A stroke occurs when the blood flow to a specific part of your brain is cut off. When this happens, the cells don’t get oxygen and begin to die, causing numerous symptoms. The most common symptoms are changes in speech and numbness or weakness of the face, legs, or arms.
The quick assessment for stroke, known by the acronym FAST (face, arms, speech, time), is seen below:
- F: Check for facial droop.
- A: Hold arms out. Does one drop downward?
- S: Is speech abnormal, delayed, or absent?
- T: It’s time to call 911 or your local emergency service if any of these symptoms are present.
How a stroke affects you depends on the location in your brain where the stroke occurs.
Evaluation and treatment for a stroke should begin as soon as possible. The quicker emergency treatment begins, the greater the chance of preventing lasting damage. Treatment depends on the type of stroke you’re having.
Ischemic strokes are the most common kind of stroke. They occur when a blood clot blocks blood flow to your brain. Medication treatment for this type of stroke must start within 4.5 hours of the event, according to 2018 guidelines from the American Heart Association (AHA) and the American Stroke Association (ASA). It aims to break up the blood clot that’s blocking or disrupting blood flow in the brain.
Doctors often use aspirin in the treatment of strokes. Aspirin thins your blood and can even help prevent future strokes.
As a preventive medication, it's especially effective in preventing secondary stroke. People who've never had a stroke before should only use aspirin as a preventive medication if they have both:
- a low risk of bleeding
- a high risk of atherosclerotic cardiovascular disease, such as stroke or heart attack
Be sure to tell your doctor if you’re already taking aspirin for other conditions.
Your doctor may also administer drugs to break up clots. A common intravenous (IV) drug is tissue plasminogen activator (tPA). It’s given during an active stroke if the person is a good candidate. This medication works to stop a stroke by dissolving the clot that’s causing it.
After a stroke, your doctor may prescribe oral drugs, such as clopidogrel (Plavix) or warfarin (Coumadin). These are used to thin your blood in order to reduce the risk of stroke in the future. Statins have also been shown to reduce the incidence of future stroke.
If drugs don’t adequately break up the blood clot and if the stroke is acute, or localized to one area, your doctor may use a catheter to access the clot and remove it manually. The catheter is threaded through your blood vessels toward the area where the clot is lodged. Your doctor can remove the clot either by a corkscrew-like device attached to the catheter or by using clot-busting agents administered through the catheter directly into the clot.
Mechanical clot removals can be performed up to 24 hours after the appearance of stroke symptoms.
A large stroke can lead to serious swelling in the brain. In some cases, surgical intervention may be necessary if drugs don’t adequately relieve the swelling. Decompressive craniectomy aims to relieve the buildup of pressure inside your skull before it becomes dangerous. For the procedure, your surgeon will open up a flap of bone in your skull in the area of the swelling. Once the pressure is relieved, the flap will typically be returned.
After emergency procedures, your doctor will evaluate the health of your arteries and determine what needs to be done to prevent another ischemic stroke.
This procedure is often performed on people who’ve had an ischemic stroke due to a blocked carotid artery. The carotid arteries are the major blood vessels in the neck that supply blood to the brain. For this procedure, your surgeon will remove plaques and blockages from these arteries in order to improve blood flow and decrease the risk of future stroke.
This surgery carries the risks associated with any surgery. There’s also the risk that it may trigger another stroke if plaques or blood clots are released during the surgery. Protective measures are used to help reduce these risks.
Unlike ischemic strokes, treatment for hemorrhagic strokes doesn’t involve blood thinners. This is because thinning your blood would cause the bleeding in your brain to become worse. If you’re already taking blood-thinning medications, your doctor may administer drugs to counteract them or to lower your blood pressure to slow the bleeding in your brain.
Depending on the damage to the vessel in your brain, you may need surgery after a hemorrhagic stroke. For surgery to be performed successfully, the abnormal blood vessel must be in a location that the surgeon can reach.
If your surgeon can access the affected artery, they may remove it completely. Removal reduces the risk of a future rupture. Depending on the location and size of the aneurysm, surgical removal may not be a good option.
Your doctor may recommend a procedure called endovascular repair. Your surgeon threads a thin wire and catheter through your blood vessels and into the aneurysm. Then, they release a coil of soft platinum wire into the area. The wire is about as thick as a strand of hair. This coil creates a net that prevents blood from flowing into the aneurysm. This keeps it from bleeding or rebleeding.
Another treatment option is clipping the aneurysm by permanently installing a clamp to prevent it from bleeding further or bursting. This procedure involves surgery and is recommended when coiling won’t be effective. Clipping is typically more invasive than coiling.
Rehabilitation following a stroke depends on the extent of the damage and what part of your brain was affected. For instance, if the stroke occurred in the right side of your brain, you may need physical rehabilitation that focuses on walking up and down stairs, getting dressed, or bringing food to your mouth. The right side of the brain controls visual-spatial functions.
You may need rehabilitation or corrective measures to also help with:
- bowel or bladder control
- fine motor activity, such as writing or drawing
Having a stroke can be a serious and life-threatening event. However, the sooner you get evaluated and treated, the quicker you can prevent long-term damage to your brain and body.
Different kinds of strokes require different treatments, rehabilitation procedures, and preventive measures. If you’re experiencing the symptoms of a stroke, seek emergency medical attention immediately.