Stroke: diagnosis and treatment (2023)

Diagnosis

Once you arrive at the hospital, things move quickly as the emergency team will try to determine what type of stroke you are having. This means that you will haveConnecticutscan or other imaging test soon after arrival. Doctors also need to rule out other possible causes of the symptoms, such as a brain tumor or a drug reaction.

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Some of the tests you can perform include:

• Physical exam.The doctor will perform a series of tests that will sound familiar to you, such as listening to your heart and checking your blood pressure. You will also have a neurological exam to see how a possible stroke affects your nervous system.
• Blood test.You may have several blood tests, including tests to check how well your blood clots, whether your blood sugar is too high or too low, and whether you have an infection.
• Computed tomography (CT).AConnecticutThe scan uses a series of X-rays to create a detailed image of the brain. ANDConnecticutThe test may show bleeding in the brain, ischemic stroke, tumor, or other conditions. Doctors can inject a dye into your bloodstream to take a closer look at the blood vessels in your neck and brain (computed tomography angiography).
• Magnetic resonance imaging (MRI).Somemagnetic resonanceIt uses powerful radio waves and magnetic fields to create a detailed image of the brain. Somemagnetic resonanceit can detect brain tissue damaged by ischemic stroke and brain hemorrhage. The doctor may inject a dye into a blood vessel to look at the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography).
• carotid ultrasound.In this test, sound waves create detailed images of the inside of the carotid arteries in the neck. This test shows the buildup of fatty deposits (plaques) and blood flow in the carotid arteries.
• Cerebral angiography.In this rarely used test, the doctor inserts a thin, flexible tube (catheter) through a small incision, usually in the groin, and guides it through the major arteries to the carotid or vertebral artery. The doctor then injects a dye into the blood vessels to make them visible on x-rays. This procedure allows you to get a detailed image of the arteries in the brain and neck.
• Echocardiogram.An echocardiogram uses sound waves to create detailed images of the heart. An echocardiogram can find the source of blood clots in the heart that may have traveled from the heart to the brain and caused a stroke.

Treatment

Treatment for an emergency stroke depends on whether you have an ischemic stroke or a stroke that involves bleeding in the brain (hemorrhagic).

Ischemic stroke

To treat an ischemic stroke, doctors must quickly restore the blood supply to the brain. This can be done using:

• EmergencyIVlek.Treatment with drugs that can break the clot should be started within 4.5 hours of the first symptoms if given intravenously. The sooner these drugs are given, the better. Prompt treatment not only increases the chances of survival but can also reduce complications.

  SomeIVInjection of tissue plasminogen activator (TPA), also called alteplase (activase) or tenecteplase (TNKase), is the gold standard for the treatment of ischemic stroke. ShootingTPAIt is usually given through a vein in the arm for the first three hours. Sometimes,TPAit can be given up to 4.5 hours after the onset of stroke symptoms.

  This medication restores blood flow by dissolving the blood clot that is causing the stroke. Quickly resolving the cause of a stroke can help a patient recover more fully from a stroke. The doctor will consider certain risks, such as possible bleeding in the brain, to determine ifTPAit's right for you.

• Emergency endovascular procedures.Sometimes doctors treat ischemic strokes directly on a blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. These procedures should be performed as soon as possible:
• Drugs delivered directly to the brain.Doctors thread a long, thin tube (catheter) through an artery in the groin and into the brain for delivery.TPAdirectly at the stroke site. The time period for this treatment is slightly longer than for the injection.TPAbut still limited.
• Clot removal with a stent retrieval device.Doctors can use a device attached to a catheter to directly remove a clot from a blocked blood vessel in the brain. This procedure is especially beneficial for people with large clots that cannot completely dissolve.TPA. This procedure is often done along with an injection.TPA.

The time frame in which these procedures can be considered is increasing due to newer imaging technology. Doctors may order perfusion imaging tests (performed withConnecticutlubricantmagnetic resonance) to help determine the likelihood that a person will benefit from endovascular therapy.

Other procedures

To reduce the risk of another stroke or transient ischemic attack, your doctor may recommend a procedure to open an artery narrowed by plaque. Options vary depending on your situation, but include:

• Cervical endarterectomy.The carotid arteries are blood vessels that run along both sides of the neck and supply blood to the brain (carotid arteries). This surgery removes the plaque that blocks the carotid artery and can reduce the risk of ischemic stroke. Carotid endarterectomy also carries risks, especially for people with heart disease or other conditions.
• Angioplastia y stent.During an angioplasty, the surgeon inserts a catheter into the carotid arteries through an artery in the groin. A balloon is then inflated to dilate the narrowed artery. A stent can then be placed to keep the artery open.

hemorrhagic attack

Emergency treatment for hemorrhagic stroke focuses on controlling bleeding and reducing pressure in the brain caused by excess fluid. Treatment options include:

