Diagnosis

Things will move quickly once you get to the hospital, as your emergency team tries to determine what type of stroke you're having. That means you'll have a CT scan or other imaging test soon after arrival. Doctors also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction.

Some of the tests you may have include:

Stroke consultation Stroke consultation

Stroke consultation at Mayo Clinic

  • A physical exam. Your doctor will do a number of tests you're familiar with, such as listening to your heart and checking your blood pressure. You'll also have a neurological exam to see how a potential stroke is affecting your nervous system.
  • Blood tests. You may have several blood tests, including tests to check how fast your blood clots, whether your blood sugar is too high or low, and whether you have an infection.
  • Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).
  • Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography).
  • Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
  • Cerebral angiogram. In this uncommonly used test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.
  • Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke.

Treatment

Emergency treatment for stroke depends on whether you're having an ischemic stroke or a stroke that involves bleeding into the brain (hemorrhagic).

Ischemic stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. This may be done with:

  • Emergency IV medication. Therapy with drugs that can break up a clot has to be given within 4.5 hours from when symptoms first started if given intravenously. The sooner these drugs are given, the better. Quick treatment not only improves your chances of survival but also may reduce complications.

    An IV injection of recombinant tissue plasminogen activator (tPA) — also called alteplase (Activase) — is the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm with the first three hours. Sometimes, tPA can be given up to 4.5 hours after stroke symptoms started.

    This drug restores blood flow by dissolving the blood clot causing your stroke. By quickly removing the cause of the stroke, it may help people recover more fully from a stroke. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you.

  • Emergency endovascular procedures. Doctors sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. These procedures must be performed as soon as possible:
    • Medications delivered directly to the brain. Doctors insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA, but is still limited.
    • Removing the clot with a stent retriever. Doctors can use a device attached to a catheter to directly remove the clot from the blocked blood vessel in your brain. This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA. This procedure is often performed in combination with injected tPA.

The time window when these procedures can be considered has been expanding due to newer imaging technology. Doctors may order perfusion imaging tests (done with CT or MRI) to help determine how likely it is that someone can benefit from endovascular therapy.

Other procedures

To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by plaque. Options vary depending on your situation, but include:

  • Carotid endarterectomy. Carotid arteries are the blood vessels that run along each side of your neck, supplying your brain (carotid arteries) with blood. This surgery removes the plaque blocking a carotid artery, and may reduce your risk of ischemic stroke. A carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions.
  • Angioplasty and stents. In an angioplasty, a surgeon threads a catheter to your carotid arteries through an artery in your groin. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery.

Hemorrhagic stroke

Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid. Treatment options include:

  • Emergency measures. If you take blood-thinning medications to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower the pressure in your brain (intracranial pressure), lower your blood pressure, prevent spasms of your blood vessels and prevent seizures.
  • Surgery. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm, arteriovenous malformation (AVM) or other type of blood vessel problem caused your hemorrhagic stroke:
  • Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can keep an aneurysm that has recently hemorrhaged from bleeding again.
  • Coiling (endovascular embolization). Using a catheter inserted into an artery in your groin and guided to your brain, your surgeon will place tiny detachable coils into the aneurysm to fill it. This blocks blood flow into the aneurysm and causes blood to clot.
  • Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain. This eliminates the risk of rupture and lowers the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if it's located deep within the brain, it's large, or its removal would cause too much of an impact on brain function.
  • Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair blood vessel malformations.

Stroke recovery and rehabilitation

After emergency treatment, you'll be closely monitored for at least a day. After that, stroke care focuses on helping you recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged.

If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders.

Most stroke survivors go to a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers.

Rehabilitation may begin before you leave the hospital. After discharge, you might continue your program in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, as an outpatient, or at home.

Every person's stroke recovery is different. Depending on your condition, your treatment team may include:

  • Doctor trained in brain conditions (neurologist)
  • Rehabilitation doctor (physiatrist)
  • Rehabilitation nurse
  • Dietitian
  • Physical therapist
  • Occupational therapist
  • Recreational therapist
  • Speech pathologist
  • Social worker or case manager
  • Psychologist or psychiatrist
  • Chaplain
Speech therapy session

Speech therapy is often a part of stroke rehabilitation.

Treatment outcomes

One way to evaluate the care of patients diagnosed with stroke is to look at the percentage of patients receiving the timely and effective care measures that are appropriate. The goal is 100 percent.

The graphs below display the percentage of eligible Mayo Clinic patients diagnosed with stroke receiving all of the appropriate care measures.

Stroke Core Measure

See related graph.

Carotid Endarterectomy Mortality

See related graph.

Carotid Stenting Mortality

See related graph.

Comprehensive Stroke Measure

See related graph.

Comprehensive Stroke – Arrival Time to Skin Puncture

See related graph.

Comprehensive Stroke – Post Thrombolysis Revascularization Rate

See related graph.

Comprehensive Stroke – Timeliness of IV t-PA Therapy

See related graph.

For additional information and data visit Medicare Hospital Compare.

For additional information about quality at Mayo Clinic visit Quality Measures.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and support

A stroke is a life-changing event that can affect your emotional well-being as much as your physical function. You may sometimes feel helpless, frustrated, depressed and apathetic. You may also have mood changes and a lower sex drive.

Maintaining your self-esteem, connections to others and interest in the world are essential parts of your recovery. Several strategies may help you and your caregivers, including:

  • Don't be hard on yourself. Accept that physical and emotional recovery will involve tough work and that it will take time. Aim for a "new normal," and celebrate your progress. Allow time for rest.
  • Join a support group. Meeting with others who are coping with a stroke lets you get out and share experiences, exchange information and build new friendships.
  • Let friends and family know what you need. People may want to help, but they may not know what to do. Let them know how they can help, such as by bringing over a meal and staying to eat with you and talk, or attending social events or religious activities with you.

Communication challenges

Problems with your speech and language can be especially frustrating. Here are some tips to help you and your caregivers cope with communication challenges:

  • Practice. Try to have a conversation at least once a day. It will help you learn what works best for you. It will also help you feel connected and help rebuild your confidence.
  • Relax and take your time. Talking may be easiest and most enjoyable in a relaxing situation when you're not rushed. Some stroke survivors find that after dinner is a good time.
  • Say it your way. When you're recovering from a stroke, you may need to use fewer words, rely on gestures or use your tone of voice to communicate.
  • Use props and communication aids. You may find it helpful to use cue cards showing frequently used words or pictures of close friends and family members, a favorite television show, the bathroom or other regular wants and needs.

Preparing for your appointment

A stroke in progress is usually diagnosed in a hospital. If you're having a stroke, your immediate care will focus on minimizing brain damage. If you haven't yet had a stroke but you're worried about your future risk, you can discuss your concerns with your doctor at your next scheduled appointment.

What to expect from your doctor

In the emergency room, you may see an emergency medicine specialist or a doctor trained in brain conditions (neurologist), as well as nurses and medical technicians.

Your emergency team's first priority will be to stabilize your symptoms and overall medical condition. Then the team will determine if you're having a stroke. Doctors will try to find the cause of your stroke to determine the most appropriate treatment.

If you're seeking your doctor's advice during a scheduled appointment, your doctor will evaluate your risk factors for stroke and heart disease. Your discussion will focus on avoiding these risk factors, such as not smoking or using illegal drugs. Your doctor will also discuss lifestyle strategies or medications to control high blood pressure, cholesterol and other stroke risk factors.

Stroke care at Mayo Clinic

Nov. 22, 2019
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