Stroke: Emergent Evaluation

Authored by MCN Neurologists

Stroke is the third leading cause of death in the USA.  Over 700,000 strokes occur every year and cause over 150,000 deaths. There are two basic types of stroke – “ ischemic” stroke, which accounts for approximately 80% of all strokes, and “hemorrhagic” stroke.  In this article, we will focus on the emergency treatment of ischemic stroke.

In ischemic stroke, one or more blood vessels carrying blood to the brain become blocked.  As a result, there is no blood flow to certain parts of the brain, which become starved of oxygen and other vital nutrients.  If blood flow is not restored quickly enough, irreversible brain damage occurs with permanent consequences.  Thus, one of the key treatments of ischemic stroke is to restore blood flow by clearing the blockage within the blood vessel as quickly as possible to minimize brain damage. There is a limited window of opportunity to correct the problem before brain cells are permanently damaged.

Symptoms of Stroke

The first step in the treatment process is to recognize the symptoms and signs of stroke. Common symptoms of stroke include:

• Weakness, numbness or paralysis of one side of the body
• Inability to speak or trouble speaking or understanding speech
• Double vision or loss of vision
• Loss of balance or vertigo (especially in addition to one of the other symptoms)
• Sudden, severe headache

If you or someone around you develops these symptoms, dial 911 immediately.  Stroke is a medical emergency, just like a heart attack.  Therefore, stroke is sometimes also called a “brain attack.”  Every minute counts.  The sooner a person having a stroke gets to the right hospital, the better their chances are for successful treatment.

What to Expect at the Hospital

Many hospitals in the Twin Cities are designated “Stroke Centers.”  Such hospitals have special expertise in treating strokes.  Typically, after arriving in the emergency room, the person having stroke symptoms is quickly examined by a doctor, typically an ER physician, who, in turn, discusses the situation with a neurologist, or the neurologist may come to the ER to examine the patient.  Various tests are done, including assessment of vital signs, blood tests, x-rays, an electrocardiogram (EKG) and a CT scan of the brain.  In some cases, an MRI scan of the brain may be done.  The purpose of these tests is to determine whether the person’s symptoms are due to ischemic stroke or some other cause, and to determine if certain treatments can be given safely.

The only FDA-approved treatment for ischemic stroke in the USA is a drug called rt-PA, which can dissolve blood clots that may be blocking a blood vessel.  This drug can only be given to individuals who meet certain medical criteria.  rt-PA is given through an IV and is only effective if given within 4½ hours from the time the stroke symptoms began.  This is one of the reasons why it is important to get to a hospital as soon as possible after stroke symptoms develop.  Though rt-PA can help many, unfortunately it is not effective in all patients.

Some individuals, especially those who have severe stroke symptoms, may also receive other treatments.  Just as a plumber uses a “snake” to clear out a blocked pipe, so also it is possible to put in a very thin tube, called a catheter, into a blood vessel in the groin and thread it all the way up into the brain.  Special wires and devices (one that is corkscrew shaped) can then be used to try and break up the clot that is blocking the artery.

The goal of all these treatments is to clear the blocked artery and get blood flowing into the brain before brain cells die.  These treatments are not without risk and therefore a careful decision balancing risks versus benefits has to be made by the involved physicians, patients and their families.

Typically, after receiving rt-PA or other treatments for ischemic stroke, a patient spends a day or two in the intensive care unit, where his/her condition is carefully monitored.  Over the next few days, additional tests may be done to determine the cause of the stroke.  Depending upon results of such testing, specific treatment is recommended to reduce the risk of having another stroke in the future.  Such treatments may include drugs like aspirin and, where applicable, drugs to reduce blood pressure and cholesterol.  Smokers will be advised to quit.  Various lifestyle modifications may be recommended, including diet and exercise.  Education is provided on the various “risk factors” for stroke and how to reduce them.  A stroke is often a life-changing event, not just for the patient but also for their family.  Therefore, it is important to become educated about stroke and ask questions of the care team.

During the hospitalization, the patient will receive specific therapies (such as occupational therapyphysical therapy and speech therapy) depending upon their stroke symptoms.  This is the start of the process of rehabilitation that can often continue for months.  Modern stroke care can enable many stroke survivors to lead long and productive lives.

Unfortunately, only a minority of stroke patients – less than 5% of all ischemic strokes nationwide – receive rt-PA and other related treatments.  The main reason is that most patients suffering a stroke do not get to the hospital in time.  The window for treatment after symptoms begin, is short.  Remember, “Time is Brain”.

Dr. Irfan Altafullah discussed stroke signs and symptoms with Fox 9 News:

          Stroke Awareness – May 2014

          Stroke Signs and Symptoms – May 2014

Dr. Irfan Altafullah discussed Stroke Symptoms and Prevention in May 2015 and Causes and Symptoms of Aphasia in June 2015 on Kare 11 News. 

For further information about Stroke and Stroke support services, click on the following links:

Minnesota Stroke Association
American Stroke Association  (information about senior care, caregiving and medical alert devices)

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