Diagnosis and Early Treatment
When someone has symptoms of a stroke or a TIA, a doctor will gather information and make a diagnosis.
They will review the events that have occurred and will:
- Take a medical history
- Do a physical and neurological examination
- Have certain laboratory (blood) tests done
- Order a CT and/or MRI scan of the patient’s brain
- Study the results of other diagnostic tests that might be needed
Diagnostic tests examine how the brain looks, works and gets its blood supply. They can identify the injured brain area. Most of them are safe and painless.
Diagnostic tests you may have fall into three categories.
Imaging tests give a picture of the brain like X-rays (CT scan or MRI).
Electrical tests record the electrical impulses of the brain.
Blood flow tests show any problem that may cause changes in blood flow to the brain.
Early treatment of ischemic stroke
Ischemic stroke happens when a blood clot blocks a vessel supplying blood to the brain. It’s the most common type, accounting for 87% of all strokes. The treatment goal is to dissolve or remove the clot.
To dissolve a clot, a medicine called alteplase (tPA) is given through an IV (intravenous line). It works by dissolving the clot so blood can flow again. Alteplase can save lives and reduce the long-term effects of stroke. It needs to be given within three hours of the start of stroke symptoms (up to 4.5 hours for some eligible patients).
To remove a clot involves a procedure called mechanical thrombectomy. Doctors use a wire-cage device called a stent retriever to remove a large blood clot. They thread a catheter through an artery in the groin up to the blocked artery in the brain. The stent opens and grabs the clot, allowing doctors to remove the stent with the trapped clot. Special suction tubes may also be used to remove the clot.
This procedure must be done within up to six to 24 hours of stroke symptom onset and after the patient has received alteplase, if eligible. Patients must meet certain criteria to be eligible for this procedure.
Early treatment of hemorrhagic stroke
Hemorrhagic stroke happens when a blood vessel bursts (ruptures) and bleeds within or around the brain.
Blood vessels can become weak due to a ballooning of part of the vessel (aneurysm). Other times there may be a tangle of blood vessels within the brain that didn’t form normally, making them weak (arteriovenous malformation or AVM). When high blood pressure isn’t controlled, it puts strain on weakened blood vessels that can lead to the ruptures that cause stroke. The treatment goal is to stop the bleeding.
For some patients, a small tube (catheter) with a camera is threaded through a major artery in an arm or leg and guided to the area of the bleed in the brain. The camera gives the surgeon a detailed view of the area to help fix the problem. Once the catheter is guided to the source of the bleeding, it leaves a mechanism, such as a coil, to prevent further rupture. This type of procedure is less invasive than standard surgical treatment.
Sometimes surgery is required to secure a blood vessel at the base of the aneurysm.