Strokes

Strokes are medical emergencies. If you have stroke symptoms, call 9–1–1 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. Time is crucial during a stroke, every minute counts.

Know the signs of a stroke and act FAST!

F

Face drooping on 1 side. Ask the person to smile and see if the smile is uneven?

A

Arm weakness on one side. Check to see if the person can raise both arms above the head.

S

Speech difficulty and an inability to make a simple sentence are signs of a stroke.

T

If the person has any of these symptoms it’s Time to call 9-1-1! (even if they get better) Also note the time of symptom onset as timing is everything!

The protocol for stroke treatment depends on the type: ischemic or hemorrhagic.

Approximately 85% of strokes are ischemic which occur when an artery in the brain becomes blocked or narrowed disrupting the flow of oxygen-rich blood to the brain. It is important to act quickly because brain tissue will die from a lack of oxygen. Treatment for ischemic cases can include medicines and/or surgical procedures. If the stroke is caused by a blood clot, and there are no conflicting medical conditions , the patient may be given a clot-dissolving medication called tissue plasminogen activator (TPA) to break it up. The doctor will inject TPA into the patient either through a vein in the arm or by inserting a catheter into the brain to deliver the medicine directly into the clot. This type of medication must be given within 4 hours of symptom onset, but , ideally, it should be given as soon as symptoms surface. If there are medical conditions that prohibit the use of TPA, the patient may receive an anti-platelet medicine that works to discourage platelets from clumping together and keeps the clot from growing larger.

Clot Retrieval Device

From a procedure standpoint, the surgeon may need to remove the clot by using a retrieval device that is fed through a catheter  into the part of the body where the blockage exists. Generally the access takes place through an artery in the patient’s groin area. The retriever device is placed past the clot and is used the pull the clot through the catheter and out of the body.

Angioplasty

If the blockage is the result of fatty deposits, or plaque, building up in the artery an angioplasty may be performed. During the procedure, a tiny balloon at the end of a long, thin tube is pushed through the artery to the blockage. When the balloon is inflated, it opens the artery. Additionally, a stent, or mesh tube,  may be placed inside the artery to help hold it open. This restores the flow of blood to the brain.

Endarterectomy

If the problem is the result of a blockage in the neck, or in the carotid artery, and the blockage is again the result of plaque, an operation that  is called a carotid endarterectomy, may be necessary. During this procedure the surgeon cleans out and opens up the narrowed artery by scraping away plaque from the walls so that blood can then flow freely to the brain.

Bypass Surgery

Sometimes, blood flow to the brain may decrease temporarily; this is called a ministroke, or a TIA, which stands for transient ischemic attack. When the brain is not getting enough blood, it cannot work properly. Bypass surgery may be advised for some patients who have multiple TIAs. During the operation, an artery on the outside of the scalp is re-routed to the part of the brain that is not getting enough blood flow. When blood flow is restored, the brain works normally, and the symptoms disappear.

Hemorrhagic  Stroke Treatment

Hemorrhagic strokes are very severe and require urgent treatment. They are the result of sudden bleeding in the brain. The bleeding may occur when a weakened blood vessel leaks or bursts. This is called an aneurysm. When an aneurysm occurs, the weakened artery may become like a balloon filled with blood. Patients usually describe an aneurysm as the worst headache of their life.

There are several types of surgery to repair an aneurysm. A clip may be placed across the
neck of the aneurysm (like a clip at the end of a balloon) to stop the bleeding. A newer approach
is to thread a long, thin tube through the artery that leads to the aneurysm. Then a tiny coil is fed through the tube into the aneurysm “balloon” to fill the space and seal off the bleeding.  For more details, please see vascular procedures.