1. Prevention

Treatment of the risk factors includes reduction of blood pressure and cholesterol, control of blood sugar, and cessation of smoking. Since plaque rupture and thrombosis lead to embolism, antiplatelet drugs (i.e., aspirin, ticlopidine, dipyridamole, and clopidrogel), alone or in combination, have been shown to significantly reduce the rate of stroke.

In addition, surgical removal of an atherosclerotic plaque from the carotid artery, known as carotid endarterectomy, has been shown to reduce the incidence of stroke in selected patients. In symptomatic patients with TIA or RIND, carotid endarterectomy has been shown to be more effective in preventing stroke and death than medical management alone in patients with more than 70% stenosis. Although carotid endarterectomy has been shown to reduce stroke rate in asymptomatic patients with severe stenosis, its efficacy against medical management alone and cost-effectiveness remain controversial. Advances in catheter-based technology have made angioplasty of the carotid artery with or without stent placement an option for certain patients unable or unwilling to undergo carotid endarterectomy.

2. Acute Management

Once a stroke has occurred, the immediate objective of treatment is to restore blood flow to the brain. Thrombolytic agents such as recombinant tissue plasminogen activator have been used to break up the occlusive intracranial emboli and restore blood flow. Thrombolysis has been shown to improve neurologic outcome in patients with stroke if given within 3 hr after the onset of symptoms. However, the risk of intracranial bleeding is increased, thus limiting thrombolysis to patients without conditions predisposed to hemorrhage. Tests to locate the source of emboli, such as echocardiography and carotid ultrasound, are performed. Antiplatelet medicine is started, and anticoagulation with warfarin is begun for patients with clots outside of the carotid system, artificial cardiac valves, atrial myxoma, endocarditits, or atrial fibrillation. After the patient is medically stabilized, rehabilitation at home or specialized facilities can help the patient regain functional ability.

3. New Developments

Many of the developments in stroke treatment have focused on the prevention of embolism and restoration of blood flow after occlusion has occurred. Research has led to advances in preventing or reducing neuronal death after ischemia. The concept of excitotoxicity, by which cell injury and death occur because of excessive stimulation from excitatory amino acids, has provided a new paradigm of cell injury. Agents are being designed to block the receptors through which excitatory amino acids mediate their toxic effects. Other agents may limit injury by reducing neuronal metabolic requirements. These and other future developments may ultimately help to reduce the medical and social impact of this common disease.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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