Stroke – Types, Causes, Symptoms, Diagnosis, Treatment

Treatment Stroke

Initial Treatment is aimed at limiting the size of the stroke and preventing further stroke. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischaemic stroke or by stopping the bleeding of a hemorrhagic stroke. This will involve administering medications and may include surgery in some cases.

Emergency treatment with medications.

Therapy with clot-busting drugs must start within 3 hours if they are given into the vein — and the sooner, the better. Quick Treatment not only improves your chances of survival but also may reduce complications. You may be given:

• Aspirin – Aspirin is an immediate treatment in the emergency room to reduce the likelihood of another stroke. Aspirin prevents blood clots from forming.
• Anticoagulants (e.g., heparin) – these medications help to prevent blot clots from getting bigger and prevent new blood clots from forming. Some people may be offered an anticoagulant to help reduce their risk of developing further blood clots in the giants. It prevents blood clots by changing the chemical composition of the blood in a way that prevents clots from occurring. Warfarin, apixaban, dabigatran, edoxaban and rivaroxaban are examples of anticoagulants for long-term use. There is also a number several plants called heparins that can only be given by injection and are used short-term. Anticoagulants may be offered if you – have a type of irregular heartbeat called atrial fibrillation that can cause blood clots have a history of blood clots develop a blood clot in your leg veins – known as deep vein thrombosis (DVT) – because a stroke has left you unable to move one of your legs.
• Antiplatelets – Most people will be offered a regular dose of aspirin. As well as being a painkiller, aspirin is antiplatelet, which reduces the chances of another clot forming. In addition to aspirin, other antiplatelet medicines such as clopidogrel and dipyridamole are also available.
• Vinpocetine – a group of medicine to reach oxygen & nutrition to the hemorrhagic/ischemic area of the brain.
• Vasodilator – medicine for ischemic stroke to reach blood to the brain’s obstacle area.
• Prednisolone /methylprednisolone – for the eradication of inflammation in the blood clots area of the brain.
• NSAID – for inflammation & removing pain.
• Gabapentin &Pregabalin or Mirogabalin –  to recover damaged nerve & inhabited the pain impulse to the brain.Mirogabalin is a gabapentinoid medication developed by Daiichi Sankyo. Gabapentin and pregabalin are also members of this class. As a gabapentinoid, mirogabalin binds to the α₂δ subunit of voltage-gated calcium channel, but with significantly higher potency than pregabalin.
• Lipid-lowering agent – to remove the excessive fat & plaque accumulated in the blood vessel in the body.
• Thrombolytic therapy  – these medications dissolve blood clots allowing blood flow to be re-established
• Antihypertensives drug  – These medications may be prescribed in cases of the hemorrhagic stroke to help lower high blood pressure.
• Antidepressants – a drug for better sleep & Removed anxiety.
• Muscle Relaxant  – to improve muscle tone & avoid spasticity or bed soreness.
• The anti-ulcerate – drug is used to avoid constipation & normalizing the boil movement.
• Diuretics Medications– to reduce swelling in the brain and drugs to treat underlying causes for the stroke, e.g., here. g.t rhythm disorders may also be given.
• Citicoline is a donor of choline in the biosynthesis of choline-containing phosphoglycerides. It has been investigated for the Treatment, supportive care, and diagnosis of Mania, Stroke, hemorrhagic stroke, ischemic stroke, Hypomania, Cocaine Abuse, and Bipolar Disorder, among others.
• Intravenous injection of tissue plasminogen activator (TPA) – Some people can benefit from an injection of a recombinant tissue plasminogen activator (TPA), also called alteplase. An infusion of TPA is usually given through a vein in the arm. This potent clot-busting drug must be given within 4.5 hours after stroke symptoms begin if it’s presented in the vein.
• TPA restores blood  – flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if TPA is appropriate for you.
• Medications are delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver TPA directly into the area where the stroke occurs. The time window for this Treatment is somewhat longer than for intravenous TPA but is still limited.
• Mechanical clot removal. Doctors may use a catheter to maneuver a tiny device into your brain to break up or grab and remove the clot physically. However, recent studies suggest that for most people, delivering medication directly to the brain (intra-arterial thrombolysis) or using a device to break up or remove clots (mechanical thrombectomy) may not be beneficial. Researchers are working to determine who might benefit from this procedure.
• Other procedures. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a course to open up an artery narrowed by fatty deposits (plaques). Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation:
• Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery, and removes plaques that block the carotid artery. Your surgeon then repairs the street with stitches or a patch from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
• Angioplasty and stents. In an angioplasty, a surgeon gains access to your carotid arteries most often through an artery in your groin. Here, they can gently and safely navigate to the carotid arteries in your neck. A balloon is then used to expand the narrowed artery. Then a stent can be inserted to support the opened street. Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. Surgery also may be performed to help reduce future risk.
• Emergency measures. Suppose you take warfarin (Coumadin) or antiplatelet drugs such as clopidogrel (Plavix) to prevent blood clots. In that case, you may be given drugs or transfusions of blood products to counteract the blood thinners’ effects. You may also be given medications to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures. Once the bleeding in your brain stops, Treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a nasty bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain.

In Acute Phases

1. Specialist stroke-unit admission
   Getting someone with a suspected stroke straight into a dedicated stroke ward is itself a treatment: organized units combine rapid imaging, round-the-clock nursing, early rehab input, and protocol-driven medical care, cutting death and disability versus care on a general ward. pubmed.ncbi.nlm.nih.govahajournals.org

2. Intravenous alteplase (rtPA)
   Alteplase is a clot-busting drug given within 4½ h of onset (sometimes after advanced imaging up to 9 h) for ischemic stroke. It lyses fibrin, reopening the blocked artery and roughly triples the chance of walking independently at 3 months, at the cost of a small rise in brain bleed risk. heart.org

3. Intravenous tenecteplase
   A single-bolus thrombolytic, tenecteplase (0.25 mg kg⁻¹, max 25 mg) is now guideline-endorsed as an alteplase alternative and is easier to give in ambulances or rural hospitals. Ongoing trials are testing windows out to 24 h in carefully imaged patients. ahajournals.orgahajournals.org

4. Mechanical thrombectomy
   For large-vessel occlusions in the anterior circulation, stent-retriever or aspiration devices can physically pull the clot out. When started within 6 h—and in selected people up to 24 h—thrombectomy yields the biggest absolute gains of any stroke therapy. ahajournals.org

5. Mobile stroke units
   Specially equipped ambulances with a CT scanner and teleneurologist give pre-hospital imaging, point-of-care labs, and on-scene thrombolysis, shortening door-to-needle times and improving functional outcomes in densely populated areas.

6. Rapid reversal of vitamin K antagonist anticoagulation
   In hemorrhagic stroke or before emergency surgery, four-factor prothrombin complex concentrate plus intravenous vitamin K normalizes the INR within minutes, limiting hematoma expansion.

7. Specific reversal of direct oral anticoagulants
   Idarucizumab binds dabigatran; andexanet alfa inactivates apixaban, rivaroxaban, and related factor Xa inhibitors. Fast reversal reduces case-fatality in DOAC-associated intracerebral hemorrhage.

8. Acute blood-pressure optimization
   In ischemic stroke, permissive hypertension maintains collateral flow; in hemorrhagic stroke, lowering systolic BP toward 140 mmHg slows bleed enlargement without harming perfusion. IV nicardipine or labetalol are typical first-line drugs.

9. Hyperosmolar therapy for brain swelling
   Mannitol bolus or hypertonic saline draws water out of swollen tissue, lowering intracranial pressure and buying time before definitive surgery or natural resolution.

10. Surgical hematoma evacuation
    Minimally invasive plus thrombolytic catheter techniques (MISTIE) or conventional craniotomy can remove mass-effect–producing bleeds, especially in cerebellar or lobar locations where neurological decline is imminent.

11. Decompressive hemicraniectomy
    When malignant middle-cerebral-artery infarction threatens herniation, removing a large skull flap lets the brain swell outward instead of downward, cutting mortality and improving long-term independence, especially in the under-60s. pmc.ncbi.nlm.nih.govahajournals.org

12. External ventricular drain (EVD)
    Intraventricular hemorrhage or obstructive hydrocephalus is relieved by placing an EVD to continuously drain cerebrospinal fluid and monitor pressure.

13. Seizure control and prophylaxis
    Acute cortical strokes can trigger early seizures. Fast-acting IV benzodiazepines treat events; levetiracetam is often chosen for short-term prophylaxis in hemorrhage or large cortical infarcts at high risk.

14. Airway protection and oxygenation
    Intubation for airway reflex loss, plus supplemental oxygen titrated to sat 94-98 %, prevents hypoxia-induced penumbral injury.

15. Strict glycemic management
    Keeping blood glucose 7.8-10 mmol L⁻¹ (140-180 mg dL⁻¹) avoids worsened outcomes linked to stress hyper- or hypoglycemia; IV insulin infusions are protocolized on many stroke units.

