Stroke – Diagnosis and Treatment

Diagnosis

Medical Examinations and Imaging

When someone might be having a stroke, health professionals jump into action. They quickly check the person’s symptoms and medical history. First, they do a neurological exam. This means checking speech, movement, and awareness.

They measure blood pressure right away. High blood pressure is a huge risk factor for both ischemic and hemorrhagic strokes.

Doctors look for signs like sudden weakness, slurred speech, drooping on one side of the face, or trouble with balance and vision. You can remember these with the F.A.S.T. method: Face drooping, Arm weakness, Speech difficulties, Time to seek help.

Imaging tests play a central role in stroke diagnosis. The CT scan is usually the first thing doctors order when a patient arrives.

Test	What It Detects	When Used
CT scan	Bleeding, tumors, ischemic stroke	Right after symptoms start
MRI	Ischemic areas, hemorrhages	May follow CT scan
Ultrasound	Plaque buildup in carotid arteries	To check for blockages
Angiogram	Detailed artery images in brain and neck	Less common, confirmation

This scan uses X-rays to get detailed pictures of the brain. It helps spot bleeding, ischemic strokes from clots, tumors, or other unusual things.

An magnetic resonance imaging (MRI) is another big tool. It uses strong magnets and radio waves to make detailed images of brain tissue.

MRI is great for showing parts of the brain damaged by poor blood flow, which is common in ischemic stroke. Sometimes, doctors inject a special dye to see blood flow better in the brain’s arteries and veins.

Diagnostic Procedures and Testing

Doctors need to figure out what type of stroke is happening, since treatments for ischemic and hemorrhagic strokes are very different.

Ischemic stroke happens when a clot blocks blood flow. Hemorrhagic stroke is when a blood vessel bursts and bleeds in or around the brain.

To sort this out, doctors use several tests.

• Neurological Examination: They check how the stroke affects speech, strength, movement, and feeling. This helps them judge how serious things are and what to do next.

• Blood Tests: Doctors test blood to see how fast it clots, sugar levels, infection, and cholesterol. The results help guide care and can show if other problems, like diabetes, played a part.

• Carotid Ultrasound: This test uses sound waves to take pictures of the arteries in the neck. It shows if fatty buildup (atherosclerosis) is narrowing or blocking the arteries, which raises stroke risk.

• Cerebral Angiogram: Sometimes, doctors insert a thin tube (catheter) through the groin and guide it to the brain’s blood vessels. They inject dye and take X-rays to see blood flow. This test is for cases where they need a really precise look for narrowing, blockages, or aneurysms.

• Echocardiogram: This uses ultrasound to make detailed images of the heart. It helps doctors spot blood clots or heart problems that could cause a stroke.

• Electrocardiogram (ECG): This checks the heart’s electrical activity. Abnormal rhythms like atrial fibrillation can lead to blood clots and ischemic stroke.

Using Neuroimaging and Specialized Techniques

Brain imaging is a mainstay in stroke diagnosis. Both CT scans and MRIs give doctors a detailed look at the brain’s structure and can quickly show if a stroke is from a clot or bleeding.

Sometimes, more tests are needed.

• CT Angiography: Doctors use contrast dye during a CT scan to highlight blood vessels and check for narrowing or blockages.
• Magnetic Resonance Angiography (MRA): This uses MRI and dye to see arteries and veins in the brain and neck.
• Magnetic Resonance Venography (MRV): This test focuses on veins, especially if doctors think there might be clots there.

If there’s a chance of brain infection or bleeding in the layers around the brain and scans don’t give clear answers, a lumbar puncture (spinal tap) might be done. This checks for blood or infection in the spinal fluid.

Recognizing and Confirming Stroke Subtypes

A stroke can be ischaemic (from a blood clot) or hemorrhagic (from bleeding inside the brain). Ischemic strokes are more common and usually come from blockages in big arteries because of atherosclerosis.

Thrombotic stroke is when a clot forms right in a brain artery. Carotid artery disease is another risk, often involving narrowed arteries that bring blood to the brain.

Stroke Type	Main Cause	Diagnostic Clues
Ischemic	Blood clot, artery blockage	Detected via CT/MRI, symptoms
Hemorrhagic	Vessel rupture, bleeding	Seen as bleeding on CT/MRI
Transient Ischemic	Temporary clot/blockage	Short-lived symptoms, tests needed

Doctors use brain scans and blood tests to tell stroke types apart and rule out other problems like brain tumors or drug side effects. A correct diagnosis is vital, since treating a clot (with clot-busters) is nothing like treating a bleed.

Treatments

Care for Blocked-Artery Stroke

If a blood vessel in the brain gets blocked, every second counts. Doctors usually give a medicine called tissue plasminogen activator (TPA) to break up clots.

They give TPA through an IV in the arm, and it works best within 4.5 hours of symptoms starting. The two main types are alteplase and tenecteplase.

Using TPA quickly can make a real difference in how well someone recovers. Some people qualify for other procedures too.

• Direct Clot Removal: A doctor may use a device called a stent retriever to pull the clot right out of the blocked blood vessel. They thread a catheter from the groin up to the brain.
• Medicine Delivered to the Brain: Sometimes, doctors send medicine straight to the clot using a catheter. This can buy a little more time than IV TPA alone.

Many hospitals use advanced scans like CT or MRI to figure out if these treatments will help. If the brain tissue still has a chance, endovascular therapy (working from inside the vessel) can really boost outcomes.

