associated with a decreased risk of stroke [Lee et al., 1999]. The data suggested that this association was mediated through beneficial effects on body weight, blood pressure, serum cholesterol and glucose tolerance, and that, apart from these effects, physical activity had no influence on stroke incidence. Substantial evidence supports the use of diets high in non-hydrogenated unsaturated fats, whole grains, fruit and vegetables, fish once a month and adequate [omega]–3 fatty acids to reduce the risk of ischaemic heart disease and probably stroke [Hu and Willett, 2002; He et al., 2002]."

"According to the HERS II trial, hormone replacement in healthy women is associated with an increased risk of ischaemic stroke [Grady et al., 2002]."

"A significant reduction in stroke risk is seen across all treatment groups [Di Mascio et al., 2000]. Most of this effect was driven by trials involving patients with a prior vascular event using a statin, or where a reduction in total cholesterol levels of more than 10% was achieved. In secondary prevention, 57 patients would need to be treated with statins to prevent 1 stroke per year [Straus et al., 2002]. The MRC/BHF Heart Protection Study had a subgroup of 1,820 patients with previous stroke or TIA and no previous coronary event: simvastatin (40 mg daily) reduced the risk of recurrent vascular events by 24% [Heart Protection Study Collaborative Group, 2002]. The PROSPER trial showed that a similar reduction in the risk of coronary events was observed under pravastatin in older individuals, without significant effect on stroke or cognition after 3 years of follow-up [Sheperd et al., 2002]. Gemfibrozil, a fibrate, can also reduce the risk of stroke [Rubins et al., 1999]."

Theory of strokes
Def. a sudden disabling attack or loss of consciousness caused by an interruption in the flow of blood to the brain, or some portion of the brain, especially through thrombosis is called a stroke.

Entities
The "most common types of strokes [are] caused by blood clots in the brain [...] Infusing stem cells into the brain may help boost recovery after a stroke [...] the cells [may] encourage new blood vessels to grow in damaged areas of the brain. [...] most patients were able to walk and look after themselves independently by the end of the trial, despite having suffered severe strokes."

Particular "types of stem cells - known as CD34+ [harvested stem cells from the bone marrow of the five people who had recently had a stroke] have the ability to stimulate the growth of new blood vessels. They were infused directly into damaged sections of the brain, via the major artery that supplies this area. [...] Four of the five patients had suffered particularly severe strokes - resulting in the loss of speech and marked paralysis down one side of the body. This type of stroke usually has a high fatality and disability rate. [...] three of the four patients were able to walk and look after themselves independently at the end of the six-month period."

"It is important to understand this is only the very earliest step towards a possible new treatment for stroke and does not prove the stem cell treatment improved these patients' recovery. A much larger trial will be needed to compare stem cell treatment with no stem cell treatment. Anyone who has seen the suffering a stroke can cause will be encouraged that doctors and scientists are continually exploring new ways to treat this devastating disease."

Stroke recovery
Rapid detection and appropriate emergency medical care are essential for optimizing health outcomes. When available, patients are admitted to an acute stroke unit for treatment. These units specialize in providing medical and surgical care aimed at stabilizing the patient's medical status. Standardized assessments are also performed to aid in the development of an appropriate care plan. Current research suggests that stroke units may be effective in reducing in-hospital fatality rates and the length of hospital stays.

In-patient programs are usually facilitated by an interdisciplinary team that may include a physician, nurse, pharmacist, physical therapist, occupational therapist, speech and language pathologist, psychologist, and recreation therapist. The primary goals of this sub-acute phase of recovery include preventing secondary health complications, minimizing impairments, and achieving functional goals that promote independence in activities of daily living.

In the later phases of stroke recovery, patients are encouraged to participate in secondary prevention programs for stroke. Follow-up is usually facilitated by the patient's primary care provider.

The initial severity of impairments and individual characteristics, such as motivation, social support, and learning ability, are key predictors of stroke recovery outcomes. Responses to treatment and overall recovery of function are highly dependent on the individual. Current evidence indicates that most significant recovery gains will occur within the first 12 weeks following a stroke.