Understanding Stroke - Treatment

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

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?

Treatment is largely based on information gathered from an emergency CT scan. But 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 their breathing, if they are unconscious or losing consciousness, by providing supplemental oxygen.
• Next, an emergency CT scan will be obtained to determine the type of stroke and its location in the brain.
• If the person is having an ischemic stroke, a clot buster drug may be given via the veins (intravenously) to dissolve the obstructing clot. They need to be given within the first three hours of symptoms. Clot busters are not given to people with hemorrhagic strokes as it may worsen the bleeding.
• 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.

After the acute situation is managed, most patients with stroke are monitored in the hospital for several days. The care may include nutritional support. 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, rehabilitative therapy, and possible surgery for critical narrowing of the arteries in the neck (carotid endarterectomy).

People at risk of having bleeding strokes need to keep their blood pressure low, if possible through diet and lifestyle changes but, when needed, also with medication. These people are also advised not to take aspirin or ibuprofen. If someone has suffered a bleeding stroke because of an aneurysm rupture, other small aneurysms can sometimes be identified and either removed or clipped.

Unfortunately, nothing can be done to reverse congenital arterial weakness.

To prevent clot strokes, some patients are first advised to take aspirin. If aspirin proves ineffective, the doctor will probably prescribe clopidogrel (Plavix), another blood-thinning drug, or warfarin (coumadin) as a last resort.