Clinical Support

Therapy after the first 3 hours

If a patient presents more than three hours after symptom onset, physicians ask many of the same diagnostic questions: Is this a stroke? What caused it? What can I do to prevent another stroke?

Some of the major issues for physicians in this phase include

• Prevention of direct complications of stroke, such as brain swelling and potential herniations
• Prevention of complications of the patient's relative immobility, such as deep venous thrombosis, aspiration pneumonia (caused by stroke-related inability to swallow), pressure sores, and contractures (flexion or distortion of joints)
• Control of hypertension, hyperglycemia, and fever

At this time, physicians provide supportive medical care, prevent and treat any acute complications, confirm the clinical diagnosis, determine exactly what caused arterial obstruction, and assess the extent of vascular disease.  Additional imaging techniques including MRI, X-ray angiography, and echocardiography may be employed. Intravenous r-TPA therapy is not an option at this point because of the increased risk that the vessels in the ischemic region of brain will hemorrhage if blood flow is restored.  

Secondary stroke prevention may be initiated following decisions about whether antiplatelet agents, anticoagulants, or surgical intervention may be appropriate. Physical, occupational, and speech therapy consultations assist in decision-making regarding patient suitability for outpatient rehabilitation.