Imagine feeling perfectly fine one moment, and the next, you can’t speak or move your arm. Stroke can happen at any time, and every second matters. But there’s hope because quick treatment with thrombolysis and thrombectomy can save lives and prevent permanent disability.
What is a stroke? Understanding the Medical Emergency
A stroke is a neurological emergency that happens when the brain’s blood flow is interrupted, either by bleeding or a blockage. Because brain cells are so sensitive to low oxygen levels, they begin to die when they don’t receive it. This may result in death, loss of function, or irreversible brain damage.
As a neurologist, I’ve seen firsthand how devastating a stroke can be. But the good news is, with rapid intervention, we can prevent much of the damage caused by a stroke. The key is acting quickly—because every minute matters when it comes to treating a stroke.
Types of Stroke: What You Need to Know
There are two main types of strokes: ischemic stroke and hemorrhagic stroke, each with different causes, but both require immediate attention.
1. Ischemic Stroke (80-85% of All Strokes)
An ischemic stroke arises when a brain blood vessel gets obstructed by a blood clot or buildup of plaque. Lack of blood supply causes brain tissue to weaken, reducing function in the affected area. Ischemic strokes can be caused by:
● Atherosclerosis (plaque buildup in the arteries)
● Cardiogenic embolism (a clot that travels from the heart to the brain)
● Small vessel disease
Thrombolysis (clot-busting medication) and thrombectomy (mechanical removal of the clot) are key treatments for ischemic stroke, and they must be given within a critical time window to be effective.
2. Hemorrhagic Stroke (15-20% of All Strokes)
When a blood vessel in the brain bursts, blood flows into the brain tissue, resulting in a hemorrhagic stroke. This can occur due to:
● High blood pressure (hypertension)
● Aneurysms (weakened areas in blood vessels)
● Arteriovenous malformations (AVMs)
In hemorrhagic strokes, the blood accumulates, putting pressure on the brain and causing damage. The treatment approach differs from ischemic stroke and may include surgical interventions to stop the bleeding and relieve pressure on the brain.
Why is timing crucial?
Time is very important when it comes to treating a stroke. Brain cells start dying within minutes of losing blood flow, so fast action is essential. This is why I stress the importance of identifying the symptoms of a stroke early and seeking immediate medical help.
The Golden Hour: The First Few Hours Are Crucial
In the case of an ischemic stroke, thrombolysis (using tissue plasminogen activator or tPA) can be incredibly effective if administered within 3 to 4.5 hours of symptom onset. For thrombectomy, a mechanical procedure to remove the clot, the window is even wider—up to 24 hours after symptom onset, depending on the stroke’s severity and location.
In Hemorrhagic Stroke, Time is Also a Factor
For hemorrhagic strokes, the main objective is to stop the bleeding as soon as possible and reduce the pressure on the brain. Surgical intervention may be necessary, especially if there’s a large amount of bleeding or a ruptured aneurysm. The faster we can control the bleeding, the better the outcomes.
Work-Up and What Neurologists Do: A Comprehensive Approach
Neurologists use a structured approach to diagnose and treat stroke patients when they arrive at the emergency room. Here’s what we do:
1. Rapid Assessment
The first step is to assess the patient quickly and accurately. We use a combination of clinical evaluation and imaging to determine the type of stroke and the severity:
1. FAST Assessment: We use the FAST acronym to quickly identify signs of stroke:
● F: Face drooping
● A: Arm weakness
● S: Speech difficulty
● T: Time to call emergency services
● Imaging: CT scan or MRI to determine whether the stroke is ischemic or hemorrhagic. CT scans are used first to rule out bleeding in the brain.
● Blood Tests: To assess the patient’s blood clotting and glucose levels and to rule out other possible causes.
2. Thrombolysis for Ischemic Stroke
If the stroke is ischemic and the patient is within the appropriate time window, thrombolysis can be administered:
● tPA (tissue plasminogen activator) is given intravenously to break up the clot and restart blood flow to the brain. The sooner tPA is given, the better the chance of minimizing brain damage.
3. Thrombectomy for Large Vessel Occlusion
For patients with a large vessel occlusion (a large clot blocking a major brain artery), a thrombectomy may be performed. This is a minimally invasive procedure in which a catheter is threaded through the arteries to remove the clot.
● Thrombectomy has been shown to dramatically improve outcomes when performed within 6 to 24 hours of symptom onset, depending on the patient’s condition.
4. Hemorrhagic Stroke Management
If the stroke is hemorrhagic, our approach is different. We focus on stopping the bleeding and reducing pressure on the brain:
● Surgical Interventions: In cases of a ruptured aneurysm or large bleed, surgery may be needed to evacuate the blood and repair the blood vessels.
● Medication: Antihypertensive medications may be administered to control high blood pressure, which is often a contributing factor in hemorrhagic strokes.
What Can You Do to Help a Stroke Patient?
If you’re with someone who might be having a stroke, here’s what you should do:
1. Call 911 Immediately. Time is critical, and paramedics need to act fast.
2.Note the Time of Symptom Onset. This will help the medical team determine the treatment window.
3. Keep the Patient Calm and Still. If the person is conscious, try to keep them calm and avoid having them move.
4. Don’t Give Them Food or Drink. In case they need surgery or medication, it’s best to avoid anything by mouth until evaluated by a doctor.
Preventing Stroke: What Can You Do?
While strokes can happen suddenly, there are ways to reduce the risk:
1.Manage Blood Pressure: One of the main risk factors for stroke is high blood pressure.
2.Stay Active: Regular cardiovascular activity can help improve circulation and reduce stroke risk.
3.Eat a Heart-Healthy Diet: Strokes can be avoided with a diet low in processed foods, saturated fats, and salt.
4.Quit smoking: Smoking raises the chances of getting a stroke and heart disease.
5. Monitor cholesterol and blood sugar levels: Keep an eye on cholesterol and blood sugar to reduce the risk of a stroke.
How HealthPil Can Help
At HealthPil, we offer teleconsultations with expert neurologists who can provide immediate guidance in the event of a stroke. Whether it’s to evaluate stroke symptoms, discuss treatment options, or get a second opinion, our specialists are ready to help.
With early intervention, thrombolysis, and thrombectomy, stroke outcomes can improve significantly. Our goal is to guide you through every step of stroke care, ensuring the best possible outcome for you or your loved ones.
FAQ
Can stroke be treated after 4.5 hours?
For ischemic stroke, thrombolysis is most effective within 3-4.5 hours, but thrombectomy can be done up to 24 hours after symptoms appear, depending on the stroke type and severity.
How do I know if someone is having a stroke?
Look for sudden facial drooping, arm weakness, speech difficulty, and time to seek help (FAST).
What is the most common cause of ischemic stroke?
Atherosclerosis (plaque buildup in the arteries) is the most common cause of ischemic stroke, leading to a blockage in the brain’s blood supply.
Can I recover from a stroke?
Many stroke patients can recover with proper treatment and rehabilitation, especially when treated quickly with thrombolysis or thrombectomy.
Can I prevent a stroke?
Yes, by managing blood pressure and cholesterol, staying active, eating a healthy diet, and avoiding smoking, you can reduce the risk of stroke.
Disclaimer:
This article is for informational purposes only and should not be considered medical advice. Always seek immediate medical attention if you suspect a stroke or any other emergency.
