Stroke diagnosis and treatment
A stroke happens when the blood supply to part of the brain is cut off. It is a medical emergency.
Prompt treatment is vital for a better chance of reducing damage or permanent disability from a stroke.
Stroke awareness campaigns focus on the main symptoms of stroke with the word FAST: Face-Arms-Speech-Time.
Face - a person's face may drop on one side, affecting the mouth or eyes
Arms - a person may not be able to lift one or both arms and keep them up because of weakness or numbness
Speech - a person's speech may be slurred or garbled, or they may not be able to talk at all
Time - dial 999 immediately.
How do I know if I’ve had a stroke?
Doctors usually diagnose a stroke from the person's symptoms, studying images of CT or MRI brain scans and carrying out physical tests.
It is important to determine the type of stroke before deciding on treatment. The two main types of stroke are:
- Ischaemic stroke, the most common, due to a blood clot.
- Haemorrhagic stroke, caused by a weakened blood vessel supplying the brain bursting.
A similar condition to a stroke is a transient ischaemic attack or TIA. The supply of blood to the brain is temporarily blocked causing what's sometimes called a ‘mini-stroke’.
Swallow tests are essential after a stroke as swallowing difficulties affect more than a third of people after a stroke.
The person is given a few teaspoons of water to drink. If they can swallow this without choking and coughing they will be asked to swallow half a glass of water. If they have problems with this, further specialist assessments will be carried out.
Heart and blood vessel tests may be carried out to confirm the cause of the stroke. These may include carotid ultrasonography, catheter angiography (arteriography), echocardiogram heart imaging.
What are the treatments for stroke?
A clot-busting drug called alteplase is used for ischaemic stroke to dissolve blood clots, also called thrombolysis. This is only effective if started during the first four and a half hours after the start of the stroke. Not all patients are suitable for thrombolysis treatment.
A regular dose of aspirin is usually given to make platelet cells in the blood less sticky and to reduce the risk of further blood clots.
Additional anticoagulant medication may be given as well as medication to reduce blood pressure and statins to lower cholesterol levels.
If the ischaemic stroke was caused by a narrowing in the carotid artery in the neck, an operation may be needed to unblock the artery.
For haemorrhagic strokes, an emergency brain operation called a craniotomy may be needed to remove blood from the brain and to repair burst blood vessels.
After the operation, medication may be given to help lower blood pressure and reduce the risk of further strokes.