Stroke occurs when blood flow to the brain is interrupted because of a blood clot (ischemic stroke) or bleeding of a blood vessel (hemorrhagic stroke). It is a serious medical condition. In fact, out of the 795,000 stroke cases in the United States each year, more than 143,579 cases result to death. It is therefore important that loved ones be given emergency intervention and be brought to the hospital right away.

Diagnosis

Upon arrival at the emergency unit of a hospital, a doctor or nurse will ask the companion or the patient to describe the symptoms felt or observed. A brief neurological examination is then conducted. An electrocardiogram or ECG may be required to check electrical activity of the heart. Imaging tests such as computed tomography or CT scan and magnetic resonance imaging or MRI are often performed to confirm diagnosis.

CT scan is the most common diagnostic test for acute stroke, since it can reveal areas of the brain that are damaged due to loss of blood supply (infarction). This test produces cross-sectional images of the brain. It is quick and available 24/7 in most hospitals. CT scan can also reveal bleeding, confirming hemorrhagic stroke. This is highly important because thrombolytic drugs (drugs that dissolve a thrombus or blood clot) can worsen bleeding and thus cannot be given for this particular type of stroke.

Magnetic resonance imaging, on the other hand, uses magnets instead of radioactive elements to create three-dimensional images of the brain. MRI can show damaged brain tissue within an hour after onset of stroke symptoms. Therefore, it is more sensitive and accurate than CT scan. However, MRI is slower and not available at hospitals at all times of the day. Likewise, it cannot be done on patients with metal implants such as pacemakers of the heart.

The National Institute of Neurological Disorders and Stroke at the National Institutes of Health has developed a guideline called the standardized NIH Stroke Scale which can be used to determine the severity of a stroke. A patient is required to answer questions and perform physical and mental tests.

Treatment

There are three stages of stroke treatment: immediate therapy after stroke attack, post-stroke rehabilitation and prevention. Immediate therapy for acute cases of stroke is dissolving the blood clot (ischemic stroke) or stopping the bleeding (hemorrhagic stroke), whichever is the case. This is done by medications or surgery. Medications are the first line of therapy against stroke. They include thrombolytics and antithrombotics such as anticoagulants and anti-platelets.

As mentioned above, thrombolytics cannot be used for hemorrhagic stroke since these drugs increase bleeding. Thrombolytics are therefore reserved, and are the first line of treatment, for ischemic stroke. A drug called t-PA or tissue plasminogen activator to dissolve blood clots is given intravenously within 3 hours after an ischemic stroke. Thus, the window of opportunity is three hours, and it is critical that loved ones who had an attack be brought to the hospital within this period. This will also give time to do imaging tests in order to make the correct treatment choice.

Antithrombotics, on the other hand, prevent blood clotting which can plug blood vessels in the brain, resulting to interruption of blood supply. Anticoagulants prevent coagulation of blood, thus decreasing the risk for stroke. Examples are warfarin and enoxaparin. Antiplatelets decreases platelet activity, thus also prevent blood clotting. Example of antiplatelets is Aspirin, given for mainly preventing stroke.

Surgery is another immediate therapy for stroke. It can also be used to prevent a stroke attack or fix malformations and damages to the blood vessels in the brain. The two types of surgical procedures commonly used are carotid endarterectomy and extracranial/intracranial or EC/IC bypass. Carotid endarterectomy is the surgical removal of fatty deposits known as plaque, in carotid arteries. These arteries can be found in our neck and mainly supply our brain with blood. EC/IC bypass surgery, on the other hand, reroutes a healthy artery in our scalp to the area of brain deprived of blood and oxygen.

Rehabilitation

Stroke can cause disability, if not death, in most number of cases. Whether the disability is mild or severe, rehabilitation is started almost immediately, while our loved one is still in the hospital. The goal of rehabilitation is to regain physical, mental and emotional functions by re-learning basic skills used in daily living. Rehabilitation mainly involves physical therapy. It aims to regain common daily functions such as sitting, standing, lying down and walking. Physical therapists design a plan unique to every patient's needs. Regular exercise is recommended to strengthen muscles and improve gait. Assessments are performed before proceeding to more complex activities such as dressing, bathing and toileting. Speech therapists may also be consulted to help patients regain abilities such as swallowing, drinking, eating, speaking and understanding words and phrases.

Thus, for most part of the rehabilitation process, your loved ones will be working closely with their rehabilitation care team that includes not only physical, occupational, and speech therapists, but also a dietician, a social worker or case manager. Frequent check up with your neurologist or neuropsychologist is also vital in this period.

Also an important part of stroke rehabilitation is social support. Rehabilitation may take months to years, and your loved ones need all the motivation they can get to push through and complete the rehabilitation program. It is important that caregiving families form a support network as well, and share information to help other families whose loved ones had just recently undergone stroke. Learn and share tips on how to cope with stress and depression, and how to maintain a positive outlook amidst the challenges of this condition.