16. Short-course dual antiplatelet therapy (DAPT)
    For minor stroke or high-risk TIA, 21-30 days of aspirin plus clopidogrel (or plus ticagrelor when clopidogrel resistance is likely) halves early recurrence without extra serious bleed risk. nejm.orgahajournals.org

17. Long-term single antiplatelet therapy
    After DAPT the patient remains on one agent—usually low-dose aspirin or clopidogrel—indefinitely to prevent platelet aggregation on atherosclerotic plaque or stents.

18. Oral anticoagulation for atrial fibrillation
    Direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) or adjusted-dose warfarin cut cardioembolic stroke risk by ≈65 %. Start after brain imaging excludes large hemorrhagic transformation (timing ranges 3–14 days depending on infarct size).

19. High-intensity statin therapy
    Atorvastatin 40–80 mg or rosuvastatin 20–40 mg lowers LDL-C and exerts plaque-stabilizing, anti-inflammatory effects that reduce recurrent ischemic events regardless of baseline cholesterol.

20. Antihypertensive drug regimen
    ACE inhibitors, angiotensin-receptor blockers, thiazide diuretics, or calcium-channel blockers—alone or combined—target <130/80 mmHg where tolerated, the single strongest modifiable risk factor across stroke subtypes.

21. Comprehensive diabetes control
    Modern regimens pair metformin with SGLT-2 inhibitors or GLP-1 receptor agonists, which also confer cardiovascular benefit. Individualize targets (HbA1c ≈7 %) to balance microvascular protection against hypoglycemia risk.

Chronic Phases

 Pharmacotherapy in this stage is critical for secondary prevention, neurorehabilitation support, and management of comorbidities such as hypertension, hyperlipidemia, and mood disorders. commonly used drugs in the chronic phase of stroke, each described in detail to guide clinicians, patients, and caregivers alike.

1. Aspirin

Aspirin irreversibly inhibits platelet cyclooxygenase-1, reducing thromboxane A₂ production and platelet aggregation. In chronic stroke, low-dose aspirin (75–100 mg once daily) is a cornerstone for secondary prevention of ischemic events. Its benefits include reduced risk of recurrent stroke and myocardial infarction. Common side effects include gastrointestinal irritation, bleeding risk, and, rarely, aspirin-induced asthma. Patients should take aspirin with food to minimize gastric upset and have periodic blood counts to monitor for bleeding tendencies.

2. Clopidogrel

Clopidogrel is a P2Y₁₂-receptor antagonist that prevents ADP-mediated platelet activation. The standard regimen in chronic stroke is 75 mg once daily, often used when patients are intolerant to aspirin or in combination with low-dose aspirin for high-risk individuals. Clopidogrel’s advantages include a modestly lower gastrointestinal bleeding risk compared to dual aspirin therapy. Monitor for rare hematologic side effects such as thrombotic thrombocytopenic purpura and ensure adherence, as missed doses can elevate recurrent stroke risk.

3. Dipyridamole

Dipyridamole inhibits phosphodiesterase and increases cyclic AMP in platelets, complementing aspirin’s actions. The extended-release combination of dipyridamole (200 mg) with aspirin (25 mg) taken twice daily reduces recurrent stroke risk more than aspirin alone. Side effects include headache, dizziness, and gastrointestinal discomfort. Its twice-daily dosing may affect adherence, so patient counseling on the importance of consistent intake is crucial for maximum benefit.

4. Warfarin

Warfarin, a vitamin K antagonist, is indicated in chronic stroke patients with cardioembolic sources such as atrial fibrillation or prosthetic heart valves. Doses are individualized to maintain an INR of 2.0–3.0. Warfarin’s efficacy in reducing embolic stroke risk is well established, but its use demands regular INR monitoring, diet management (consistent vitamin K intake), and vigilance for bleeding complications. Drug–drug interactions (e.g., with antibiotics, antifungals) necessitate comprehensive medication review.

5. Dabigatran

Dabigatran is a direct thrombin inhibitor approved for stroke prevention in non-valvular atrial fibrillation. The chronic-phase dose is typically 150 mg twice daily (or 110 mg twice daily in patients over 75 years or with renal impairment). Compared to warfarin, dabigatran offers predictable pharmacokinetics, fewer dietary interactions, and no routine monitoring. Common side effects include dyspepsia and bleeding; a specific reversal agent (idarucizumab) is available for emergencies.

6. Rivaroxaban

Rivaroxaban, a direct factor Xa inhibitor, is prescribed at 20 mg once daily (15 mg in moderate renal impairment) for stroke prophylaxis in atrial fibrillation. Its once-daily dosing enhances adherence compared to twice-daily agents. Clinical trials have shown rivaroxaban to be noninferior to warfarin in preventing stroke, with a similar or reduced risk of intracranial bleeding. Monitor renal function annually and counsel on adherence, as missed doses can rapidly diminish anticoagulant effect.

7. Apixaban

Apixaban is another direct factor Xa inhibitor, dosed at 5 mg twice daily (2.5 mg twice daily if two of the following are met: age ≥80 years, weight ≤60 kg, or creatinine ≥1.5 mg/dL). It has demonstrated superiority over warfarin in reducing both stroke and major bleeding. Apixaban’s dual-daily regimen may challenge adherence, so scheduling doses with meals or routines can help. Routine laboratory monitoring is not required, but periodic renal and hepatic assessments are advised.

8. Atorvastatin

Atorvastatin, a high-intensity HMG-CoA reductase inhibitor, is recommended at 40–80 mg daily for patients in the chronic phase of stroke to achieve LDL-cholesterol levels below 70 mg/dL. Beyond lipid lowering, atorvastatin stabilizes atherosclerotic plaques and has anti-inflammatory effects. Side effects include myalgias and, rarely, hepatotoxicity. Liver function tests should be checked before initiation and periodically thereafter. Lifestyle counseling on diet and exercise complements statin therapy.

9. Rosuvastatin

Rosuvastatin at 20–40 mg daily is another high-potency statin option for secondary prevention of stroke. It offers robust LDL reduction and potential pleiotropic benefits, such as improved endothelial function. The risk of muscle symptoms and liver enzyme elevations is low but warrants baseline and follow-up monitoring. Patients should report unexplained muscle pain or weakness immediately.

10. Simvastatin

Simvastatin, dosed at 20–40 mg daily, is a moderate-intensity statin suitable for patients with tolerability concerns. It effectively lowers LDL cholesterol but has more drug–drug interactions via CYP3A4 metabolism. Avoid concomitant use with certain antifungals, macrolide antibiotics, or protease inhibitors. Monitor for muscle toxicity and adjust dose based on interacting medications.

11. Pravastatin

Pravastatin (40–80 mg daily) is a hydrophilic statin with fewer hepatic and muscular side effects and minimal cytochrome P450 interactions. It may be preferred in elderly patients or those on multiple medications. Its LDL-lowering efficacy is moderate; additional lipid-lowering agents may be required to reach target goals.

12. Perindopril

Perindopril, an ACE inhibitor, is dosed at 4–8 mg once daily for long-term blood pressure control and vascular protection. In chronic stroke survivors, ACE inhibitors reduce recurrent stroke risk beyond blood pressure lowering by improving endothelial health. Cough and hyperkalemia are potential side effects; monitor electrolytes and kidney function periodically.

13. Lisinopril

Lisinopril at 10–40 mg once daily is another ACE inhibitor widely used in secondary prevention. Its once-daily dosing supports adherence. Similar to perindopril, lisinopril reduces vascular events and has a well-established safety profile. Monitor for cough, angioedema, and renal function changes.

14. Losartan

Losartan (50–100 mg once daily) is an angiotensin II receptor blocker (ARB) that offers stroke recurrence protection comparable to ACE inhibitors but without the cough side effect. It also confers renal benefits in diabetic patients. Monitor potassium and kidney function, particularly in those with baseline renal impairment.

15. Metoprolol

Metoprolol, a β₁-selective blocker, is dosed at 50–200 mg daily (often divided) to control heart rate and blood pressure. In chronic stroke, β-blockers help manage hypertension and reduce cardiac workload, indirectly lowering stroke recurrence risk. Fatigue, bradycardia, and sexual dysfunction are possible side effects; dosage should be titrated carefully.

16. Carvedilol

Carvedilol, a nonselective β-blocker with α₁-blocking activity, is started at 6.25 mg twice daily and titrated to 25 mg twice daily. It aids blood pressure control and offers antioxidant properties beneficial to cerebral vessels. Dose adjustments are needed in heart failure, and clinicians should watch for orthostatic hypotension and weight gain.

