All patients with stroke need to be stabilised as soon as possible, in order to control any problems that may impair recovery. This includes careful management of hydration, nutrition and swallowing problems, as well as measures to prevent pneumonia and blood clots forming in the veins of the legs. High blood pressure and blood sugar levels may require treatment. A stroke patient may require oxygen for breathing problems. After the acute phase of stroke treatment, the focus of management shifts to rehabilitation and preventing another stroke from occurring. After the type of stroke was correctly diagnosed, some specialised treatments may be considered depending on the patient’s condition and the services available.
The ambulance staff or the doctors will do a clinical evaluation and request tests to determine what type of stroke you suffered. The initial evaluation of a suspected stroke involves checking vital signs, such as blood pressure, heart rate and respiration, and stabilisation of the patient.
Tests to determine the type and severity of a stroke can include blood tests or an ECG. Imaging tests are often to produce pictures of the brain and include CT scans or MRI scans of the brain and a carotid doppler ultrasound scan that shows the blood flow to the brain.
Some patients may be eligible to receive a medication that can dissolve or break up the clot that is obstructing an artery. This medication is called tissue plasminogen activator or tPA treatment. TPA is commonly known as ‘clot‑buster’ treatment. TPA should be given at hospitals with stroke units that have scanning facilities. TPA can only be given to patients who are having a stroke caused by a blood clot, and it must be given within four‑and‑a‑half hours of the start of stroke symptoms. In some cases, tPA cannot be used.
In some patients, a large blood clot can be physically removed during a procedure called a mechanical thrombectomy. This procedure can only be done in very specialist centres were they have the correct scanning equipment, treatment facilities, and trained specialist to undertake the procedure. Mechanical clot removal can typically only be attempted under specific circumstances and within 6 hours after a stroke occurred.
An operation, called a ‘carotid endarterectomy’, may be carried out by specialist doctors on narrowed blood vessels in the neck. Should you need an operation, you will be seen by a specialist, who will explain what it involves. However, most people are given tablets and asked to change their lifestyle in order to help prevent further strokes. In most cases of TIA this is not necessary
The aim after a haemorrhagic stroke is to stop the bleeding and stabilize the patient. In some cases, surgery may be needed to remove blood that has pooled in the brain. Very specialist procedures can sometimes be undertaken to fix burst blood vessels.