Quick Facts Table: Ischemic Stroke Treatments

Treatment	Purpose	Time Window
IV TPA (alteplase/tenecteplase)	Breaks up blood clots	Within 4.5 hours
Endovascular therapy	Removes/dissolves clots	Up to 24 hours*

Other Methods for Preventing Another Stroke

To prevent another stroke or new blockages, doctors might suggest:

Procedure	How It Helps	When Used
Carotid endarterectomy	Removes built-up plaque from artery	Blocked carotids
Angioplasty with stenting	Opens narrowed artery and keeps it open	Narrowing present

• Carotid Artery Surgery: Carotid endarterectomy removes plaque from neck arteries and helps blood flow better to the brain.
• Angioplasty and Stenting: A balloon widens the artery, and a mesh tube (stent) keeps it open.

Both aim to keep blood moving well and cut down on repeat strokes. The choice depends on the patient’s health, artery condition, and stroke history.

Treatments for Bleeding in the Brain

If a blood vessel bursts and causes bleeding, stopping the bleed and lowering brain pressure become the top focus.

• Doctors might give medicine to lower blood pressure and control swelling.
• They use medications or blood products to reverse blood thinners if needed.
• They also take quick steps to prevent vessel spasms and stop seizures.

This fast action helps protect brain tissue and lowers the risk of other problems.

Urgent Steps in Stroke Care

When a stroke is suspected, emergency teams act fast to stabilize the patient.

They may:

• Reverse Blood Thinners: If someone is on anti-clot drugs, doctors use antidotes or transfusions to undo their effects.
• Manage Pressure: Medicines or procedures help reduce brain pressure and limit damage.
• Control Seizures and Blood Pressure: Special drugs manage these issues as needed.

Surgical Solutions

Sometimes, bleeding or blood vessel issues call for surgery.

Surgical treatments might include:

Surgery/Procedure	Purpose	Used For
Clipping	Stops flow into aneurysm.	Brain aneurysms
Coiling/Embolization	Blocks aneurysm and causes clotting.	Brain aneurysms
AVM removal	Removes abnormal blood vessel cluster.	Accessible AVMs
Stereotactic radiosurgery	Repairs vessels without open surgery.	Deep or hard-to-reach areas

• Removing Pooled Blood: If bleeding creates large blood collections, removing them relieves pressure on the brain.
• Fixing Blood Vessel Problems: For aneurysms or arteriovenous malformations (AVMs), doctors have some options:
  • Clipping an Aneurysm: A small metal clip blocks blood flow to a weak spot.
  • Coiling/Embolization: Tiny coils go into the aneurysm to stop blood from entering.
  • Surgical AVM Removal: If doctors can safely remove a cluster of faulty vessels, this lowers the future bleeding risk.
  • Focused Radiation (Stereotactic Radiosurgery): Highly targeted radiation beams fix vessel problems without open surgery.

Each surgery aims to stop more bleeding and cut risks from weak or abnormal blood vessels.

Support After Stroke

Once immediate treatment ends, the focus shifts to regaining lost skills and independence. Recovery really depends on where the stroke hit and how much brain tissue took a hit.

Some individuals notice weakness or numbness on one side; others might lose the ability to speak, understand, or even swallow.

Stroke rehab usually kicks off in the hospital. After that, it might continue at a rehab center, a nursing home, or right at home—it just depends on what fits best.

Therapists shape therapy to what each person actually needs, and it can include things like:

• Physical Therapy: Relearning movement, balance, and coordination.
• Occupational Therapy: Training for daily tasks, like getting dressed or eating.
• Speech-Language Therapy: Working on speech, understanding, and swallowing.
• Nutritional Support: Helping with feeding issues if they pop up.
• Cognitive and Psychological Support: Memory work and counseling.

The care team often pulls together a mix of experts:

• Neurologist (brain specialist)
• Physiatrist (rehab doctor)
• Nurses with stroke and rehab training
• Dietitian
• Physical, occupational, and speech therapists
• Social worker or case manager
• Psychologist or psychiatrist
• Chaplain

Example Rehabilitation Schedule

Therapy Type	Focus Area	Example Activities
Physical Therapy	Strength, balance, movement	Walking, stretching, exercises
Occupational Therapy	Daily skills, hand function	Dressing, cooking, writing
Speech Therapy	Talking, swallowing, language	Naming objects, reading, feeding
Diet/Nutrition	Safe eating, nutrition	Modified diets, supplements
Counseling	Mood, motivation, memory	Goal setting, support, education

Ways to Cope and Get Help

Dealing With Speech and Language Difficulties

After a stroke, people often find that expressing themselves or understanding others just isn’t the same.

Some might struggle to get words out, or words come slower. Others realize they can’t follow what people are saying as well as before.

Helpful Strategies:

• Talk Regularly: Even a short conversation each day can build confidence and help practice speaking and listening.
• Stay Calm: Both stroke survivors and caregivers should try to keep things relaxed. Tension or rushing just makes talking harder.
• Use Fewer Words: If full sentences feel tough, short phrases or single words can still get the message across.
• Gestures and Facial Expressions: Hand signs, facial cues, and body language can really help when words won’t come.

Communication Tools:

Tool Type	Examples	How It Helps
Cue cards	Words, names, pictures	Prompts for key words
Visual tools	Photos of family, bathroom signs, objects	Shows wants or needs
Apps & devices	Simple speech apps	Offers new ways to talk or respond

Caregiver Tips:

• Listen patiently and give plenty of time for answers.
• Show you care, even if the response is slow or short.
• Don’t jump in to finish sentences—let the person try.
• Keep background noise low so it’s easier to focus.

Support for Communication:

• Practicing daily can help the brain heal and adapt.
• Written words, pictures, or just pointing at things can make it easier to share needs.
• Support groups and speech therapists offer guidance and practice.

Adjusting to communication problems after a stroke takes time and patience. Small changes and using the right tools can make everyday life better.