Stroke: Diagnosis and Treatment

Diagnosis 

• If a stroke is suspected, immediate medical attention and hospitalization are necessary.
• The evaluation begins with a detailed history and physical examination. Several medical tests are required to determine if a stroke has occurred and to check for possible causes. These tests may include blood tests, electrocardiogram (EKG), and CT or MRI scans of the head.
• In people who are at risk for a stroke, or who have had a transient ischemic attack, an evaluation is needed to determine the risk of future stroke. This may include an echocardiogram of the heart, a Doppler scan of the carotid arteries in the neck, or magnetic resonance angiogram (MRA) of the carotid arteries.

Treatment 

• Immediate management of a stroke includes supplemental oxygen, intravenous fluids, aspirin, and antihypertensive medications.
• In some cases, thrombolytic agents, or “clot–busting” drugs, are used to dissolve artery–blocking clots in the brain. These drugs can only be used within a few hours of the onset of the stroke, and only in certain patients. Patients at risk of bleeding are not eligible.
• Surgery may be needed in some instances, as in the case of a cerebral bleeding, a ruptured aneurysm, or narrowing of the carotid arteries.
• Most cases of stroke are preventible. Lifestyle changes that can significantly reduce the risk of stroke include smoking cessation, weight loss, blood pressure and cholesterol reduction, and control of blood sugar. In many cases, a healthy diet and regular exercise can normalize body weight, cholesterol, blood pressure, and blood sugar.
• In some cases, medications may be necessary. The most common are drugs to control blood pressure and cholesterol and medications that “thin” the blood, such as aspirin, coumadin, and clopidogrel.
• Patients with atherosclerosis of the carotid arteries in the neck may require a surgical procedure, carotid endarterectomy, to reestablish blood flow. This procedure is relatively simple and can significantly reduce the risk of a future stroke.