Understanding Stroke -- Diagnosis and Treatment

How Do I Know If I've Had a Stroke?

You should consider these symptoms warning signs and consult your health care provider or call 911 right away:

  • Sudden weakness or numbness in the face, arm, or leg on one side of the body.
  • Abrupt loss of vision, strength, coordination, sensation, speech, or the ability to understand speech. These symptoms may become worse over time.
  • Sudden dimness of vision, especially in one eye.
  • Sudden loss of balance, possibly accompanied by vomiting, nausea, fever, hiccups, or trouble with swallowing.
  • Sudden and severe headache with no other cause followed rapidly by loss of consciousness -- indications of a stroke due to bleeding.
  • Brief loss of consciousness.
  • Unexplained dizziness or sudden falls.

When a patient displays stroke-like symptoms, a doctor, often a neurologist (a doctor who specializes in managing strokes) must not only confirm the symptoms but also identify the type of stroke, its location, and the extent of brain damage. Treatment decisions hinge on all these issues. Testing is typically done quickly, since immediate treatment may limit brain and nerve damage.

The doctor first examines the patient and obtains a medical history, if possible. A standard exam includes checking blood vessels in the eyes, listening for unusual noises in the heart and in the prominent carotid arteries of the neck (a sign of atherosclerosis, or hardening of the arteries), measuring blood pressure and pulse rate, and testing strength, sensation, and reflexes (a sign of good nerve health).

CT or MRI scans are the most critical tests used to diagnose stroke.

What Are the Treatments for Stroke?

Treatment is based on information gathered through a medical history, physical exam, and an emergency CT scan. Upon arrival in an emergency room with a suspected stroke, the doctors and medical staff will do the following tasks:

  • First, the hospital staff will assist a person with breathing, if the person is unconscious or losing consciousness, by providing supplemental oxygen.
  • A quick history will be taken from the patient or loved one to determine the exact time symptoms started.
  • A physical exam will be done to determine the severity of symptoms.
  • Next, an emergency CT scan will be obtained to determine the type of stroke and its size and location in the brain.
  • If the person is having an ischemic stroke, a clot buster drug (tPA) may be given via the veins (intravenously) to dissolve the obstructing clot. Clot busters need to be given within the first three to four and a half hours of the onset of symptoms. If it can't be determined when symptoms started, the patient is not a candidate for tPA. Clot busters are not given to people with hemorrhagic strokes as they may worsen the bleeding.
  • In a small number of cases, emergency surgery might be needed to drain blood from a hemorrhagic stroke or to clip a ruptured artery or aneurysm -- blocking off the vessel to halt further bleeding.

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After the acute situation is managed, most patients with stroke are monitored in the hospital for several days. Upon release, patient and doctor carefully review necessary steps for recovery and prevention of future strokes. Advice will likely involve diet and lifestyle changes, ongoing drug treatment, physical therapy, and possible surgery for critical narrowing of the arteries in the neck (carotid endarterectomy).

People at risk of having strokes need to keep their blood pressure under control through diet and lifestyle changes and, when needed, with medication.

To prevent ischemic strokes, some patients are first advised to take aspirin. If aspirin proves ineffective, the doctor will probably prescribe Aggrenox or clopidogrel (Plavix), two other blood-thinning drugs, or coumadin (Warfarin) for special situations. Three other blood thinners have been approved to prevent stroke in those with atrial fibrilation -- apixiban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).

People at particularly high risk for stroke from a blood clot because of an existing heart condition would be treated with heparin for acute symptoms and warfarin for long-term therapy. Most patients will also be prescribed a drug to lower cholesterol, such as  atorvastatin or simvastatin.

In some patients, surgery to prevent future ischemic strokes might be recommended. Carotid endarterectomy removes plaque from the large carotid arteries leading from the neck into the brain. It is recommended when the arteries are narrowed by 70% or more. Another technique called carotid angioplasty can be used to widen clogged brain arteries. A stent can be inserted into the artery with a catheter. When released from the catheter, the stent expands to the size of the artery and holds it open. Stents are usually made of metal and are permanent but can also be made of a material that the body absorbs over time. Some stents have medicine that helps keep the artery from getting blocked again.

Another crucial element of stroke treatment, in addition to emergency and follow-up medical care, is rehabilitation. Immediately after a stroke, other parts of the brain can compensate for areas lost to trauma by forming new neurological pathways. Intensive rehabilitative therapy basically aims to enhance the brain's own recovery efforts. A typical program may involve speech, nutritional, physical, and occupational therapy as well as social services.

The psychological well-being of victims, families, and caregivers plays a crucial role in rehabilitation. Successful recovery depends on both the quality of care and the positive mindset of the victim. Antidepressants may be needed to alleviate post-stroke depression. Several stroke associations offer psychological support via hot lines, discussion groups, and literature.

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Lifestyle and Stroke

Physical rehabilitation should include regular, gentle aerobic exercise. Swimming in a heated pool is particularly useful for restoring lost motor function and keeping muscles loose. Exercises are easier to perform in the water because of its natural buoyancy.

People at high risk for stroke should not smoke and should eat a heart-healthy diet. Women at high risk should not take birth-control pills.

Mind-Body Medicine

Techniques that teach the body to relax and the mind to focus on healing can help recovering stroke victims. Among other benefits, these techniques can increase tolerance to pain and also alleviate the depression or anger that is common in the wake of a stroke. Hypnotherapy, meditation, and yoga all can be useful. Some stroke victims working to restore lost muscle control and motor function benefit from biofeedback.

Nutrition and Diet

Proper diet has much to contribute to stroke prevention, but it can do little to reverse stroke damage. With prevention in mind, your diet should be rich in vitamins, minerals, and other nutrients. Focus on a diet high in fresh fruits, vegetables, low-fat dairy, and lean protein sources. Avoid processed foods and those high in trans and saturated fats.

WebMD Medical Reference Reviewed by James Beckerman, MD, FACC on February 03, 2017

Sources

SOURCES: 

World Health Organization. 

Silbergleit, R. Academy of Emergency Medicine, 2005 Apr. 

Braunwld, E. (editor); et al, Harrison's Principles of Internal Medicine 16th Edition, McGraw-Hill Professional, July 23, 2004. 

Bendixen, B. and Ocava, L. Current Cardiology Report 2002, Mar. 

Berger C. Stroke. 2005, June. 

Roy, M. Journal of Association of Physicians of India, 2004, Dec.

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