Diagnosis and Treatment

How do you diagnose a stroke?

Diagnosis of stroke is usually made after obtaining a clinical history and performing a neurological exam. Imaging such as CT scan and MRI can help confirm the diagnosis. There can be many conditions that mimic stroke symptoms and it is important to differentiate between them from a stroke.

What happens after I call 911 if I think I am having a stroke?

EMS providers will screen if you are having the symptoms and signs for a stroke and notify a nearby emergency department capable of handling strokes.

On arrival to the Emergency department, you will be assessed by an ED provider or Neurologist. A CT scan will be performed to rule out bleeding in the brain ( hemorrhagic stroke). If the CT scan is negative for blood, you will be assessed to see if you are a candidate for early treatment to restore blood flow. This includes administering a clot buster (tPA) or more recently, a procedure called mechanical thrombectomy. If the doctor if suspecting that you may be suffering from a large vessel occlusion, another type of scan called CT Angiogram is performed, which is a dye test to see if the clot is blocking a major artery.

It is important to provide EMS and doctors with information such as last time normal before symptoms were witnessed, if you are on a blood thinner, had recent bleeding or surgery as this could affect some of the decisions.

What are the treatments for stroke ?

Treatment for stroke includes early treatment to reverse or minimize the effects of stroke, finding the cause, developing a plan for preventing another stroke and rehabilitation.

Early treatment: Assessing if you are a candidate for Intravenous alteplase and mechanical thrombectomy, controlling blood pressure and addressing other complications that can occur at the time of a stroke.

Finding a cause: Most ischemic strokes are either due to a) narrowing or blockage of the small arterial branches in the brain, b) narrowing in the larger arteries in the neck (carotids) and clot formation that travels into the brain (atherosclerosis) or c) due to a blood clot formed in the heart that travels to the brain (cardioembolic). There are also many other conditions that can cause a stroke including blood clotting disease, inflammation of the blood vessels, certain autoimmune conditions, drugs and stimulants and congenital heart disease.

Doctors may order further tests such as an MRI brain to look at the exact location of the stroke, an Echocardiogram (ultrasound of the heart), heart monitoring to look for irregular heart rhythms such as Atrial fibrillation, ultrasounds of the neck etc.

Specific treatment plan: It is important to identify a cause, so that an individualized plan can be created to prevent another stroke.

Depending on the cause for the stroke, most patients will be started on either on an antiplatelet (for example aspirin, clopidogrel), or blood thinners ( Warfarin, Apixaban, Rivoraxaban or Edoxaban).

Some patients may require carotid surgery or stenting, cardiac procedures or other types of procedures to reduce their risk of another stroke.

Identifying and treating stroke risk factors: Doctors will screen for risk factors such as blood pressure, diabetes, cholesterol, smoking and start treatment to control these risk factors to prevent another stroke.

Rehabilitation: This is an important part of stroke recovery and a team of rehab doctors, physical therapists, occupational therapists and speech-language therapists will help provide a plan to help recover and minimize the disability following a stroke.

Follow up: After being discharged from the hospital it will be important to follow up with your doctor to make sure you continue to stay on the right treatment and your risk factors are well controlled.