Understanding stroke - diagnosis and treatment

How do I know if I’ve had a stroke?

When a patient displays stroke-like symptoms, a neurologist - a doctor who specialises 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 where possible, obtains a medical history. A standard examination includes checking blood vessels in the eyes, listening for unusual noises in the heart and in the prominent carotid arteries of the neck (checking for signs of atherosclerosis or narrowing of the arteries), measuring blood pressure and pulse rate, and testing strength, sensation, and reflexes (signs 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 a CT scan. For patients arriving within the three-hour “window” for using clot-dissolving drugs this should be done immediately. Upon arrival with a suspected stroke in accident and emergency, the doctors and medical staff will do the following tasks:

• First, the hospital staff will assist a person with their breathing by providing supplementary oxygen if they are unconscious or losing consciousness.
• Next, an emergency CT scan will be obtained to determine the type of stroke and its location in the brain.
• If the person is in the early stage of having an ischaemic stroke, a medication called tissue plasminogen activator (tPA) may be given via the veins to dissolve the obstructing clot. “Clot busters” are not given to people with haemorrhagic strokes as it may worsen the bleeding.
• Emergency surgery might be needed to drain blood from a haemorrhagic stroke or to clip a ruptured artery or aneurysm and block 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. Their early care may include management of their airway, fluid and nutritional balance, skin pressure care and other nursing support, depending on their level of disability. 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, called carotid endarterectomy, if critical narrowing of the arteries in the neck has been discovered to be the cause of the stroke.

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