Palliative Care for Strokes

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Stroke remains the third-leading cause of death in the United States following heart disease and cancer. Each year, nearly 800,000 people are injured by a stroke and140,000 die of them.

Because stroke is so deadly, you should be prepared with information about palliative care programs in your area for a friend or family member who experiences this serious medical issue.

Types of Stroke and Emergency Treatment

Ischemic stroke happens when there is a narrowing or blockage of a vessel in the brain caused by a thrombosis or embolism.

A cerebral thrombosis is the formation of a blood clot within the brain that blocks blood flow. A cerebral embolism occurs when a clot that has formed elsewhere in the body travels to the brain and blocks blood flow.

Ischemic stroke patients who survive the acute attack may be given clot-buster medication, such as tPA; blood thinners, such as heparin; or anti-clotting agents, such as aspirin.

A hemorrhagic stroke happens when a vessel ruptures and bleeds within the brain. This injury is most commonly caused by an aneurysm, which is a weakening and bulging of an area of the vessel. Trauma and increased pressure in the brain can lead to a hemorrhagic stroke as well.

Hemorrhagic stroke treatment is aimed at controlling intracranial pressure, or pressure within the skull. No blood thinners or anticlotting agents are used since the stroke is caused by bleeding. The goal of treatment is to stop the bleeding and decrease intracranial pressure to minimize damage to the brain.

Interventions include intravenous medications to lower intracranial pressure and decrease swelling in the brain, surgery to repair ruptured vessels, or endovascular treatments to block blood flow to the ruptured vessel.

Stroke Death and Palliative Care

Despite emergency treatments, approximately one in three stroke victims die as a result.

Death may follow a stroke fairly quickly or come some time later. Stroke victims who survive the initial attack may suffer severe physical and mental deficits. Paralysis, difficulty swallowing, incontinence, and mechanical ventilation increase the risk of death. A stroke may leave people in a coma or a persistent vegetative state, opening the door to difficult and important decisions about their well-being.

Palliative care and hospice programs can help these those injured by stroke and their loved ones make difficult decisions while addressing everyone's physical, emotional, and spiritual needs. The focus of palliative care versus hospice is different for people who had a stroke. Palliative care is usually done in the hospital setting without any limitations on life expectancy. Palliative care can be started before a terminal diagnosis is made.

Hospice care, however, is only appropriate for people who likely have six months or fewer to live and who prefer to die in their home environment. Hospice is an appropriate choice for someone who has decided against life-prolonging treatments, such as tube feedings and mechanical ventilation. Stroke victims with hospice care are usually brought home or admitted into a nursing care facility for the remainder of their days.

Sources:

The Internet Stroke Center. Stroke Statistics. http://www.strokecenter.org/patients/about-stroke/stroke-statistics/

Holloway RG, Benesch CG, Burgin S, Zentner JB. Prognosis and Decision Making in Severe Stroke. JAMA. 2005;294:725-733.

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