• Emergency measures.If you are taking blood thinners to prevent blood clots, you may be given medications or transfusions of blood products to counteract the effects of the blood thinners. You may also be given medicine to reduce pressure in the brain (intracranial pressure), lower blood pressure, prevent blood vessel spasms, and prevent seizures.
• Surgery.If the area of ​​bleeding is large, the doctor may perform surgery to remove the blood and relieve pressure on the brain. Surgery can also be used to repair blood vessel problems associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke, or if an aneurysm, arteriovenous malformation (AVM), or other type of blood vessel problem has caused a hemorrhagic stroke.
• Surgical haircut.The surgeon places a small clamp at the base of the aneurysm to stop the flow of blood into the aneurysm. This clamp can prevent the aneurysm from rupturing or prevent a fresh aneurysm from bleeding again.
• Coiling (intravascular embolization).Using a catheter inserted into an artery in the groin and guided to the brain, the surgeon inserts small detachable coils into the aneurysm to fill it. This blocks the blood supply to the aneurysm and causes the blood to clot.
• SurgicalBY Melimination.Surgeons can remove the smaller one.BY Mif it is in an accessible area of ​​the brain. This eliminates the risk of rupture and reduces the risk of hemorrhagic stroke. However, it is not always possible to delete a file.BY Mif it's deep in the brain, it's big, or removing it would affect brain function too much.
• Stereotactic radiosurgery.Stereotactic radiosurgery using multiple beams of highly focused radiation is an advanced, minimally invasive method of treating blood vessel deformities.

Convalescence and rehabilitation after a stroke

After emergency treatment, you will be closely monitored for at least one day. Then, post-stroke care focuses on helping you recover as much as possible and return to independent living. The effects of a stroke depend on the area of ​​the brain involved and the amount of tissue damaged.

If the stroke affected the right side of the brain, there may be problems with movement and sensation on the left side of the body. If a stroke has damaged brain tissue on the left side of the brain, movement and sensation on the right side of the body may be affected. Damage to the left side of the brain can cause speech and language disorders.

Most stroke survivors participate in a rehabilitation program. Your doctor will prescribe the most rigorous treatment program possible, based on your age, your general health, and the degree of disability caused by your stroke. The doctor will take into account your lifestyle, interests and priorities, as well as the availability of family members or other caregivers.

Rehabilitation can start before you leave the hospital. Once you are discharged from the hospital, you may continue the program in the same hospital's rehab ward, in another rehab ward, or in a skilled care facility, on an outpatient basis or at home.

Recovery from a stroke is different for each person. Depending on your condition, your treatment team may include:

• Doctor trained in brain diseases (neurologist)
• Physiotherapist (physiotherapist)
• rehab nurse
• Dietary
• Physiotherapist
• Occupational therapist
• recreational therapist
• Speech therapist
• Social worker or case manager
• psychologist or psychiatrist
• Chaplain

Treatment results

One way to assess the care of patients diagnosed with stroke is to look at the proportion of patients who received appropriate, timely, and effective measures of care.

The charts below show the percentage of eligible Mayo Clinic patients diagnosed with a stroke and receiving all appropriate care.

Impact core measurement

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Mortality after carotid endarterectomy

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Mortality after carotid stenting

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Full stroke measurement

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Complex stroke: time to reach skin puncture

See the related chart.

Complex cerebrovascular accident: rate of revascularization after thrombolysis

See the related chart.

Complex cerebrovascular accident: current status of intravenous t-PA therapy

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Clinic tests

Explore Mayo Clinic researchtesting new treatments, interventions, and tests as a means of preventing, detecting, treating, or controlling this disease.

coping and support

A stroke is a life-changing event that can affect your emotional well-being as well as your physical functioning. At times you may feel helpless, frustrated, depressed, and apathetic. You may also have mood swings and a lower sex drive.

Maintaining self-esteem, connections, and interest in the world are important elements of recovery. Several strategies can help you and your caregivers, including:

• Don't be hard on yourself.Accept the fact that physical and emotional recovery will take time and hard work. Strive for the "new normal" and celebrate your progress. Give me time to rest.
• Join a support group.Meeting other people who are struggling with stroke allows you to get out of the house and share experiences, exchange information, and make new friends.
• Let your friends and family know what you need.People may want to help but don't know what to do. Let them know how they can help, such as bringing you food, stopping to eat and chat with you, or attending social events or religious activities with you.

Communication challenges

Speech and language problems can be especially frustrating. Here are some tips to help you and your caregivers deal with communication challenges:

• Practice.Try to talk at least once a day. This will help you figure out what is best for you. It will also help you feel connected and regain your confidence.
• Relax and take your time.Conversation can be easier and more enjoyable in a relaxed situation where you are not in a hurry. Some people who have suffered a stroke consider eating dinner to be a good time.
• Say it your way.As you recover from a stroke, you may need to use fewer words, rely on gestures, or use your tone of voice to communicate.
• Use props and communication aids.You may find it helpful to use reference cards that represent frequently used words or images of close friends and family, your favorite TV show, the bathroom, or other common wants and needs.

preparation for the meeting

An ongoing stroke is usually diagnosed in the hospital. If you have a stroke, your immediate attention will be focused on minimizing brain damage. If you haven't had a stroke yet but are concerned about future risks, you can discuss your concerns with your doctor at your next scheduled appointment.

What to expect from a doctor

In the emergency room, you may meet with an emergency medicine specialist or a doctor trained in brain diseases (neurologist), as well as nurses and medical technicians.

The priority of the emergency team will be to stabilize the symptoms and general health. The team will then determine if you are having a stroke. Doctors will try to find the cause of the stroke to determine the most appropriate treatment.

If you seek advice from your doctor during your scheduled visit, your doctor will assess your risk factors for stroke and heart disease. Your discussion will focus on avoiding these risk factors, such as not smoking or using illegal drugs. Your doctor will also explain lifestyle strategies or medications to control high blood pressure, cholesterol, and other risk factors for stroke.