17. Nimodipine

Nimodipine, a dihydropyridine calcium channel blocker, is used off-label in chronic stroke mainly for its neuroprotective effects and cerebral vasodilation. The typical dose is 30 mg every four hours for up to 21 days post-subarachnoid hemorrhage; in ischemic stroke recovery some clinicians extend lower doses for weeks. Hypotension and reflex tachycardia are possible, so blood pressure monitoring is essential.

18. Citicoline

Citicoline (CDP-choline) at 500–2,000 mg daily is a neuroprotective agent that supports membrane repair and neurotransmitter synthesis. Clinical trials in chronic stroke suggest benefits in cognitive recovery and functional outcomes. Side effects are rare but may include gastrointestinal discomfort. Its adjunctive use in rehabilitation programs can enhance neuroplasticity.

19. Piracetam

Piracetam, a nootropic agent dosed at 1,200–4,800 mg daily in divided doses, is employed to improve cognitive deficits and facilitate motor recovery. Studies report modest gains in attention and motor coordination. Side effects are minimal but can include agitation and insomnia. Use must be individualized, and patient response closely monitored.

20. Donepezil

Donepezil, an acetylcholinesterase inhibitor used primarily in Alzheimer’s disease, is sometimes prescribed off-label (5–10 mg nightly) for post-stroke cognitive impairment. It can improve attention and executive function by increasing synaptic acetylcholine. Side effects include nausea, diarrhea, and vivid dreams; start at the low end of dosing and titrate cautiously.

21. Memantine

Memantine, an NMDA receptor antagonist dosed at 10 mg twice daily, may benefit chronic stroke patients with moderate to severe cognitive impairment. By reducing excitotoxicity, memantine supports neuronal survival. Common side effects include headache, dizziness, and constipation. Gastrointestinal tolerance is generally good, but ongoing cognitive assessment is necessary.

22. Fluoxetine

Fluoxetine, a selective serotonin reuptake inhibitor (SSRI) at 20 mg daily, has dual roles in chronic stroke: treating post-stroke depression and promoting motor recovery via neuroplasticity enhancement. Studies show improved gait and limb function when combined with physical therapy. Monitor for insomnia, sexual dysfunction, and risk of hyponatremia in the elderly.

23. Sertraline

Sertraline, another SSRI dosed at 50–100 mg daily, is effective for post-stroke depression and anxiety. Some evidence suggests it may enhance rehabilitation outcomes. Side effects include gastrointestinal upset, insomnia, and sexual side effects. Regular mood assessments and monitoring of sodium levels are recommended, especially in older adults.

24. Baclofen

Baclofen, a GABA_B receptor agonist dosed at 5–20 mg three times daily, is used to manage spasticity in chronic stroke survivors. It reduces muscle tone and improves mobility, but can cause drowsiness, weakness, and hypotonia. Intrathecal baclofen pumps are an alternative for refractory spasticity, delivering medication directly to the spinal cord.

25. Tizanidine

Tizanidine, an α₂-adrenergic agonist started at 2 mg every six to eight hours (max 36 mg/day), treats spasticity with fewer anticholinergic effects than other agents. It can cause hypotension, dry mouth, and liver enzyme elevations; periodic liver tests are advised. Dose titration should be gradual due to variable patient sensitivity.

26. Gabapentin

Gabapentin, an anticonvulsant dosed at 300–1,200 mg three times daily, addresses neuropathic pain and central post-stroke pain syndrome. It modulates calcium channels to reduce neuronal hyperexcitability. Side effects include dizziness, somnolence, and weight gain; dosing should start low and increase based on tolerance and pain relief.

7. Pregabalin

Pregabalin (75–150 mg twice daily) offers similar benefits to gabapentin with more predictable pharmacokinetics. Its efficacy in post-stroke neuropathic pain and spasticity management is supported by clinical experience. Monitor for dizziness, peripheral edema, and visual disturbances. Dose adjustments are necessary in renal impairment.

28. Duloxetine

Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI) at 30–60 mg daily, treats chronic pain (including central post-stroke pain) and depression. It enhances descending inhibitory pain pathways and improves mood. Nausea, insomnia, and mild increases in blood pressure can occur; baseline and follow-up assessments of blood pressure are recommended.

29. Alendronate

Alendronate, a bisphosphonate dosed at 70 mg once weekly, helps prevent osteoporosis and fractures in immobile stroke survivors. By inhibiting bone resorption, it preserves bone density. Advise patients to take it on an empty stomach with water and remain upright for at least 30 minutes to reduce esophageal irritation. Monitor bone density periodically and ensure adequate calcium and vitamin D intake.

30. Vitamin D₃ (Cholecalciferol)

Vitamin D₃ supplementation (800–2,000 IU daily) is crucial for bone health, muscle function, and fall prevention in chronic stroke patients. Deficiency is common and contributes to frailty and fracture risk. Vitamin D enhances calcium absorption and neuromuscular coordination. Serum 25-hydroxyvitamin D levels should guide dosing, and periodic monitoring prevents toxicity.

Treatment for Stroke Complications

The 30 agents below are grouped loosely by the complication they address, but many do double duty. Doses are typical adult ranges unless noted; local protocols, renal/hepatic function, and drug interactions always override.

1. Alteplase (recombinant tissue plasminogen activator, rt-PA)

• Role: First-line thrombolytic for eligible ischemic strokes within 4.5 h from onset.

• How it works: Converts plasminogen to plasmin, dissolving fibrin clots.

• Dose: 0.9 mg/kg (max 90 mg); 10 % as bolus, remainder over 60 min.

• Key cautions: Strict blood-pressure control (<185/110 mm Hg before, <180/105 mm Hg after), rule out hemorrhage on CT.

• Adverse effects: Intracranial bleeding (~6 % symptomatic), systemic bleeding, angio-edema in ACE-inhibitor users.

2. Tenecteplase

• Role: Newer, genetically modified rt-PA variant; growing evidence supports one-off bolus use.

• Dose: Single IV bolus 0.25 mg/kg (max 25 mg) in trials.

• Advantages: Faster to give (no infusion pump), more fibrin-specific, possibly less bleeding.

3. Aspirin

• Role: First antiplatelet started 24 h after thrombolysis or immediately if thrombolysis is not given.

• Dose: 160–325 mg once daily for 2–4 weeks, then 75–100 mg daily lifelong.

• Benefit: Reduces early recurrent ischemic stroke and long-term vascular events.

4. Clopidogrel

• Role: Alternative or add-on to aspirin in high-risk transient ischemic attacks (TIAs) or minor stroke; monotherapy in aspirin intolerance.

• Dose: 300–600 mg loading, then 75 mg once daily.

• Note: CYP2C19 poor metabolizers respond less; check gene or choose ticagrelor.

5. Dipyridamole/Aspirin fixed dose (Aggrenox)

• Role: Dual antiplatelet in some guidelines for secondary prevention.

• Dose: 25 mg aspirin + 200 mg extended-release dipyridamole twice daily.

• Side effects: Headache (cerebral vasodilation), GI upset.

6. Ticagrelor

• Role: Rapid-acting antiplatelet for minor stroke/TIA dual therapy with aspirin (21 days), then monotherapy up to 90 days.

• Dose: 180 mg loading, then 90 mg twice daily.

• Pearl: Direct-acting; no reliance on CYP activation—helps when clopidogrel fails.

7. Warfarin

• Role: Long-standing oral anticoagulant for cardio-embolic stroke due to atrial fibrillation, mechanical valves.

• Dose: Titrate to INR 2–3 (2.5–3.5 for valves). Start 4–14 days post-stroke if stable.

• Limitations: Food and drug interactions, INR monitoring, risk of intracranial bleed.

8. Apixaban

• Role: Direct factor Xa inhibitor; preferred in older or renally-impaired patients due to favorable bleeding profile.

• Dose: 5 mg twice daily (2.5 mg BID if age ≥ 80 y, weight ≤ 60 kg, or Cr ≥ 1.5 mg/dL).

• Advantage: Lower intracranial bleed risk than warfarin.

9. Rivaroxaban

• Role: Once-daily Xa inhibitor for non-valvular atrial fibrillation, DVT/PE prevention post-stroke immobility.

• Dose: 20 mg daily with food (15 mg if CrCl 15–49 mL/min).

10. Dabigatran

• Role: Direct thrombin inhibitor; can be reversed quickly, attractive for younger stroke survivors.

• Dose: 150 mg twice daily (110 mg BID if ≥ 80 y or high bleed risk).

• Reversal: Idarucizumab (see drug 11).

11. Idarucizumab

• Role: Monoclonal antidote that binds dabigatran with 350× affinity—life-saving in hemorrhagic conversion.

• Dose: 5 g IV (two 2.5 g vials) over 10 min.

• Onset: Within minutes; restores clotting.

12. Andexanet alfa

• Role: Reversal agent for rivaroxaban and apixaban during life-threatening bleed.

• Dose: 400–800 mg IV bolus then 4–8 mg/min infusion for 2 h, guided by last Xa-inhibitor dose/time.

