Diagnosing and Treating Stroke

Every second counts. Diagnosing and treating stroke within the first 4.5 hours of recognized stroke symptoms can minimize the effects of a stroke.

Diagnosing Stroke

Ischemic strokes are caused by a blocked artery in the brain. A ruptured blood vessel causes a hemorrhagic stroke. Treatment for ischemic stroke is different from treatment for a hemorrhagic stroke. Ischemic strokes may be treated with a clot-busting drug, called alteplase, or tissue plasminogen activator (t-PA). It’s extremely important to receive a correct diagnosis before treatment begins. For you to receive alteplase (t-PA), a doctor must diagnose your stroke as an ischemic stroke and treat you within 4.5 hours of the onset of symptoms. If more than 4.5 hours passes, alteplase (t-PA) can’t be given. In the emergency room, your doctor or stroke emergency team may:

• Ask you when the symptoms of the stroke started.
• Ask you about your medical history.
• Conduct a physical and neurological examination.
• Order blood tests.
• Order a CT or MRI brain scan to determine the type of stroke.
• Study the results of other diagnostic tests that might be needed.

Stroke diagnostic tests

Diagnostic tests examine how the brain looks, works, and receives its blood supply.

CT (c)omputed tomography or CAT scan uses radiation to create a picture (like an X-ray) of the brain. It is usually one of the first tests given to a patient with stroke symptoms. CT test results provide valuable information about the stroke, including location and extent of brain injury.

MRI (magnetic resonance imaging) uses a large magnetic field to produce an image of the brain. Like the CT scan, it shows the location and extent of brain injury. The image produced by an MRI is sharper and more detailed than a CT scan, so it’s often used to diagnose small, deep-brain injuries.

CTA (c)omputed tomographic angiography is a CT scan that uses a special intravenous contrast material (dye) to look for abnormalities such as an aneurysm.

Stroke Treatment

Treating ischemic strokes

Acute immediate treatment provided by a trained stroke team can help keep the amount of brain injury to a minimum.

• Alteplase (t-PA) is the only FDA-approved drug to treat ischemic stroke. It is a clot-busting drug that must be given within the first 4.5 hours of recognized stroke symptoms. Medication may also be used to treat brain swelling that sometimes occurs after a stroke.

When someone has a stroke, he/she are at risk of another. Once the medical team identifies what caused the stroke, they may prescribe treatments or procedures to reduce the risk of a second stroke:

• Antiplatelet agents and anticoagulants interfere with the blood’s ability to clot and can play an important role in preventing stroke.
• Carotid endarterectomy is a procedure in which blood vessel blockage is surgically removed from the carotid artery in the neck.

Sometimes a stroke is the first sign a person has of other health conditions, such as high blood pressure, high cholesterol, diabetes, or atrial fibrillation. If any of these are diagnosed, the health care team will prescribe appropriate treatment.

Treating hemorrhagic strokes

 Surgery may be needed depending on the cause of the hemorrhage.

• Surgery is often recommended to either place a metal clip at the base of an aneurysm or to remove the abnormal vessels that make up an AVM. Some procedures are less invasive and use of a catheter that is inserted through a major artery in the leg or arm. The catheter is guided to the aneurysm or AVM, where a device is placed, such as a coil or clip, to prevent rupture.
• Medication is used to control high blood pressure. Other medicine may be given to reduce the brain swelling that sometimes follows a stroke.

Learn More About Our Stroke Services

For more information about our stroke services, please call (415) 353-6927.