Stroke Care and Rehabilitation

There are two main types of stroke:

1. Ischemic strokes are caused by a blockage or clot in a blood vessel in your brain. This is the most common type of stroke.
2. Hemorrhagic strokes are the result of bleeding in the brain. These include subarachnoid hemorrhages. 

Duke hospitals use the latest tests, medications, and procedures to treat your stroke quickly and provide coordinated care for recovery. Our goal is to minimize the negative effects of stroke, including permanent disabilities, and return you to your daily activities.

Imaging
A stroke occurs when there is a problem with blood flow in or to the brain. Quickly diagnosing the type and location of the problem helps prevent death and permanent disability. To do so, Duke stroke experts use imaging techniques to see inside the brain. According to American Heart Association (AHA) clinical guidelines, brain imaging should be performed and results obtained within 45 minutes after a suspected stroke patient arrives at a hospital. Duke hospitals consistently beat this national target.

Clot-Busting Medications (Thrombolytics)
For ischemic strokes (those caused by a narrowed or blocked artery), thrombolytics -- drugs that dissolve blood clots blocking blood flow to your brain -- are the first line of treatment. AHA guidelines suggest a clot-busting medication should be given within 4.5 hours of the start of stroke symptoms. Duke hospitals do this faster than the national average of institutions reporting to the AHA. Additional medications may be prescribed later on to prevent future clotting and narrowing of the arteries.

Medications for Hemorrhagic Strokes
For hemorrhagic strokes (those caused by bleeding), the priority is stopping the bleed and finding its source. This may require drugs to lower your blood pressure or counteract blood thinners. 

Thrombectomy
This type of minimally invasive surgery removes a blood clot. Specially trained neurosurgeons or radiologists insert a thin, flexible tube called a catheter into a blood vessel -- usually in the groin -- and guide it to the clot, which is then removed. In some cases, a tiny mesh cylinder called a stent may be placed to help prevent the artery or vein from being blocked again.

Vascular Surgery
You may need surgery to repair blood vessels that were damaged by a stroke. Depending on the type of damage, your surgeon can make a small incision and operate through a catheter to repair the vessel. Other vessels may require a more invasive procedure.

Duke's Telestroke Network
For people who live far outside of Durham or Raleigh, Duke’s Telestroke Network gives patients and doctors at six NC and VA hospitals access to Duke stroke specialists 24/7. Patients at these hospitals get the immediate care they need and, when necessary, are transferred faster to hospitals providing advanced procedures, which can make a life-or-death difference.

After we identify the cause(s) of your stroke and provide emergency care, we turn our attention to longer-term stroke recovery. We offer rehabilitation and therapy services through our wide network of outpatient and inpatient locations, like the Duke Rehabilitation Institute.

Stroke Risk Factor Management
Medically supervised exercise programs, nutrition and weight loss counseling, and high blood-pressure management are available to help reduce your risk of having another stroke. 

Communication and Swallow Therapy
Stroke can affect both communication and swallowing. Whether you have aphasia or other cognitive-communicative impairments, we will help you communicate with your medical team and your family. Our speech-language pathologists will assess your swallowing abilities and provide ongoing therapy and recommendations to make eating and drinking safer and easier.

Physical and Occupational Therapy
Licensed therapists work together to assess any physical impairments your stroke may have caused. From there, a rehabilitation team will develop a plan to help you regain as much mobility and independence as possible.

Mental Health and Respite Care
We provide mental health services for patients and caregivers who need support to cope with the emotional challenges that a stroke can bring. Respite care provides caregivers a break from tending to their loved one while a qualified replacement fills in temporarily. These services are provided locally by Caregivers Support Center and Durham Center for Senior Life.

Designated Stroke Centers
A designated stroke center meets national stroke-care standards set by the American Heart Association/American Stroke Association (AHA/ASA) and is accredited by The Joint Commission -- an independent, accrediting organization recognized for its quality standards in health care. Designated stroke centers follow the groups’ recommendations and guidelines and have established ways to measure improvements in stroke care and patient outcomes. 

• Duke University Hospital is a certified Comprehensive Stroke Center.
• Duke Raleigh Hospital is a certified Primary Stroke Center.
• Duke Regional Hospital is a certified Primary Stroke Center.

Award-Winning Care
Two of Duke's hospitals received 2021 AHA/ASA "Get with the Guidelines-Stroke Gold Plus with Honor Roll" awards. These awards recognize our stroke centers' ongoing commitment to improving patient care and patient outcomes. In addition, these honors recognize how quickly clot-busting treatment is started in patients at our hospitals.

• Duke University Hospital (PDF, 206.20 KB)
• Duke Raleigh Hospital (PDF, 206.19 KB)

Clinical Research
As national leaders in stroke research, our stroke specialists help to write the national guidelines for stroke prevention and treatment. We participate in clinical trials that give you access to the latest treatments available.

Stroke Survivor Support Group 
Our stroke survivor support group meets at Duke Regional Hospital. The meeting is open to all survivors as well as their friends and family. For more information, click here.