Having a stroke is a ticking time bomb; what matters most is that you get to a hospital emergency room as quickly as possible. Many of the most effective treatment options can only be administered within a short window of time, so knowing how to identify a stroke and take swift action is crucial.

Overview

A stroke, sometimes called a brain attack, is a medical emergency that occurs when the blood supply to part of your brain is drastically reduced or interrupted. This happens when a blood vessel in the brain bursts or is blocked. When the brain cells stop receiving oxygen and nutrients from the blood, they begin to die. This is when brain damage begins to occur and it takes only a matter of minutes. Swift treatment is crucial to avoid severe brain damage and other serious complications.

Types of Stroke

There are two primary types of strokes. The most common is an ischemic stroke, which occurs when there is a blockage or narrowing in an artery leading to your brain. The blockage is due to a blood clot or other debris that has lodged in your artery. Ischemic strokes account for about 90 percent of all stroke attacks. The other type of stroke is called a hemorrhagic stroke. This type of stroke means that a weak vessel in your brain has ruptured or leaked. Such a rupture can occur because of high blood pressure or bulges in your brain's blood vessels (aneurysms) that have burst.

If you think that you are experiencing a stroke or are with someone who is, you must act immediately. Every second counts - increasing damage occurs to brain cells the longer they go without oxygen. The faster you get to a hospital, the more likely the chances are for a full recovery.

Because you need to act quickly and without confusion, remember to act F.A.S.T. This acronym, created by the National Stroke Association, will help you quickly recognize if a person is having a stroke:

• Face: Ask the individual to smile. Does part of their face droop?
• Arms: Have the person raise both arms. Does one fall down?
• Speech: Ask the person to repeat a simple sentence. Do they have trouble with this task?
• Time: If the individual has trouble with any of the above challenges, get them to a hospital.

If after doing the F.A.S.T. test, the person fails any of the criteria, you must dial 911 immediately. The faster they can receive medical treatment, the greater their chances for recovery.

Once it becomes clear that someone is having a stroke, the next step is swift diagnosis and intervention. Doctors must first determine the type of stroke; treatment for hemorrhagic and ischemic strokes is very different. First, a patient will undergo a physical and neurological exam. Lab work including blood and urine tests will be performed, as well as brain imaging.

An MRI is often used to help doctors locate which area of the brain suffered damage from the stroke. Testing might also include a CAT scan, which provides a 3-D image of the brain, its vessels, and the blood flow. A doctor may wish to perform an arteriogram or cerebral angiogram, which is a specialized x-ray that is taken of the brain and arteries after they have been injected with a dye. This test is especially helpful if other tests have not revealed the cause of the stroke.

Emergency Treatment

Once it has been determined whether the stroke is hemorrhagic or ischemic, doctors can then begin an appropriate course of treatment.

• Hemorrhagic Stroke: If a patient is suffering from a hemorrhagic stroke, the initial goals are to control bleeding, minimize pressure in the brain, and stabilize blood pressure. Once bleeding in the brain has ceased, the patient is put on bed rest and given supportive care so that their body can absorb the excess blood in your brain. Surgery can be an effective means to correct certain blood vessel irregularities common in hemorrhagic strokes. Surgical options include:
  • Aneurysm Clipping: In this procedure, a very small clamp is positioned at the base of the aneurysm (a bulge in a blood vessel in your brain); this keeps it from bursting or will prevent it from re-bleeding. The clip is a permanent solution.
  • Aneurysm Embolization (Coiling): An alternative to clipping, in this procedure, a surgeon uses a catheter to place a very small coil inside the aneurysm. This coil blocks the flow of blood into the aneurysm and prevents a rupture or re-ruptures.
• Ischemic Stroke: If an ischemic stroke is the diagnosis, initial treatment will focus on restoring blood flow to the brain and as quickly as possible.
  • Emergency Medications: There is a window of about four and a half hours to administer clot-busting drugs. Swift treatment increases the odds of survival, and diminishes chances for complications. A patient will most likely be given doses of the following medications:
    • Aspirin: This is the most effective immediate drug for ischemic strokes and will help reduce the chances of having another stroke. The ER staff needs to know if a patient has already taken any aspirin that day.
    • Tissue Plasminogen Activator (t-PA): A very potent medication, t-PA dissolves blood clots and helps increase chances of recovery. It is usually given through an IV in the arm, but can also be administered directly into the brain. The window for giving a patient this drug is only about 4 ½ hours.
  • Surgery: If a patient has arrived too late to be administered t-PA, they might be a candidate for a Mechanical Clot-Busting procedure, which makes use of a corkscrew shaped device placed at the end of a catheter. This device pulls out part, or all, of the clot that is lodged in the brain. Surgery such as angioplasty, which can widen plaque-lined arteries that leads to the brain, is sometimes recommended to help reduce your risk of having another stroke.

For either type of stroke, once stabilized, the focus of treatment will then turn to recovery and rehabilitation.

For many patients, recovering from a stroke can take months and sometimes years. Some people who have a stroke do not ever fully recover. After having a brain attack a person's sense of intellect, movement, and overall perception of the world changes. The abilities that a person loses after a stroke depend on the extent of brain damage, the type of stroke, as well as the part of the brain where the stroke occurred. During a stroke, some of the brain cells are only damaged and not killed, and are able to resume their functioning. Sometimes, one region of the brain compensates for another region that was damaged during the stroke.

The goal of rehabilitation is to improve a stroke survivor's functioning so that they can regain as much independence as possible; life skills such as eating, dressing, walking, and communicating often must be re-learned. Rehabilitation does not reverse the effects of a stroke; rather, it helps people regain the strength and confidence to carry on despite the stroke's effects. Rehabilitation begins in the hospital immediately following the stroke; once the patient has recovered enough, he or she may be moved to a specialized rehabilitation hospital or long-term care facility. Another option is to move back home and receive outpatient therapy.

Conclusion

Prompt emergency treatment is crucial for the best chance of survival and recovery from a stroke. If you or someone you know shows the signs of having a stroke, seek immediate emergency medical care at a hospital.