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How Do I Know If I've Had a Stroke?

When a patient displays stroke-like symptoms, a doctor, often a neurologist (a doctor who specializes in managing strokes) must not only confirm the symptoms but also identify the type of stroke, its location, and the extent of brain damage. Treatment decisions hinge on all these issues. Testing is typically done quickly, since immediate treatment may limit brain and nerve damage.

The doctor first examines the patient and obtains a medical history, if possible. A standard exam includes checking blood vessels in the eyes, listening for unusual noises in the heart and in the prominent carotid arteries of the neck (a sign of atherosclerosis, or hardening of the arteries), measuring blood pressure and pulse rate, and testing strength, sensation, and reflexes (a sign of good nerve health).

CT or MRI scans are the most critical tests used to diagnose stroke.

What Are the Treatments?

Treatment is largely based on information gathered from an emergency CT scan. But upon arrival in an emergency room with a suspected stroke, the doctors and medical staff will do the following tasks:

• First, the hospital staff will assist a person with their breathing, if they are unconscious or losing consciousness, by providing supplemental oxygen.
• Next, an emergency CT scan will be obtained to determine the type of stroke and its location in the brain.
• If the person is having an ischemic stroke, a clot buster drug may be given via the veins (intravenously) to dissolve the obstructing clot. They need to be given within the first three hours of symptoms. Clot busters are not given to people with hemorrhagic strokes as it may worsen the bleeding.
• Emergency surgery might be needed to drain blood from a hemorrhagic stroke or to clip a ruptured artery or aneurysm — blocking off the vessel to halt further bleeding.

After the acute situation is managed, most patients with stroke are monitored in the hospital for several days. The care may include nutritional support. Upon release, patient and doctor carefully review necessary steps for recovery and prevention of future strokes. Advice will likely involve diet and lifestyle changes, ongoing drug treatment, rehabilitative therapy, and possible surgery for critical narrowing of the arteries in the neck (carotid endarterectomy).

People at risk of having bleeding strokes need to keep their blood pressure low, if possible through diet and lifestyle changes but, when needed, also with medication. These people are also advised not to take aspirin or ibuprofen. If someone has suffered a bleeding stroke because of an aneurysm rupture, other small aneurysms can sometimes be identified and either removed or clipped. Unfortunately, nothing can be done to reverse congenital arterial weakness.

To prevent clot strokes, some patients are first advised to take aspirin. If aspirin proves ineffective, the doctor will probably prescribe clopidogrel (Plavix), another blood-thinning drug, or warfarin (coumadin) as a last resort. People at particularly high risk for clot stroke because of an existing heart condition would be treated with heparin for acute symptoms and warfarin for long-term therapy. In some patients, surgery to prevent future clot strokes might be recommended. The most favored procedure is carotid endarterectomy, to remove plaque from large carotid arteries leading from the neck into the brain. A newer technique called carotid angioplasty can be used to widen clogged brain arteries. A stent can be inserted into the artery with a catheter: When released from the catheter, the stent expands to the size of the artery and holds it open.

Another crucial element of stroke treatment, in addition to emergency and follow-up medical care, is rehabilitation. Immediately after a stroke, other parts of the brain can compensate for areas lost to trauma by forming new neurological pathways. Intensive rehabilitative therapy basically aims to enhance the brain's own recovery efforts. A typical program may involve speech, nutritional, physical, and occupational therapy, as well as social services.

The psychological well-being of victims, families, and caregivers plays a crucial role in rehabilitation. Successful recovery depends on both the quality of care and the positive mindset of the victim. Antidepressants may be needed to alleviate post-stroke depression. Several stroke associations offer psychological support via hot lines, discussion groups, and literature.

A Spider-Venom Remedy?

Researchers have discovered that compounds in spider venom may be useful in limiting stroke damage. A spider paralyzes its prey by injecting substances that block the action of a chemical called glutamate, which controls muscle movement in insects. Glutamate also exists in the human brain, serving as an important neurotransmitter when it is present in the right quantities.

After a stroke, however, damaged nerve cells release glutamate in such large amounts that it kills surrounding cells. Hence the interest in spider venom: If the venom compounds manufactured by the spider can halt the workings of glutamate in insect prey, perhaps a version of those same compounds can also limit the cascading neuronal death that occurs during stroke in a human. Other more recent areas of experimentation to limit stroke damage, especially those due to clots, involve lowering the temperature of the brain to decrease oxygen used in the cells, and the use of catheters to attempt to retrieve the clot from the brain.

Lifestyle

Physical rehabilitation is impossible without regular, gentle aerobic exercise. Swimming in a heated pool is particularly useful for restoring lost motor function and keeping muscles loose.

People at high risk for stroke should not smoke and should eat a low-fat diet. Women at high risk should not take birth-control pills.

Mind-Body Medicine

Techniques that teach the body to relax and the mind to focus on healing can help recovering stroke victims. Among other benefits, these techniques can increase tolerance to pain and also alleviate the depression or anger that is common in the wake of a stroke. Hypnotherapy, meditation and yoga all can be useful. Some stroke victims working to restore lost muscle control and motor function benefit from biofeedback.

Nutrition and Diet

Proper diet has much to contribute to stroke prevention, but it can do little to reverse stroke damage. With prevention in mind, your diet should be rich in vitamins, minerals and other nutrients that combat high blood pressure, excessive clot formation, and atherosclerosis. Particularly noteworthy stroke-deterring nutrients include potassium, magnesium, vitamin E and the essential fatty acids contained in fish oils. Some studies suggest that selenium may also protect against stroke. A low-fat diet, however, is probably the best nutrition-related preventive step you can take for both heart attack and stroke.