• Caveat: Limited availability and high cost.

Blood-pressure control and vasospasm

13. Labetalol

• Role: IV beta-blocker with alpha action; titratable control of acute severe hypertension before/after thrombolysis.

• Dose: 10–20 mg IV over 1–2 min, may repeat or infuse 2 mg/min (max 300 mg).

• Why: Smooth, predictable fall in BP without raising intracranial pressure (ICP).

14. Nicardipine

• Role: Dihydropyridine calcium-channel blocker infusion for continuous BP modulation.

• Dose: Start 5 mg/h; increase by 2.5 mg/h every 5 min to 15 mg/h max.

• Perk: Short half-life—adjust rapidly if BP lowers too far.

15. Hydralazine

• Role: Arteriolar vasodilator used intermittently when beta-blockers contraindicated.

• Dose: 5–20 mg IV every 20 min as needed.

• Watch for: Reflex tachycardia, headache—may raise ICP, so monitor.

16. Nimodipine

• Role: Oral calcium-channel blocker uniquely indicated to prevent cerebral vasospasm after aneurysmal subarachnoid hemorrhage—a hemorrhagic stroke subtype.

• Dose: 60 mg orally every 4 h for 21 days.

• Outcome: Improves neurological recovery even though BP drop is modest.

Limiting cerebral edema

17. Mannitol

• Role: Osmotic diuretic for malignant cerebral edema or herniation syndrome.

• Dose: 0.25–1 g/kg IV over 20 min; may repeat every 4–6 h with serum osmolality goal < 320 mOsm/kg.

• Effect: Draws water from brain into blood, reducing ICP within minutes.

18. Hypertonic saline (3 % or 23.4 %)

• Role: Alternative or add-on to mannitol when hypotension or renal injury preclude diuresis.

• Dose: 3 % saline infusion 30–50 mL/h or 23.4 % 30 mL bolus over 10 min for impending herniation.

• Monitor: Serum sodium (target 145–155 mEq/L), central line for ≥ 3 %.

Post-stroke seizures

19. Levetiracetam

• Role: First-choice anti-seizure medication (ASM) for early-onset post-stroke seizures because of minimal interactions.

• Dose: 500 mg IV/PO twice daily; titrate to 1 000–1 500 mg BID.

• Side effects: Fatigue, irritability but no respiratory depression.

20. Phenytoin

• Role: Legacy ASM for acute seizure control when IV load needed.

• Dose: 15–20 mg/kg IV loading (< 50 mg/min), then 100 mg PO/IV every 8 h.

• Concerns: Arrhythmias during rapid push, gingival overgrowth, CYP interactions.

Spasticity and motor stiffness

21. Baclofen

• Role: GABA-B agonist that inhibits spinal reflexes causing flexor/extensor spasms.

• Dose: Start 5 mg orally three times daily; titrate to 20 mg TID. Intrathecal pumps for severe cases (test dose 50 mcg).

• Watch: Sedation, confusion; taper slowly to avoid withdrawal seizures.

22. Tizanidine

• Role: Alpha-2 adrenergic agonist diminishing polysynaptic spinal transmission.

• Dose: 2 mg at bedtime, uptitrate by 2–4 mg to 8 mg TID as tolerated.

• Pearl: Less muscle weakness than baclofen but can cause hypotension, dry mouth, LFT elevation.

23. Botulinum toxin type A

• Role: Focal chemodenervation for disabling spasticity affecting hand, ankle, or shoulder.

• Dose: 100–400 units injected into target muscles every 3 months.

• Benefit: Reduces tone, pain, and improves limb positioning without systemic sedation.

Post-stroke depression and emotional lability

24. Sertraline

• Role: SSRI with largest evidence base in stroke survivors for mood and possible motor recovery.

• Dose: 25 mg daily for 1 week, then 50 mg daily (max 200 mg).

• Advantages: Few cardiovascular effects, safe in elderly.

25. Fluoxetine

• Role: Another SSRI historically linked to improved motor outcome in small studies, though larger trials mixed.

• Dose: 20 mg once daily.

• Caution: Hyponatremia, GI bleed in antiplatelet users—monitor sodium, consider PPI.

Lipid lowering for secondary prevention

26. Atorvastatin

• Role: High-intensity statin recommended for all atherosclerotic ischemic strokes, irrespective of baseline LDL.

• Dose: 40–80 mg nightly.

• Effect: 16 % relative risk reduction in recurrent stroke; pleiotropic anti-inflammatory benefits.

27. Rosuvastatin

• Role: Alternative potent statin; may better lower triglycerides and raise HDL.

• Dose: 20–40 mg nightly (5–10 mg in Asians or CKD).

• Monitor: LFTs, CK if myalgia.

Neuroprotection and recovery enhancers (adjuncts)

28. Edaravone

• Role: Free-radical scavenger approved in Japan and parts of Asia for acute ischemic stroke within 24 h.

• Dose: 30 mg IV twice daily for 14 days.

• Data: Meta-analyses suggest modest functional improvement; minimal side effects aside from rare renal issues.

29. Citicoline (CDP-choline)

• Role: Nucleotide precursor thought to stabilize neuronal membranes and boost acetylcholine; used widely as OTC or prescription adjunct.

• Dose: 500–1 000 mg PO/IV twice daily for 6 weeks or longer.

• Evidence: Safe; mixed efficacy, but some trials show improved cognitive and motor scores.

Infection prophylaxis and systemic safety

30. Ceftriaxone

• Role: Broad-spectrum third-generation cephalosporin studied for post-stroke neuroprotection and to prevent aspiration pneumonia—one of the leading deadly complications.

• Dose: 1–2 g IV once daily for 5–7 days in high-risk dysphagic patients (local antibiogram governs).

• Note: Over-use breeds resistance; best reserved for patients with confirmed aspiration or immunosuppression.

Surgery

• Surgical blood vessel repair – Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM), or another type of vascular malformation caused your hemorrhagic stroke:
• Surgical clipping – A surgeon places a tiny clamp at the base of an aneurysm to stop blood flow to it. This clamp can keep an aneurysm from bursting or prevent re-bleeding of an aneurysm that has recently hemorrhaged.
• Coiling (endovascular embolization) – In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon recommends tiny detachable coils into the aneurysm (aneurysm coiling). The waves fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.
• Surgical AVM removal – Surgeons may remove a smaller AVM if it’s located in an accessible area of your brain to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM if its removal would cause too significant a reduction in brain function or if it’s large or located deep within your brain.
• Intracranial bypass – In some unique circumstances, surgical bypass of intracranial blood vessels may be an option to treat poor blood flow to a region of the brain or complex vascular lesions, such as aneurysm repair.
• Stereotactic radiosurgery – Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced, minimally invasive treatment used to repair vascular malformations.
• Thrombectomy –  A small proportion of severe ischaemic strokes can be treated by an emergency procedure known as thrombectomy. This removes blood clots and helps restore blood flow to the brain. Thrombectomy is only effective at treating ischaemic strokes caused by a blood clot in a large artery in the brain. It’s most effective when started as soon as possible after a stroke. The procedure involves inserting a catheter into an artery, often in the groin. A small device is passed through the catheter into the street in the brain. The blood clot can then be removed using the device or through suction. The procedure can be carried out under local or general anesthetic.

Non Pharmacological Treatment

51. Speech Therapy

If a stroke damages a person’s ability to use language and speak or swallow, rehabilitation with a speech therapist can help them regain some or most of the powers they initially lost with the stroke. For those with severe damage, restoration can provide methods and skills to help a person adapt and compensate for severe damage.

Physiotherapy Treatment

Treatment of hemiplegia requires the coordination of several health professionals. A physiotherapist, occupational therapist, a physician, a surgeon, and support from family, etc.

• Treatment is focused on finding the causative factor and checking its further progression. Secondly, after a few days, rehabilitation therapy helps to minimize disability.
• Several medicines are prescribed to control the primary cause such as antihypertensive, anti-thrombolytic agents to dissolve the clot, drugs to control cerebral edema, etc.
• Intensive physical therapy is begun after a few days. Activities such as walking and standing are done repeatedly under the guidance of a physiotherapist. It helps to improve the muscular functions which have become rigid. It is aimed to make the patient self-sufficient to perform his daily activities.
• The patient is taught to move his affected arm with his strong arm. With exercise, it is possible to maintain joints’ flexibility and prevent tightening and shortening of muscles. Speech therapy is simultaneously begun to improve communication and speaking skills.

• Speech therapy – to improve communication
• Occupational therapy improves daily functions such as eating, cooking, toileting, and washing.

Recovery can take months, and it may be several days or weeks after the stroke before doctors can accurately predict recovery.

