Last updated: August 8, 2022
Patients who arrive at the emergency room within three hours of initial symptoms have fewer negative outcomes than those whose care was delayed.1 A stroke is a serious and often life-threatening condition. It is a leading cause of disability and the fourth leading cause of death among Americans. Until 1958, if you were to experience a stroke, supportive care was all that was available. But with prompt recognition, we can stop a stroke in its path.
There are treatments available that can save lives and prevent or limit disability caused by a stroke. The success of such treatments depends on how much time has passed since the symptoms appeared. Therefore, it is crucial for all people to recognize the symptoms of a stroke. This article will give you the information you need to quickly recognize a stroke and respond accordingly.
There are blood vessels dedicated to providing every region of the brain with the nutrients and oxygen needed to function. Over the years, plaque from cholesterol and lipids may build up in the blood vessels causing them to narrow. If that plaque ruptures and damages the vessel wall, the body tries to heal it. Clot-forming cells will reach the site and clot off the vessel. Once the blood vessel is closed, there is no blood flow to the tissue beyond the blockage. Sometimes, the clot will dislodge, travel through the blood, and block a smaller vessel downstream. Without oxygen and nutrition, the tissue beyond the blockage will begin to die.
This type of stroke is called ischemic, and the severity depends upon the location of the blood clot. This is the predominant form of stroke and 8 out of every 10 cases of stroke are ischemic.
A less frequent type of stroke occurs when a blood vessel ruptures and causes bleeding in or around the brain, called a hemorrhagic stroke. Although not impossible to treat, this type of stroke tends to be more serious and challenging to manage.
Review the healthcare provider algorithm for a response to a stroke which includes the Cincinnati Prehospital Stroke Scale and take our online quiz for stroke response.
Ischemic stroke risk increases with the same factors that heighten the risk of suffering a heart attack:
Anything that you can do to eliminate or change these risk factors will decrease your chances of having a stroke. However, these risks are not the only factors linked to stroke. There can be a genetic component to stroke risk, as well as drug-related factors.
Hemorrhagic stroke can appear without any kind of previous risk, as it is a stroke that can appear due to an aneurysm or congenital issues.
The medical management of a stroke varies depending on the length of time since symptoms first appeared, and since this will affect prognosis, prompt recognition of a stroke is crucial.
Keep in mind that stroke symptoms usually start quite suddenly and get worse over time. You may be sitting at a table and suddenly be unable to hold your coffee cup or get your words out correctly.
Signs and symptoms of stroke include sudden:
A useful acronym to recognize and respond to ischemic stroke is FAST::
In the case of a hemorrhagic stroke, the symptoms appear more abruptly than ischemic stroke. The headache is the first thing to appear, consisting of severe pain that makes the patient feel like “my head is going to explode”, then the rest of the symptoms start to appear.
Nausea and vomiting are common along with dizziness and a very stiff neck, usually accompanied by confusion and even seizures, this set of symptoms is called “meningeal syndrome” due to the inflammation of the meninges (a set of membranes that cover the brain and spinal cord) due to a critical and immediate hemorrhage in the brain.
It is important to remember that diagnostic imaging is the best way to determine the type of stroke the patient experienced. Diagnostic imaging includes:
Computed tomography (CT) scan: Special x-ray equipment that create detailed pictures or scans of inside the body.
Magnetic resonance imaging (MRI): Magnets and radio waves create pictures of the organs and structures of the body.
These tests can detect changes or damage to the brain tissue. However, healthcare providers must act fast to treat this condition adequately.
It is imperative that you get help and get to a hospital quickly following the onset of symptoms of a stroke. Treatment for stroke is completely time-dependent. A clot-busting medication can be given to clear the clot from the vessel, but only if you are at the hospital within three hours (4.5 hours for some patients) of symptom onset. Call 911 immediately. Call 911 immediately. It can be hard to realize how urgent the situation is. However, do not pack clothing for the hospital or wait for relatives to return your call or arrive. The amount of damage done by the stroke is subject to how long the blood vessel remains blocked. Keep in mind that time is brain. For every minute that you delay getting medical attention, more brain tissue is being damaged.
If you are calling help for a friend or family member, after dialing 911, you should attempt to determine the time since the symptoms began. If you arrived at your family member’s house and found them having symptoms, it may be advantageous to phone a neighbor that may have seen them. You are attempting to figure out the time that the patient was “last known well”. This could be a telephone conversation, a neighbor who saw them getting their mail earlier in the day, or the report of someone who was with them when their symptoms began. This is important because the clot-busting medication can only be given within a certain timeframe.
It is also important to note that in the case of a hemorrhagic stroke since this type of stroke does not derive from pressures from a clot or a plaque, utmost care must be taken if the patient was taking any form of clot-busting medication since these kinds of treatments generally worsen the stroke itself.
The paramedics and EMTs will focus on two things:
Don’t be surprised if EMS encourages you to go to a hospital other than the one that you would prefer. There are certain hospitals that are classified as Stroke Centers at different levels. Comprehensive stroke centers (usually the larger teaching hospitals) are capable of not only giving clot-busting medication but are also able to perform procedures quickly to remove the clot and restore your blood flow.
If you are transported to a hospital that is not a stroke center, valuable time will be wasted while they complete their assessment and diagnostic testing and then transfer you to an appropriate stroke center for treatment. Transporting you directly to the closest stroke center available can save precious time. Most EMS have protocols in place for this purpose.
Since ischemic stroke is the most common type of stroke, its treatment is the one described here. At the end of this section, you will find links to articles on stroke management which include the treatment of hemorrhagic stroke. Remember, for any type of emergency treatment, the earlier it’s begun, the better the results.
Clot-busting medication: tPA is a clot-busting medication that has been used for many years to treat strokes, heart attacks, and pulmonary embolisms (clots in the blood vessels of the lungs). It is given intravenously and dissolves the clot to restore blood flow. It is, however, not without complications. tPA can cause bleeding in the brain and other parts of the body. So, you will be assessed to make sure that you are not at high risk of bleeding. For example, if you recently had a major injury, surgery, or internal bleeding, it would be too dangerous to administer a clot-busting medication for your stroke. Clot-busting medication cannot be administered if more than three hours (4.5 hours in some cases) have elapsed since symptom onset. After such time the risks outweigh the benefits. That is why it is important to know when symptoms began. The time that your symptoms began is the time when the blood vessel became occluded.
Percutaneous interventions: just like with a heart attack there are procedures to place a catheter directly into a vessel that feeds the brain and removes the clot that is blocking it. A catheter is placed through the groin and threaded up to the blood vessel that has been blocked. The clot can then be dissolved by directly delivering clot-busting medication or it can be physically removed with the help of a tiny device at the end of the catheter.
The treatment of a hemorrhagic stroke varies from the ischemic one. Due to the fact that a hemorrhagic stroke appears more suddenly and even without previous risks associated (hypertension in the case of an ischemic stroke) the time to act when presented with a hemorrhagic stroke must be faster.
Anticonvulsants due to the high risk of seizures related to a hemorrhagic stroke, different forms of anticonvulsants are administered, which can then be extended for weeks or even months until the risk is lowered.
Antihypertensive agents and diuretics, since most hemorrhagic strokes derive from sudden high blood pressure, a drug to lower blood pressure is administered along with one that helps the intracranial and meningeal pressure. Treatment is given with care due to the risks associated with the drugs and with the stroke itself.
Surgical procedures: The main objective of surgery to treat a hemorrhagic stroke is to drain the blood from the meninges, alleviating the pressure, and helping with the onset of symptoms.