Emergency treatment of stroke
The first 3 hours are essential to treatment and outcome after a stroke. The correct treatment given within a couple of hours of the onset of symptoms can make a huge difference to the outcome. It can minimise the brain damage and limit physical and mental problems. Unfortunately far too frequently the diagnosis and treatment of stroke is not given a high enough priority compared to conditions such as a heart attack.
In the emergency department
When you are in the emergency department the doctors should assess you to determine if you have had a stroke or a transient ischaemic attack (TIA) also known as a mini stroke. If you have had a stroke the doctors need to decide if you have had an ischaemic (often caused by a blood clot) or haemorrhagic (caused by bleeding) stroke.
In the ideal world this would be done with a combination of physical examination, blood tests, a tracing of your heart (ECG) and an emergency CT or MRI scan of your brain within 1-2 hours of arriving in the emergency department. This is absolutely essential for you to receive the correct treatment. In most hospitals you probably won’t get a CT or MRI scan within 1-2 days, never mind 1-2 hours.
Ischaemic Stroke
If you are diagnosed with an ischaemic stroke the aim of treatment is to dissolve the clot within 3 hours of the onset of symptoms and minimise brain damage. The drug used to dissolve the clot in the brain is exactly the same as is given to people who have had a heart attack. The National Institute for Health and Clinical Excellence (NICE) has just issued guidelines on the treatment of ischaemic stroke.
NICE Guidelines for treatment of ischaemic stroke
“You should receive the clot busting drug (called tPA) within 3 hours of the onset of stroke symptoms after a haemorrhagic stroke has been ruled out. It should be given by a physician trained and experienced in the management of acute strokes and only in centres with facilities that enable it to be used in full accordance with it’s marketing authorisation.”
Unfortunately this will probably mean that only large hospitals and teaching hospital will be able to do it. So your chances of receiving this cutting edge treatment depend entirely on where you live.
How does the clot busting drug work?
It is given into a drip into your blood and it reaches the blocked blood vessel in the brain. It dissolves it restoring the blood flow to that part of the brain. It will minimise the damage caused and give you the best chance of full recovery. The same drug is given after a heart attack and enables people to avoid the heart damage and get back to a normal life.
Why can’t all stroke patients get the clot-busting drug?
If you have had a haemorrhagic stroke the clot-busting drug will cause even more bleeding, making your stroke much worse and quite possibly killing you. So you can see why it’s essential to get the correct diagnosis.
What if my local hospital can’t use the clot-busting drug?
All you’ll receive is an aspirin tablet and the standard stroke care. Not a brilliant option.
Haemorrhagic Stroke
If you’ve had a haemorrhagic stroke you’ll receive supportive treatment to minimise damage. You’ll have a physical examination, blood tests and ECG done. If you have high blood pressure you’ll be started on treatment to slowly reduce it. If your blood sugar is high it will be reduced with insulin. If you have an aneurysm (ballooning of the brain artery) you may have an emergency operation to fix it or it may be left and assessed over several days. You will be admitted to the hospital and will soon start the long period of stabilisation, treatment and rehabilitation.
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