Occupational therapy

Occupational therapy Occupational Therapists may specifically help with hemiplegia with tasks such as improving hand function, strengthening hand, shoulder, and torso, and participating in activities of daily living (ADLs), such as eating and dressing. Therapists may also recommend a hand splint for active use or stretching at night. Some therapists make the splint; others may measure your child’s hand and order a sling. OTs educate patients and families on compensatory techniques to continue participating in daily living, fostering independence for the individual – which may include environmental modification, use of adaptive equipment, sensory integration, etc.

Rehabilitation & Therapy for Hemiplegia

1. Improving motor control

  a.Neurofacilitatory Techniques

• In Stroke Physical Therapy, these therapeutic interventions use sensory stimuli (e.g., quick stretch, brushing, reflex stimulation, and associated reactions) based on neurological theories to facilitate movement in patients following stroke (Duncan,1997). The following are the different approaches: –

i.Bobath

• Berta & Karel Bobath’s approach focuses on controlling responses from the damaged postural reflex mechanism. Emphasis is placed on affected inputs facilitation and standard movement patterns (Bobath, 1990).

ii. Brunnstrom

• Brunnstrom’s approach is one form of neurological exercise therapy in the rehabilitation of stroke patients. The relative effectiveness of Neuro-developmental Treatment (NDT) versus the Brunnstrom method was studied by Wagenaar and colleagues (1990) from the perspective of the functional recovery of stroke patients. This study showed no apparent differences in the effectiveness of the two methods within the framework of active recovery.

iii. Rood

• Emphasize the use of activities in developmental sequences, sensation stimulation, and muscle work classification. Cutaneous stimuli such as icing, tapping, and brushing are employed to facilitate activities.

iv. Proprioceptive neuromuscular facilitation (PNF)

• Developed by Knott and Voss, they advocated the use of peripheral inputs as stretch and resisted movement to reinforce existing motor responses. Total activity patterns are used in the Treatment and followed in a developmental sequence.
• It was shown that the commutative effect of PNF is beneficial to stroke patients (Wong, 1994). Comparing the effectiveness of PNF, the Bobath approach, and traditional exercise, Dickstein et al. (1986)demonstrated that no one system is superior to the rest of the others (AHCPR, 1995).

b. Learning theory approach

i. Conductive education

• In Stroke Physical Therapy, Conductive education is one of the methods in treating neurological conditions including hemiplegic patients. Cotton and Kinsman (1984) demonstrated a neuropsychological approach using the concept of CE for adult hemiplegia. The patient is taught how to guide his movements towards each task-part of the task by using his speech – rhythmical intention.

ii. Motor relearning theory

• Carr & Shepherd, both Australian physiotherapists, developed this approach in 1980. It emphasizes the practice of functional tasks and the importance of relearning real-life activities for patients. Principles of learning and biomechanical analysis of movements and tasks are important. (Carr and Shepherd, 1987)
• No evidence adequately supports the superiority of one type of exercise approach over another. However, the therapeutic process aims to increase physical independence and facilitate the motor control of skill acquisition. Substantial evidence supports the effect of rehabilitation in terms of improved functional independence and reduced mortality.

c. Functional electrical stimulation (FES)

• FES is a modality that applies a short burst of electrical current to the hemiplegic muscle or nerve. In Stroke Physical Therapy, FES has been demonstrated to be beneficial for restoring motor control and spasticity and reducing hemiplegic shoulder pain and subluxation.
• It is concluded that FES can enhance acute stroke patients’ upper extremity motor recovery (Chae et al., 1998; Faghri et al., 1994; Francisco, 1998). Alfieri (1982) and Levin et al. (1992) suggested that FES could reduce spasticity in a stroke patient. A recent randomized controlled trial study meta-analysis showed that FES improves motor strength (Glanz 1996). A study by Faghri et al. (1994) has identified that FES can significantly improve arm function, electromyographic activity of the posterior deltoid, the range of motion, and reduced severity of subluxation and pain of the hemiplegic shoulder.

d. Biofeedback

• Biofeedback is a modality that facilitates the cognizance of electromyographic activity in selected muscles or awareness of joint position sense via visual or auditory cues. In Stroke Physical Therapy, the result of studies in biofeedback is controversial.
• A meta-analysis of 8 randomized controlled trials of biofeedback therapy demonstrated that electromyographic biofeedback could improve motor function in stroke patients (Schleenbaker, 1993). Another meta-analysis study on EMG has shown that EMG biofeedback is superior to conventional therapy alone for improving ankle dorsiflexion muscle strength (Moreland et al., 1998. Erbil and coworkers (1996) showed that biofeedback could improve earlier postural control to improve impaired sitting balance.
• A conflicting meta-analysis study by Glanz et al. (1995) showed that biofeedback was not efficacious in improving the range of motion in the ankle and shoulder in a stroke patient. Moreland (1994) conducted another meta-analysis and concluded that EMG biofeedback alone or with conventional therapy did not provide superior to traditional physical therapy in improving upper- extremity function in an adult stroke patient.

2. Hemiplegic shoulder management

• Shoulder subluxation and pain of the affected arm are not uncommon in at least 30% of all patients after stroke (RCP, 1998), whereas subluxation is found in 80% of stroke patients (Najenson et al., 1971). It is associated with the severity of disability and is common in patients in a rehabilitation setting. Suggested interventions are as follows:

a. Exercise

• Active weight-bearing exercise can be used to improve motor control of the affected arm; introduce and grade tactile, proprioceptive, and kinesthetic stimulation; and prevent edema and pain. In Stroke Physical Therapy, Upper extremity weight bearing can be used to lengthen or inhibit tight or spastic muscles while simultaneously facilitating muscles that are not active (Donatelli, 1991). According to Robert (1992), the amount of shoulder pain in hemiplegia was related most to loss of motion. He advocated providing ROM exercise (caution to avoid improvement) as Treatment as early as possible.

b. Functional electrical stimulation

• Functional electrical stimulation (FES) is an increasingly popular treatment for hemiplegic stroke patients. It has been applied in stroke physical therapy for the Treatment of shoulder subluxation (Faghri et al.,1994), spasticity (Stefanovska et al., 1991), and functionally for the restoration of function in the upper and lower limb (Kralji et al., 1993). In Stroke Physical Therapy, Electrical stimulation effectively reduces pain and severity of the subluxation and possibly facilitates recovery of arm function (Faghri et al., 1994; Linn et al., 1999).

c. Positioning & proper handling

• In Stroke Physical Therapy, proper Positioning and handling of the hemiplegic shoulder, whenever in bed, sitting and standing, or during lifting, can prevent shoulder injury is recommended in the AHCPR & SIGN guidelines for stroke rehabilitation. In Stroke Physical Therapy, Positioning can be therapeutic for tone control and neuro-facilitation of stroke patients (Davies, 1991). Braus et al. 94 found shoulder-hand syndrome reduced from 27% to 8% by the instruction to everyone, including family, on handling techniques.

d. Neuro-facilitation

e. Passive limb physiotherapy

• Maintenance of a full pain-free range of movement without traumatizing the joint and the structures can be carried out. In Stroke Physical Therapy, at no time should pain in or around the shoulder joint be produced during Treatment. (Davies, 1991).

f. Pain relief physiotherapy

• Passive mobilization as described by Maitland can help gain relief from pain and range of movement (Davies, 1991). In Stroke Physical Therapy, other treatment modalities, such as thermal, electrical, cryotherapy, etc., can be applied for shoulder pain musculoskeletal in nature.

g. Reciprocal pulley

• The reciprocal pulley appears to increase the risk of shoulder pain in stroke patients. It is not related to the presence of subluxation or to muscle strength. (Kumar et al., 1990)

h. Sling

• In Stroke Physical Therapy, the use of the sling is controversial. No shoulder support will correct a glenohumeral joint subluxation. However, it may prevent the flabby arm from hanging against the body during functional activities, thus decreasing shoulder joint pain. They also help to relieve downward traction on the shoulder capsule caused by the arm’s weight (Hurd, Farrell, and Waylonis, 1974; Donatelli,1991).

3. Limb physiotherapy

• Limb physiotherapy/Stroke Physical Therapy includes passive, assisted-active, and active range-of-motion exercise for the hemiplegic limbs. This can be effective management for preventing limb contractures and spasticity and is recommended within AHCPR (1995). Self-assisted limb exercise reduces spasticity and shoulder protection (Davis, 1991). Adams and coworkers (1994) recommended passive full-range-of-motion practice for paralyzed limbs for potential reduction of complications for stroke patients

4. Chest physiotherapy

• In Stroke Physical Therapy, evidence shows that cough and forced expiratory technique (FET) can eliminate induced radio aerosol particles in the lung field. Directed coughing and FET can be used for bronchial hygiene clearance in a stroke patient.

5. Positioning

• In Stroke, Physical Therapy’s consistent “reflex-inhibitory” patterns of posture in resting is encouraged to discourage physical complication of stroke and to improve recovery (Bobath, 1990).
• Meanwhile, therapeutic Positioning is a widely advocated strategy to discourage the development of abnormal tone, contractures, pain, and respiratory complications. It is essential in maximizing the patient’s functional gains and quality of life.

