A stroke is a medical emergency and every second counts. The sooner you are diagnosed and treated, the less damage will be caused to your brain. Time is brain, say stroke experts.
A stroke is a ‘brain attack’ and is caused by a disruption of the blood supply to the brain. This is either the result of a blood clot (called an ischaemic stroke) or due to bleeding in the brain from a burst blood vessel (a haemorrhagic stroke).
Different emergency treatment is given for the two types of stroke, and tests are needed to ensure the right type is given.
People who have had a stroke will need a brain scan, blood tests, blood pressure checks and an electrocardiogram (ECG) to find the cause of the stroke, what damage it has done and what medical treatment is needed.
Thrombolysis
Treatment may involve thrombolysis, which breaks down clots. Clot-busting drugs work by destroying the chemical bonds that hold a clot (thrombus) together.
It is given intravenously, through a small tube in a vein of the arm. But clot-busting treatment is only really effective when given soon after a stroke and within three hours of the first symptoms. That is why it's so important to go straight to hospital if you think you or someone else has had a stroke.
Factors such as the severity of the stroke and medical and family history are considered before the decision is made to use thrombolysis.
Before thrombolysis can be given, a brain scan is needed to check the type of stroke that has occurred. This could be a CT or an MRI scan, both of which can give the doctors the information they require.
Overall, thrombolysis leads to more individuals returning to independent lives, and about 30% more patients will have a good recovery.
The aim is to give the clot-buster drug alteplase within 30 minutes of arriving in hospital, says Dr Tony Rudd of the Royal College of Physicians.
“It’s a drug that breaks down blood clots within the artery, which enables blood flow to return,” says Dr Rudd.
“We had a man in his forties who had lost the use of his arm and leg and had no understanding of language,” says Dr Rudd. “He’d had a huge stroke.
“He was given thrombolysis within about two hours and he was allowed home two days later and avoided long-term damage.”
Thrombolysis can have serious side effects. Because it cuts the chemical bonds that hold clots together, it can prevent good clotting around the stroke zone. It can also cause major brain bleeding, including into the brain. This is probably because the damaged brain tissue is very fragile. For a small number of patients (about 1 in 20), the bleeding will make things worse and may even be fatal.
Ischaemic strokes make up 85% of stroke cases. The rest (haemorrhagic strokes) are caused by a burst blood vessel in the brain.
Haemorrhagic strokes cannot be treated with clot-busting drugs. Some may be treated with surgery that eases pressure from swelling on the brain (aneurysm).
Minor strokes
A minor stroke, also called a transient ischaemic attacks (TIA), can be a prelude to a stroke. Treatment can involve clearing any blockage in the artery feeding the brain. This is a surgical procedure called a carotid endarterectomy.
If surgery is not required, TIA and stoke patients can be treated with a range of medication, including blood-thinning medication such as aspirin, dipyridamole or clopidogrel. Watch a video on TIAs.
You may also be prescribed medicines to control:
- high blood pressure
- high cholesterol
- diabetes (high blood sugar)
- atrial fibrillation (fast and irregular heartbeat)
Other treatments and therapies include ensuring you can swallow safely and ensuring you can regulate your temperature.
