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Diagnosis and Treatment

After making sure they get immediate medical attention at the first sign of a stroke, the first step in caring for someone with stroke symptoms is to diagnose the stroke.

Diagnosis:

There are two common diagnostic tests for stroke:

  • CT (Computerized Tomography): A CT scan is the first test done to see if symptoms are caused by bleeding (a hemorrhagic stroke) or a brain tumor. These can be seen right away on a CT, while an ischemic stroke will not be seen on a CT for several days.
  • MRI (Magnetic Resonance Imaging) and MRA (Magnetic Resonance Angiography): An MRI/MRA is done the first or second day to show where the damage is in the brain and if there is any blockage in the blood vessels. When an MRI/MRA cannot be done due to a pacemaker or for other reasons, a second CT scan may be taken.

These tests may be done to help find the cause of a stroke, although the cause cannot always be found:

  • Carotid Duplex: A carotid duplex is an ultrasound (sound wave) test that shows the blood flow of the carotid arteries. If there is blockage, further testing may be needed.
  • Echocardiogram: An echocardiogram is an ultrasound that shows the chambers, valves and function of the heart.
  • TCD (Transcranial Doppler): A TCD is an ultrasound that shows the arteries in the brain and detects slow or blocked blood flow.
  • Coagulation Tests: Blood is drawn and tested to detect blood clotting problems.
  • TEE (Transesophageal Echocardiogram): A TEE detects problems with the chambers and valves of the heart. It can also detect an irregular heartbeat or defect in the septum wall of the heart that may cause blood clots to form in the heart, break off and travel to the brain.
  • Angiogram: An angiogram is used to detect:
    • Blood clots in the arteries in the brain
    • Weak spots, called aneurysms, in the lining of the blood vessels
    • Defects of the blood vessel walls
    • The amount of blockage in a vessel

Treatment:

Treating a stroke requires immediate care, rehab therapy to improve functioning from resulting deficits, and care for risk factors. This often includes medication and lifestyle changes.

Because treatment needs to start right away, many stroke victims are given T-PA (tissue plasminogen activator), a "clot-busting" medication that's administered through a vein in the arm or an artery in the groin within 4½ hours of the start of the symptoms, T-PA is designed to break up a clot that's blocking the blood flow to the brain. 

Before T-PA can be given, a checklist is followed and a special type of CT scan is done to detect a blood clot or any bleeding in the brain.

T-PA cannot be given if bleeding is present or if there are certain other conditions. The doctor will explain the risks and benefits.

Medications Used in Treatment:

These are some of the medications that your doctor may prescribe to help prevent another stroke. The choice of medications depends on the type of stroke

Antiplatelet medications are used to prevent blood cells from sticking together and forming clots. Some of the most common are:

  • Aspirin: Aspirin is given to reduce the "stickiness" of the blood, which reduces the risk of stroke. Aspirin comes in plain or coated tablets. Coated tablets are less irritating to the stomach. There are many brands and strengths of aspirin, and it's important to buy the correct strength. To be sure, ask your pharmacist.
    Aspirin can cause nausea, stomach burning, or indigestion. Call your doctor right away if you have:
    • Severe stomach pain
    • Bruising or bleeding
    • Bloody or dark urine
    • Bloody or dark stools
    • Ringing in the ears
  • Clopidogral (Plavix®): Plavix may be prescribed to help stop the blood from forming clots in the blood vessels. Some possible side effects include indigestion, nausea, committing, rash and diarrhea.Call your doctor right away if you have:
    • Severe stomach pain
    • Bruising or bleeding
    • Bloody or dark urine
    • Bloody or dark stools
    • Fever or chills
  • Aggrenox®: Aggrenox is a medication that contains aspirin and dipyridamole. Aggrenox is used to help prevent future strokes in people who have already had a TIA or stroke. It helps prevent clots from forming that could block a blood vessel in the brain and cause another stroke. Call your doctor right away if you have:
    • Severe headache
    • Severe stomach pain
    • Bloody vomit that looks like coffee grounds
    • Blood in stool or urine
    • Ringing in the ears
    • Yellowing of skin or eyes
    • Skin rash with hives or intense itching
  • Call 911 or go to the nearest emergency room if you have:
    • Swelling of the face or eyelids
    • Wheezing or trouble breathing
    • Severe dizziness or drowsiness
    • Chest pain
    • Signs of a stroke:
      • Sudden numbness or weakness
      • Sudden confusion, or trouble speaking or understanding
      • Sudden trouble seeing out of one or both eyes
      • Sudden trouble walking, dizziness, or loss of balance or coordination
      • Sudden severe headache with no known cause

Anticoagulants are often called blood thinners. These medications decrease the blood's clotting ability, which helps prevent clots from forming in blood vessels. Here are some of the most common:

  • Warfarin (Coumadin®): The amount of Coumadin you take is determined by the rate at which your blood clots. You doctor will be ordering a blood clot called an INR to check your blood clotting time. Your Coumadin dose may or may not be changed, depending on your text results. Before taking any prescription or over-the-counter products, check with your doctor or pharmacist.
    • Coumadin, Vitamin K and Your Diet: Vitamin K counteracts the effects of Coumadin. Do not take any vitamin K supplements. There is a high amount of vitamin K in broccoli, kale, Brussels sprouts, spinach and greens (collard, mustard, and turnip), and a moderate amount in green leafy and romaine lettuces, asparagus and cabbage. Do not make any major changes in how much you eat these foods. If you like these foods and eat them often, you can continue to do so, but you need to be consistent. The key is to avoid major changes in vitamin K intake in your diet from week to week
  • Direct Thrombin Inhibitor (Pradaxa®): Dabigatran (Pradaxa®) is an anticoagulant that's best taken with a glass of water (with or without food).
  • Factor Xa Inhibitors (Xarelto® and Eliquis®): Of these medications, Xarelto is taken once daily with the evening meal while Eliquis is taken twice a day, with or without food.

 

Anticoagulant Safety Measures: Safety is vitally important when taking anticoagulants, since different medications work differently, so be sure to follow these measures:

  • Tell your doctor or dentist that you're taking an anticoagulant before you plan any medical or dental procedures. You may be instructed to stop taking it for a short time.
  • Check with your doctor before:
    • Taking any aspirin or aspirin products
    • Taking any NSAIDs (anti-inflammatory medications), such as naproxen (Aleve®) or ibuprofen (Advil®)
    • Drinking alcoholic beverages
  • Contact your doctor right away if you have severe stomach or abdominal pain, bruises, bleeding, bloody or dark urine, yellowing of the skin or the whites of your eyes,fever, chills, or sore throat.
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