6. Tone management

• A goal of Stroke Physical Therapy interventions has been to “normalize tone to normalize movement.” Therapy modalities for reducing tone include stretching, prolonged stretching, passive manipulation by therapists, weight-bearing, ice, contraction of muscles antagonistic to spastic muscles, splinting, and casting.
• The inadequacies of methods have hampered research on tone-reducing techniques to measure spasticity (Knutsson and Martensson, 1980) and the uncertainty about the relationship between spasticity and volitional motor control (Knutsson and Martensson, 1980; Sahrmann and Norton, 1977).
• The manual stretch of finger muscles, pressure splints, and dantrolene sodium do not produce apparent long-term improvement in motor control (Carey, 1990; Katrak, Cole, Poulus, and McCauley, 1992; Poole, Whitney, Hangeland, and Baker, 1990). Dorsal resting hand splints reduced spasticity more than volar splints. Still, the effect on motor control is uncertain (Charait, 1968), while TENS stimulation showed improvement for chronic spasticity of lower extremities (Hui-Chan and Levin, 1992).

7. Sensory re-education

• Bobath and other therapy approaches recommend using sensory stimulation to promote sensory recovery of stroke patients.

8. Balance retraining

• Re-establishment of balance function in patients following stroke has been advocated as an essential component in the practice of stroke physical therapy (Nichols, 1997). Some studies of patients with hemiparesis revealed that these patients have a tremendous amount of postural sway, the asymmetry with greater weight on the non-paretic leg, and a decreased ability to move within a weight-bearing posture (Dickstein, Nissan, Pillar, and Scheer, 1984; Horak, Esselman, Anderson, and Lynch, 1984). Meanwhile, research has demonstrated moderate relationships between balance function and parameters such as gait speed, independence, wheelchair mobility, reaching, as well as dressing (Dickstein et al., 1984; Horak et al., 1984; Bohannon, 1987; Fishman, Nichols, Colby, and Sachs, 1996; Liston and Brouwer, 1996; Nichols, Miller, Colby and Pease, 1996). Some tenable support on the effectiveness of Treatment of disturbed balance can be found in studies comparing the effects of balance retraining plus physiotherapy treatment and physiotherapy treatment alone.

9. Fall prevention

• In Stroke Physical Therapy, falls are one of the most frequent complications( Dromerick and Reading, 1994), and the consequences are likely to affect the rehabilitation process and its outcome negatively. According to the systematic review of the Cochrane Library (1999), which evaluated the effectiveness of several fall prevention interventions in the elderly, there was significant protection against falling from interventions that targeted multiple identified risk factors in individual patients. The same is true for interventions that focus on behavioral interventions targeting environmental hazards plus other risk factors

10. Gait re-education

• Recovery of independent mobility is a fundamental goal for the immobile patient, and much therapy is devoted to gait-reeducation. Bobath assumes abnormal postural reflex activity is caused by dysfunction, so gait training involves tone normalization and preparatory activity for gait activity.
• In contrast, Carr and Shepherd advocate task-related training with methods to increase strength, coordination, and flexible MS system to develop skills in walking, while Treadmill training is combined with a suspension tube. Some patients’ body weight can be effective in regaining walking ability when used as an adjunct to conventional therapy three months after active training (Visintin et al., 1998; Wall and Tunbal, 1987; Richards et al., 1993).

11. Functional Mobility Training

• To handle the functional limitations of stroke patients, available tasks are taught to them based on movement analysis principles. In Stroke Physical Therapy these tasks include bridging, rolling to sit to stand and vice versa, transfer skills, walking and staring, etc. (Mak et al., 2000).
• Published studies report that many patients improve during rehabilitation. The most substantial evidence of benefit is from studies that have enrolled patients with chronic deficits or have included a no-treatment control group (Wade et al., 1992; Smith and Ashburn et al., 1981).
• Meanwhile, early mobilization helps prevent compilations, e.g., DVT, skin breakdown contracture, and pneumonia. Evidence has shown better orthostatic tolerance (Asberg, 1989) and earlier ambulation (Hayes and Carroll, 1986).

12. Upper limb training

• By three months poststroke, approximately 37% of the individuals continue to have decreased upper extremities (UE) function. Recovery of UE function lags behind that of the lower extremities because of the more complex motor skill required of the UE in daily life tasks. That means many individuals who have a stroke are at risk for lowered quality of life.
• Many approaches to the physical rehabilitation of adults post-stroke exist that attempt to maximize motor skill recovery. However, the literature does not support the efficacy of any single system. The followings are the current approaches to motor rehabilitation of the UE.

a. Facilitation models

• They are the most common intervention methods for deficits in UE motor skills, including Bobath, proprioceptive neuromuscular facilitation, Brunnstrom’s movement therapy, and Rood’s sensorimotor approach. There is some evidence that practice based on the facilitation models can result in improved motor control of UE ( Dickstein et al.,1986, Grade A; Wagenaar et al., 1990 ). However, intervention based on the facilitation models has not been effective in restoring the fine hand coordination required to perform actions ( Kraft, Fitts & Hammond, 1992; Butefisch et al., 1995 ).

b. Functional electric stimulation

• In Stroke Physical Therapy, Functional electric stimulation (FES) can be effective in increasing the electric activity of muscles or increasing the dynamic range of motion in individuals with stroke ( Dimitrijevic et al., 1996; Fields, 1987; Faghri et al., 1994, Kraft, Fitts and Hammond, 1992 ). Some evidence shows that FES might be more effective than facilitation approaches ( Bowman, Baker, and Waters, 1979; Hummelsheim, Maier-Loth, and Eickhof, 1997 ).

c. Electromyographic biofeedback

• In Stroke Physical Therapy, biofeedback can contribute to improvements in motor control at the neuromuscular and movement levels ( Kraft, Fitts and Hammond, 1992; Moreland and Thomson, 1994; Wissel et al., 1989; Wolf and Binder-MacLoed, 1983; Wolf, LeCraw and Barton,1989; Wolf et al., 1994 ). Some studies have shown improvements in the ability to perform actions post-test after biofeedback training ( Wissel et al.,1989; Wolf and Binder-MacLoed, 1983; Moreland and Thomson, 1994). However, the ability to generalize and incorporate these skills into daily life is not measured.

d. Constraint-induced therapy

• Constraint-Induced (CI) therapy was designed to overcome the learned nonuse of the affected UE. In the most extreme form of CI therapy, individuals post-stroke are prevented from using the less affected UE by keeping it in a splint and sling for at least 90% of their waking hours. Studies have found that the most extreme of CI therapy can effect rapid improvement in UE motor skills ( Nudo et al., 1996; Taub and Wolf, 1997; Taub et al., 1993; Wolf et al., 1989 ), and that is retained for at least as long as two years ( Taub and Wolf, 1997 ). However, CI therapy is currently effective only in those with distal voluntary movement ( Taub and Wolf, 1997 ).

13. Mobility appliances and equipment

• Small changes in an individual’s local ‘environment’ can significantly increase the independent use of a wheelchair or walking stick. However, little research has been done on these ‘treatments’. It is acknowledged that walking aids and mobility appliances may benefit selected patients.
• Tyson and Ashburn (1994) showed that walking aids affected poor walkers – a beneficial effect on gait (Level of evidence = III, Recommendation = Grade B). Lu and coworkers (1997) concluded that the wrist crease stick is better than the stick measured to the greater trochanter. (Level of evidence = IIb, Recommendation = Grade A

14. Acupuncture 

• The World Health Organisation (WHO) has listed acupuncture as a possible treatment for paresis after stroke. Studies have sown its beneficial effects in stroke rehabilitation.
• Chen et al. (1990) performed a controlled clinical trial of acupuncture on 108 stroke patients. They stated that the total effective rate of increasing average muscle power by at least one grade was 83.3% in the acupuncture group compared with the control group, which was 63.4% (p<0.05).
• Hua et al. (1993) reported a significant difference in changes in the neurological score between the acupuncture group and the control group after four weeks of Treatment in an RCT, and no adverse effects were observed in patients treated with acupuncture.

15. Vasomotor training 

• Early muscle pump stimulation can reduce venous stasis and enhance the body’s general circulation. It then hastens the recovery process.

16. Edema management

• The use of intermittent pneumatic pumps, elastic stockings, or bandages and massage can facilitate the venous return of the oedematous limbs. Therefore, the elasticity and flexibility of the musculoskeletal system can be maintained and enhance the recovery process and prevent complications like pressure ulcers.

17. Acupuncture

• Acupuncture is an alternative therapy that people have used for centuries. Although stroke patients in the US rarely utilize it, it is an accepted practice among stroke sufferers in some countries, including China. This therapy is considered to boost the blood flow to the parts that do not have features.
• This is why it is often utilized in paralysis, where the blood flow increases, helping to bring the muscles to function. Acupuncture is widely used in cases of language issues and balance troubles. Although some researchers have stated that acupuncture is beneficial and effective, often, these studies are skewed or small.

