How do I know if I am having a stroke?
What are the symptoms of a stroke?
What should I do if I think that I am having a stroke?
What should I do if someone else is having a stroke?
If I go to the Emergency Room with a stroke, what will be done for me?
What kind of treatment will I receive for my ischemic stroke?
What happens if I have bleeding inside my brain?
What kind of treatment will I receive for a intracerebral hemorrhage?
What happens if I have bleeding around my brain?
What kind of treatment will I receive for a subarachnoid hemorrhage?
Does it matter where I go to receive treatment for my stroke?
Are all hospitals able to care for strokes?
The symptoms of a stroke are determined by the part of the brain that is injured by the stroke. The symptoms may come on all at once or may come on gradually, depending upon what is causing your stroke. Common stroke symptoms include, but are not limited to, the following:
- Sudden weakness or numbness of face, arm or leg; especially if all on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
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The sooner a stroke is treated, the better the chance of recovery. So, if you think that you or someone you know is having a stroke, you should:
Call 911 immediately
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The doctors will need to make sure that the symptoms you are experiencing are indeed due to a stroke. In order to do this, the doctors will find out more about you by asking you and your family about your medical problems and about the symptoms you are experiencing. You will likely have an EKG to assess your heart rhythm and activity. The doctors will need to do a physical exam and draw some blood to send to the laboratory. Pictures of your brain will also be obtained in most circumstances. The pictures of your brain will help to determine if you are having an ischemic stroke (blockage without bleeding) or if you have bleeding in or around your brain (hemorrhagic stroke).
Pictures of your brain may be obtained using any of the following:
Computed tomography (CT scan): A CT scan may be normal if it is done soon after the onset of symptoms. A CT scan is the best test to look for bleeding in or around your brain. In some hospitals, a perfusion CT scan may be done to see where the blood is flowing and not flowing in your brain.
Magnetic resonance imaging (MRI scan): A special MRI technique (diffusion MRI) may show evidence of an ischemic stroke within minutes of symptom onset. In some hospitals, a perfusion MRI scan may be done to see where the blood is flowing and not flowing in your brain.
Angiogram: a test that looks at the blood vessels that feed the brain. An angiogram will show whether the blood vessel is blocked by a clot, the blood vessel is narrowed, or if there is an abnormality of a blood vessel known as an aneurysm. An angiogram can be done by one of the following methods:
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CT angiogram (CTA)
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MR angiogram (MRA)
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Catheter based angiogram
Carotid duplex: A carotid duplex is an ultrasound study that assesses whether or not you have atherosclerosis (narrowing) of the carotid arteries. These arteries are the large blood vessels in your neck that feed your brain.
Transcranial Doppler (TCD): A TCD is an ultrasound study that assesses whether or not you have atherosclerosis (narrowing) of the blood vessels inside of your brain. A TCD can also be used to see if you have emboli (blood clots) in your blood vessels.
Echocardiogram: An echocardiogram is an ultrasound study of the heart. It can be done by placing the ultrasound probe on your chest (a transthoracic echocardiogram) or in your throat (a transesophageal echocardiogram). The purpose of an echocardiogram is to see if there are blood clots in your heart that may have led to your stroke.
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If your doctors determine that you have had an ischemic stroke (non-hemorrhagic), you may be a good candidate to receive a clot-busting medication known as tissue plasminogen activator (tPA). This drug must be given within 3 hours of the onset of your symptoms. People who receive tPA are 50% more likely to recover from their stroke than people who do not receive tPA. The drug is given as an intravenous (IV) infusion over 1 hour and if you receive the drug, you will need to be watched closely in an intensive care unit setting for at least 24 hours.
Important facts about tPA:
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tPA must be given within 3 hours of symptom onset; you may not receive tPA if you awaken with your symptoms since it is impossible to tell when your symptoms started.
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You must have a CT scan before you receive tPA; it must be clear that you have not had bleeding in or around your brain before receiving tPA.
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You may not receive tPA if you have bleeding problems or are on blood thinners such as warfarin (Coumadin®).
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The sooner you receive tPA, the better your chance of recovery.
Whether or not you receive tPA, you should receive aspirin for your stroke as soon as possible. Early use of aspirin decreases the risk of death and disability after stroke, but it is not nearly as effective as tPA.
Other treatments for ischemic stroke in the hospital include evaluating your safety for eating (swallowing function is commonly effected), monitoring your heart rate and rhythm, monitoring your blood pressure, medication to prevent blood clots from forming in paralyzed arms or legs and starting physical therapy as early as possible.
More about ischemic stroke
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If you have bleeding inside of your brain, this is called an intracerebral hemorrhage (ICH). Treatment for ICH is limited to medical, and possibly surgical, care in an intensive care unit (ICU). There are currently no specific drugs or surgery that is certain to improve outcome in persons suffering an ICH, but research is ongoing.
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If you have bleeding around your brain, this is called a subarachnoid hemorrhage (SAH). If you have SAH, the source of bleeding (usually an aneurysm) must be identified with an angiogram. Treatment depends upon surgical repair of the aneurysm. Sometimes the aneurysm can be treated with a catheter instead of surgery. Most patients who have SAH will also receive a drug called nimodipine (Nimotop®). This drug is shown to improve outcome in persons who have had SAH.
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Some hospitals are better able to care for strokes than other hospitals. The ability to appropriately care for strokes depends upon the hospital having stroke specialists available 24 hours a day. It has been recommended that hospitals able to best deliver care for stroke be called stroke centers. Primary Stroke Centers are now being certified by JCAHO, Harborview Medical Center is certified. Stroke centers should have the following services available:
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Acute stroke teams
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Written care protocols
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Emergency medical services
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Emergency department
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Stroke unit
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Neurosurgical services
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Commitment and support of medical organization; a stroke center director
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Neuroimaging services (CT and MRI scanning capabilities)
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Laboratory services
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Outcome and quality improvement activities
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Continuing medical education
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