A stroke occurs when part of the brain loses its oxygen supply because a blood vessel bursts or is blocked by a clot. If someone shows symptoms of a stroke, it’s important to act quickly.
A person with an ischemic stroke may benefit from medication called tissue plasminogen activator (tPA, also known as alteplase). It breaks up and disperses clots to restore blood flow to the brain.
Diagnosis
If you think someone is having a stroke, call 911 immediately. The longer symptoms go untreated, the more brain damage happens and the lower the chance of a good recovery.
NYU Langone’s emergency care team will ask the person questions about their symptoms and history, then do a physical exam. They will look for the hallmark signs of a stroke: sudden numbness or weakness on one side of the face or body; trouble walking or seeing; and slurred speech. They will also check for a seizure (abnormal shaking of the head).
To help find out what caused the stroke, doctors may order blood tests or imaging studies. CT scans (also called CAT scans) show detailed pictures of the brain and can reveal a clot or other problems. They might use a special dye, called contrast, to highlight the arteries that carry blood to the brain more clearly. Cerebral angiography is another test that uses a thin tube (catheter) inserted into an artery in the groin or wrist and a dye to look for blockages. MRI scans of the brain are also very useful for finding out what caused the stroke.
Other tests might include an electrocardiogram, which checks for heart problems, and a transcranial doppler ultrasound of the neck arteries, which measures blood flow. They might also do a C-reactive protein test and a blood cholesterol level, which can show whether the stroke was caused by an infection or inflammation.
If the person is having a hemorrhagic stroke, they might need surgery to remove the blood clot that’s blocking an artery in their brain. The doctor might also give them a clot-busting medicine called tPA (tissue plasminogen activator) but only within three to four hours of when their symptoms first started. The medicine dissolves existing clots and can greatly improve the chances of a good recovery. The medication cannot be given after that time because it can cause dangerous bleeding complications. The person also might need fluids or nutrients, which can be given through a vein in their arm (intravenously). They may have sticky electrodes placed on their head with wires attached to a machine that records electrical activity in the brain.
Emergency Treatment
Whether you are having a stroke or know someone who is, it’s important to recognize the warning signs and seek emergency treatment as soon as possible. By doing so, you can improve your chances of a better outcome and avoid long-term disability.
The most common causes of stroke are blood clots that block blood flow to the brain (ischemic stroke) and bleeding into or within the brain (hemorrhagic stroke). If you see the symptoms, call 911 immediately and be sure to explain exactly what is happening. The EMS professionals who respond to your call will ask questions about when the symptoms started so they can get the treatment you need quickly.
Clot-busting drugs are an option for most ischemic strokes if they can be given within three hours of the first symptoms. These medicines dissolve the clot and restore blood flow to the brain. However, these drugs are only effective if they are administered as early as possible and only work for a limited time window (the exact time frame depends on the kind of stroke you have).
Hemorrhagic strokes can be more serious than ischemic strokes and usually need immediate medical attention. You may need surgery to control bleeding, repair the ruptured blood vessels or lower pressure in the brain. In some cases, doctors may also prescribe blood thinners to help prevent another stroke or heart attack. These medications can lower blood pressure, reduce your risk of a heart attack by lowering blood cholesterol levels and slow down the growth of plaque inside your arteries.
Some people who have had a hemorrhagic stroke will need to be placed on a ventilator machine for breathing support. You may also need a tube to help you swallow and a feeding tube to provide nutrition. Other treatments may include a heart test to see how well your heart is working and to treat any problems that are found.
You will probably need a combination of medicine to treat your stroke and to prevent future strokes. These might include aspirin, dipyridamole or cilostazol, which are all drugs used to thin your blood. You may also be given a medication called anticoagulants, such as warfarin to help your body stop clots from forming.
Treatment in the Hospital
Once a person is at the hospital, doctors work quickly to figure out what kind of stroke they’re dealing with. They start with a physical exam and neurological test. They also take blood and request scans to get detailed images of brain tissue, blood vessels and blood flow. A CT (computerized tomography) scan is usually the first one, which can provide the most information in a short amount of time.
In the case of an ischemic stroke, the goal is to restore normal blood flow to the brain. Clot-busting drugs are an option, but they have to be given within three to four hours of the onset of symptoms in order to be effective. One of these medications is called tissue plasminogen activator, or tPA, and it’s injected into the body to break up existing clots. However, it only works in a very narrow window—too much time passes and it increases the risk of serious bleeding complications.
Other treatment options for ischemic stroke include a carotid artery procedure called carotid endarterectomy or a less invasive version called carotid artery stenting. Neurosurgeons use these treatments to remove fatty deposits from the carotid arteries, which can help prevent future strokes.
A hemorrhagic stroke is a medical emergency, and treatment can be very complicated. Hemorrhagic strokes are often caused by a burst blood vessel, so doctors try to improve clotting and lower the pressure in the space surrounding the brain with medication and surgery.
Antiplatelet agents, such as aspirin and Plavix, stop blood fragments from clumping together to form clots and are commonly prescribed soon after a stroke occurs to reduce the risk of subsequent clots. Blood thinners, such as heparin and warfarin, can also be used to reduce the risk of clots that may have traveled from the heart.
Rehabilitation
If the doctor thinks you’ve had a stroke, you’ll need treatment right away to improve your chances of recovery. You’ll be taken to a hospital for rehabilitation. This may be a rehabilitation ward in the hospital, a rehab center where you stay overnight, or a clinic that provides outpatient therapy. A team of specialists will help you: physical therapists who can teach you exercises to improve your movement, balance and coordination; occupational therapists who can teach you ways to do daily tasks; speech-language pathologists who can treat problems with your ability to speak and swallow; and psychologists or social workers who can help with emotional problems like depression.
You may have a physical exam and blood tests to see how your body is functioning. If you had a very bad stroke, you might have to stay in the hospital for a few weeks or months. The rehab process can be frustrating, and it’s hard to know when you will see progress. But it’s important to stick with the program. Many stroke survivors find that the most improvement happens in the first few weeks and then slows down, but some people keep improving for months or even years.
The most effective treatments for a stroke are given within three hours of the start of symptoms. That’s why it is important to call 911 or have someone do it if you think you are having a stroke. You could be saved by getting immediate medical attention.
Some people who have had a stroke have a second stroke within 24 hours. This is called a transient ischemic attack (TIA), or mini-stroke, and it can be just as dangerous as a full-blown stroke. If you have a TIA, get help as soon as possible to reduce the risk of another stroke.
It’s normal to feel frustrated or depressed after a stroke. But try to remember that these feelings can make it harder for you to recover. You’ll get a psychological assessment to see how you are feeling and to check for any emotional problems that might be getting in the way of your recovery.