18. Talk Therapy

• Some people have problems coping with their new disabilities after a stroke. It is common for people to have emotional reactions after a stroke.
• A psychologist or other mental health professional can help people adjust to new challenges and situations. These professionals use talk therapy and other methods to help people with reactions such as depression, fear, worries, grief, and anger.

19. Lifestyle

• The methods previously discussed that may prevent or decrease a person’s stroke risk are essentially the same for people who have had a stroke (or TIA) and want to avoid or reduce their chances of having another stroke.
• In summary, quit smoking, exercise, and if obese, lose weight. Limit alcohol, salt, and fat intake and eat more vegetables, fruits, whole grains, and more fish and less meat.

Prescribed Medications and Side Effects

Medications are usually prescribed for people with a high risk of stroke. The medicines are designed to lower risk by inhibiting clot formation (aspirin, warfarin, and other antiplatelet drugs). Also, antihypertensive medications can help by reducing high blood pressure. Medications have side effects so discuss these with your doctor.

Preventing Another Stroke: Surgery

There are some surgical options for stroke prevention. Some patients have plaque-narrowed carotid arteries. The plaque can participate in clot formation on the highway and even shed clots to other areas in the brain’s blood vessels. Carotid endarterectomy is a surgical procedure where the surgeon removes plaque from the inside of the arteries to reduce the chance of strokes in the future.

Preventing Another Stroke: Balloon and Stent

Some clinicians also treat plaque-narrowed carotid (and occasionally other brain arteries) with a balloon on the end of a narrow catheter. Inflating the balloon pushes plaque aside and increases the vessel’s lumen (opens up the ship). This opened artery is then reinforced (kept open) by an expandable stent that becomes rigid when expanded.

Life After a Stroke

About two-thirds of people (over 700,000) that have a stroke each year survive and usually need some rehabilitation. Some who get clot-busting drugs may recover completely, and others will not. Many people with disabilities after a stroke can function independently with therapy and rehabilitation methods. Although the risk of having a second stroke is higher after the first stroke, individuals can take the steps outlined in previous slides to reduce this risk.

MANAGING STROKE COMPLICATIONS

Ataxia, Gait Disturbance, and Falls

• Mobilize patients within 24 hours, provided that they are alert and hemodynamically stable. Rehabilitation includes lower limb strength training to increase walking distance after stroke. Gait and standing post-stroke are improved with gait retraining (including task-specific), balance training, electromyography (EMG)-biofeedback training, and functional electrical stimulation.

Deterixcity

• Refer patients with upper limb weakness or decreased coordination for physical and occupational therapy. Mental practice is associated with improved motor performance and activities of daily living performance.

Cognitive Dysfunction

• Compensatory strategies (e.g., reminders, day planners) improve memory outcomes. Consider referral of patients with cognitive deficits for neuropsychological assessment or an OT trained in the cognitive evaluation. Also, consider referral to driving simulation training or assessment programs.

Neglect: Visual scanning techniques and limb activation therapies improve neglect. Consider referral of patients with chemosensory neglect for perceptual retraining by an OT and neuropsychologist.

Dysarthria and Dysphasia

• Consider referral of patients with impaired speech for assessment and training. Intensive speech and language therapy in the acute phase, especially with severely aphasic patients, showed significant improvement in language outcomes.

Hemianopsia

• Consider ophthalmologist referral regarding optical prisms for patients with homonymous hemianopsia as this improves visual perception scores.

Community Re-Integration

• Referral to community-based support services is associated with increased social activity. Education and information also have a positive benefits.
• Maintain Adequate Delivery of oxygen is essential to maintaining oxygen levels. In some cases, airway ventilation may be required. Supplemental oxygen may also be necessary for patients when tests suggest low blood levels of oxygen.
• Manage Fever – Fever should be monitored and aggressively treated with medication since its presence predicts a poorer outlook.
• Evaluate Swallowing – Patients should have their swallowing function evaluated before giving any food, fluid, or medication by mouth. If patients cannot adequately swallow, they are at risk of choking. Patients who cannot eat on their own may require nutrition and fluids delivered intravenously or through a tube placed in the nose.
• Maintain Electrolytes – Maintaining a healthy electrolyte balance (the ratio of sodium, calcium, and potassium in the body” s fluids) is critical.
• Control Blood Pressure – Managing blood pressure is essential and complicated. Blood pressure often declines spontaneously in the first 24 hours after stroke. Patients whose blood pressure remains elevated should be treated with antihypertensive medications.
• Monitor Increased Brain Pressure – Hospital staff should observe for evidence of increased pressure on the brain (cerebral edema), a frequent complication of hemorrhagic strokes. It can also occur a few days after ischemic strokes. Early symptoms of increased brain pressure are drowsiness, confusion, lethargy, weakness, and headache. Medications such as mannitol may be given during a stroke to reduce anxiety or its risk. Keeping the top of the body higher than the lower part, such as by elevating the head of the bed, can decrease pressure in the brain and is standard practice for patients with ischemic stroke. However, this practice also lowers blood pressure, which may be dangerous for patients with a massive stroke.
• Monitor the Heart – Patients must be monitored using electrocardiographic tracings to check for atrial fibrillation and other heart rhythm problems. Patients are at high risk for heart attack following stroke.
• Control Blood Sugar (Glucose) Levels – Elevated blood sugar (glucose) levels can occur with severe stroke and may be a marker of serious trouble. Patients with high blood glucose levels may require insulin therapy.
• Monitor Blood Coagulation – Regular blood coagulation tests are essential to ensure that the blood is not so thick that it will clot nor so thin that it causes bleeding.
• Check for Deep Venous Thrombosis – Deep venous thrombosis is a blood clot in the lower leg or thigh veins. It can be a severe post-stroke complication because there is a risk of the clot breaking off and traveling to the brain or heart. Deep venous thrombosis can also cause a pulmonary embolism if the blood clot travels to the lungs. If necessary, an anticoagulant drug such as heparin may be given, increasing the bleeding risk. Patients who have had a stroke are also at risk for pulmonary embolisms.
• Prevent Infection – Patients with a stroke are at increased risk for pneumonia, urinary tract infections, and other widespread infections.

Home Treatments of Stroke

Changing Your Diet

This is the first one on the list of the most effective tips on treating stroke naturally at home within a short period that we would like to introduce in the article, and everyone should make use as soon as possible.

Eating Ginkgo Biloba

Ginkgo biloba is used to treat stroke. It aids in preventing the blood clots from growing and increases the bloodstream to the brain. The herb has been proven to inhibit free-radical formation.

This herb is used widely in Europe to treat complications of stroke containing balance and memory problems, vertigo as well as disturbed thought processes

Eating Turmeric

Turmeric is one of the home remedies for treating stroke that you and my other readers should know and use for good. Many studies say that turmeric’s compound curcumin can reduce blood clots’ formation. Turmeric is a critical ingredient in cooking and may be found in most curry spice blends. You should consider eating more curry dishes to reduce and treat your stroke.

 Eating Ginger

Ginger is a cardiac tonic because it can treat stroke, decrease cholesterol levels, aid poor circulation, and prevent excessive blood clots. Taking 2 tsp of ginger daily for about seven days can neutralize the blood clotting effects of 100 mg of butter. You can take advantage of ginger in your cooking or take ginger tea by using 1-2 tsp of freshly grated ginger root per cup of hot water. Steep it until cool. Besides, you can also add ginger to salads. Continue reading this entire article to discover other home remedies for stroke that you can follow easily at home. In brief, this is also one of the most valuable tips on treating stroke naturally and fast at home that people should not look down on, yet try using right from today to be free from this stubborn and severe health issue!

 Eating Carrot

In a study, consumption of carrots can reduce the risk of stroke. Women who eat 5 servings of carrots per week suffer 68% fewer stresses than those who eat carrots less than 2 times a month. Carrots are high in beta-carotene and other essential carotenoids. So, eat more carrots to see how to treat stroke naturally. They are great as snacks, especially the baby carrots. Add them to vegetable soups or make carrot juice. In case you want to do better, add some pieces of garlic and ginger with zest.

Using Pigweed

Some experts think that pigweed can prevent stroke as it can reduce the risk of heart attack, while there are biological similarities between heart attack and ischemic strokes. Pigweed is a great plant source of calcium. Use young leaves in salads or steam more mature leaves.

 Using Apple Cider Vinegar

It is helpful to stroke problems in a lot of ways. It is a natural purifier and detoxifier, so its functions are to cleanse the blood of any toxins that can contribute to the stroke problem. This vinegar also helps thin the blood, making it more accessible throughout the body.

