What to expect during stroke treatment

If you have a stroke, you will immediately be taken to the the nearest hospital with a stroke unit. Urgent assessment and treatment by a specialized team is critical to the best outcome.

• On arrival, the first course of action is to have your blood pressure measured and an electrocardiogram (ECG) to check for abnormal heart rhythms.
• Blood samples are taken to test for diabetes, high cholesterol, blood clotting problems and other relevant conditions.The doctors' first priority is to identify what the type of stroke, which is determined by what triggered it.
• An ischemic stroke is caused by a blood clot and a hemorrhagic stroke is caused by bleeding. If the stroke was triggered by bleeding, it would be extremely dangerous to administer an anti-clotting drug.

One or more of the following diagnostic tests may be used to identify the type of stroke: either ischemic or hemorrhagic.

• Computed tomography (CT) scan: A scan based on multiple X-rays, which is used to produce a 3D picture that can confirm the diagnosis of a stroke and determine whether or not  it was caused by bleeding in the brain.
•  Magnetic resonance imaging (MRI) scan: A scan that creates pictures generated by a magnetic field, used to identify the precise location of the stroke and help medical staff to decide on further treatment.
•  Cerebral angiogram: A special X-ray taken after a dye is injected into the arteries supplying the brain. It provides a detailed map of the blood flow to the brain, revealing where there is a blockage or bleeding within the brain's blood supply.

• If a stroke is found to have been caused by a blood clot, you may be given a thrombolytic drug to dissolve the clot, assuming you receive it within four-and-a-half hours of the start of your symptoms. After this, the risk of bleeding outweighs the benefits of dissolving the clot.
• You'll likely be given antithrombotic drugs like aspirin, dipyridamole (Persantine) or clopidogrel (Plavix).
• Up to six hours after a stroke, a clot-busting drug can be delivered via a catheter directly to the site of the blockage. The clot can also be removed with a device thet extracts, dissolves or breaks it up.

• After a non-disabling ischemic stroke or a transient ischemic attack (TIA), if tests identify a substantial blockage in the carotid artery, doctors may suggest an operation to open up the artery in order to reduce the risk of another stroke.
• You may also need medication to reduce blood pressure and blood clotting, and to lower cholesterol.
• After a hemorrhagic stroke, if the original bleeding has stopped, which it commonly would, in order to reduce the risk of further bleeding, doctors monitor blood pressure carefully and prescribe medication to keep it under control.
• If doctors think that your stroke is related to taking aspirin or an anticoagulant like warfarin, you may be given a drug to reverse its effects. Occasionally in the case of bleeding, surgery may be suggested to drain the blood from your brain, though this isn't suitable for everyone.
• Open surgery or keyhole surgery may also be advised to seal a cerebral aneurysm if this is what has caused the bleeding.

• Recovery can continue for months, even years. The brain is a remarkable organ. Some studies have shown improvements up to 14 years later.