Taking  easierVitamin C

It is a natural antioxidant. This vitamin can eliminate free radicals that contribute to the condition. Besides, the vitamin also aids the immune function and replenishment of tissues. As you know, stroke can be risky. Still, it is a condition that can be scanned. With the proper nutritional supplements and treatment considerations, people can experience a nearly complete recovery from this condition.

Using Coconut Oil

Coconut oil is high in medium fatty acids. These fats function to boost nutrient absorption, which contributes to improving recovery. The unique composition of this oil also promotes neutral passageways to facilitate brain functioning and healing. This is also a great natural ingredient, and the use of it is also among the best tips on how to treat stroke naturally at home without requiring any drugs, pills, or medical interventions, so people should try making use of it as soon as possible to achieve the best result as desired!

 Taking Vitamin B6

Vitamin B6 is a water-soluble vitamin that can be helpful, good stroke victims fighting against related illnesses. Vitamin B6 is best taken sublingually as oral administration is less efficient in allowing it to enter the bloodstream quickly. It is inexpensive and available at most health food stores and pharmacies. More importantly, it has no toxicity; in other words, it is difficult to overdose on B6 so that you can use it without worry.

Taking Vitamin B12

B12 is also a water-soluble vitamin that allows the function of physical, emotional, and meant all abilities. It involves the metabolic process of each body cell, making it essential to those with the body’s systems weakened by a stroke. Besides, B12 also plays a vital role in aiding the body in absorbing fatty acids. This is important as omega-3 fats are responsible for maintaining brain and nerve tissue health.

 Using Fish Oil

Fish oil is also a great and nutritious natural ingredient that can help with tips and home remedies on treating stroke naturally at home! Omega-3 fatty acids have been proven to offer positive benefits, including treating stroke. Fish oil, especially from fatty fish like salmon, is very ish in healthy fatty acids and has an ideal ratio of DHA, EPA and ALA.; an alternative for vegetarian people is hempseed oil, although it is more expensive.

 Using Taurine

A component of many drinks, taurine is a natural organic acid. It has been used to regulate hypoglycemia, hypertension, and diabetes, which ma,y be risk factors among patients who are finding ways to stroke. It helps stroke treatment by increasing oxygen uptake to the brain and stabilizing the cellular membranes’ health. Besides, it also prevents free-radical damage to the body.

 Using Chinese Motherwort

Some practitioners in traditional Chinese medicine take aerials to treat stroke. This herb works on the liver, heart, and kind, my meridians, and relieves blood stagnation. A study found that the extract could reduce the area affected by a stroke, improve neurological damage caused by a stroke and have a protective effect on cells brain cells cell study supports the traditional use of this herb for boosting recovery after a stroke. Never combine this remedy with other blood thinning or stroke medicines.

 Using Baikal Skullcap

It is one of the fundamental herbs in Chinese medicine, and it I,s used to treat stroke. The root has 4 potent fourlavonoids: norwogonoside, baicalin, oroxyloside as well as wogonoside. Skullcap extract may help recovery by treating paralysis and cerebral thrombosis resulting from stroke. This study also shows that the skullcap extract treats stroke-related brain damage and helps to heal. Consult your doctor before taking this herb or combining it with other blood thinners.

Using Ginseng

Ginseng is an herb that encourages your body’s defenses against stress and disease. A study tested ginseng extract containing ginsenoside Rb1 with induced stroke. This study also found that the section on the recovery of neural behavior stimulated the formation of new brain neurons. Consult your doctor before taking it in case of life from heart or blood pressure problems.

Drinking Raw Fresh Juices

A patient suffering from a stroke needs to add raw fresh juices to the daily diet as this will help to relieve the stroke’s severity; taking raw freshnaturalices will also help to ease the side effects and allow this person to get back to normality effectively and slowly.

Taking A Bath In Epsom Salt

Taking a bath in Epsom salt several times a week has been a remedy for treating stroke. This aids in relaxing the muscles and rejuvenating them as well. This method is suggested to help lessen a person who has suffered from a stroke getting back to normality a lot faster.

 Reducing Stress

Stress contributes to the particular problem; if severe, it can lead to a heart attack or stroke. Many options help you reduce stress levels, such as adequate sleep, regular exercise, laughing or volun, and tearing. Watching television does not relieve but may aggravate stress. Besides, try to avoid situations that make you angry or anxious.

 Herbal Remedies of Stroke 

Many natural remedies are based on the standard Chinese medication to cure the impairments causing bcausedmic stroke. Most natural supplements are designed to help increase the blood flow to the brain regions damaged during the cerebral mishap. Some supplements are known for their neuroprotective effects. That means they can protect the brain cells from further harm.

 Massage

Massage is a particular touch therapy shown and well-known to lessen blood pressure, improve depression, and advertise leisure. Some researchers have actually found that it is very usefbeneficialke survivors since it can help decrease the amount of depression and anxiety they feel over the restrictions. Massage can also enhance the blood flow to the muscles that are either spastic or paralyzed.

 Drinking Soy Milk 

This is actually an interesting tip on how to treat stroke and prevent this disease naturally without meeting any difficulty (excepting the case that you are a soy hater!). Soy milk is an ideal drink for people with high blood pressure as it has effects on preventing atherosclerosis, adjusting blood lipid disorders, and lowering blood pressure. People should consume about 500ml soy milk mixed with 50g of white sugof ar for times throughout the day.

Eating Grape

Grapes, including fresh grapes and raisins, are suitable for people with high blood pressure because the composition of the train’s high level of potassium salt ha,s antihypertensive and diuretic, and effects can enrich the amount of potassium lost by the use of Western medicine.

Eating Apple

Apple is always good for health. Some people even believe that if they eat apples even on dry days, they will not have the risk of any disease. Apple contains a high potassium level and pushes the extra sodium out of the body. This will help the body manage and maintain the normative blood pressure. For good, you should eat three apples three drink the apple juice three times (about 50ml/per time) per day. These are e best tips on how to treat stroke naturally; people should not miss them!

 Eating Grapefruit 

Grapefruit contains a high level of naringenin – an antioxidant that can help the liver to burn excess fat effectively. Grapefruit also helps to improve blood sugar control and lower blood od sugar level, which is very good for people with cardiovascular disease or obesity.

 Eating Garlic

Garlic has effects on lowering hyperlipidemia and hypertension. Every day, if you eat two cloves of raw garlic, pickled or garlic, or drink 5ml of vinegar with pickled garlic, it can help to maintain stable blood pressure levels. In addition, a diet with garlic can help to reduce the risk of colon cancer, prevent esophageal cancer, and inhibit breast cancer. Eating one or two cloves of garlic daily will help reduce 13-25% of the triglycerides level and lower the risk of blood pressure, cholesterol, and blood clotting.

 Eating Tomato 

This is one of the best tips on how to treat stroke at home that I would like to show my readers in this article. They are very rich in vitamins C and P. If people eat raw tomatoes regularly every 1-2 days, they can effectively prevent high blood pressure, especially when there are bleeder eye complications. In addition, Vitamin A, C, and lyco,pene contained in tomatoes can help to prevent prostate, lung, and stomach cancer. Tomatoes also affect blood pressure, preventing atherosclerosis – one of the dangerous factors that lealeadingary artery disease in the heart and stroke.

 Eating Water Spinach

Water spinach is very good for health. It contains a high level of calcium so that it helps maintain the osmotic pressure of the circuits and blood pressure at normal levels. Water spinach is a particular veggie that is perfect for people with high blood pressure with the sign of a headache – a leading cause of stroke. This is the last tip on how to treat stroke naturally, which pe, people should which  try!

Homeopathic Treatment

There are the following remedies that are helpful in the Treatment of  stroke:

• Aconite Nap –the remarkable therapy for cerebral stroke, it is the first remedy to be employed in a sudden and violent attack
• Baryta carb – it is very USA beneficial in this case where bleeding is associated with one-sided paralysis
• Kali Brom – this remedy is indicated when there is a sudden rua picture of blood vessels in the brain with paralysis and comma.
• Opium – excellent medicine for apoplexy; comma and obstructed respiration; patient lies down; loss of consciousness with eyes half open after the brain hemorrhage.
• Pituitrinum – well-known medicine for cerebral stroke; checks the cerebral hemorrhage; helps absorb blood clots; apoplexy due to hypertension.
• Zincum met – acts well in the cases of cerebral stroke, brain-fag; paralysis of the brain.
• Hyoscyamus – brain hemorrhage with involuntary stools and urination; patient falls and ms; red face.
• Glonoinum – threatened apoplexy due to sunstroke
• Nux Vomica – threatened brain hemorrhage with giddiness; pain and fullness of head; apoplexy in alcoholics
• Strontium carb – threatened cerebral hemorrhage from shock after high blood pressure and as a sequence of chronic hemorrhage
• Asterias rub – threatened cerebrovascular bleeding; a sudden rush of blood to the head.

References