Treatment options depend on the type of stroke: ischemic
or hemorrhagic. An ischemic stroke, by far the more common of the two,
occurs when blood flow to the brain is blocked or reduced. The blockage
could come from a blood clot in an artery wall or an embolism, typically
caused when a blood clot breaks off from another site and travels up
into the brain, depriving the brain of oxygen and the nutrients it
needs. A hemorrhagic stroke happens when a weakened blood vessel bursts
in or on the surface of the brain, damaging brain cells as a result.
Independent of whether the stroke is ischemic or hemorrhagic,
however, treatment for a stroke quite literally can’t begin soon enough.
So it’s important to call 911 right away if you see any signs of a stroke,
rather than try to drive yourself or have someone else drive you to the
hospital. “Calling 911 is strongly recommended if you suspect a stroke,
and one major reason is that EMTs [emergency medical technicians] can
begin critical prehospital care(NOT RECOVERY!) immediately, which can make a big
difference in outcomes,” says Jayne Zhang, M.D., attending physician of
neurology at Johns Hopkins School of Medicine.
For instance, the EMT can monitor blood pressure, oxygen levels, heart rhythm and blood glucose (since low blood sugar can mimic stroke symptoms),
assess symptoms using tools — like the Cincinnati Prehospital Stroke
Scale, or what’s known as B.E.F.A.S.T. (short for “balance, eyes, face
drooping, arm weakness, speech, time”) to quickly identify signs of
stroke — and possibly begin treatment, Zhang says. If that’s not
possible, “EMTs can alert the hospital stroke team before arrival so
they’re ready with a stroke protocol, shaving off critical minutes.”
Treatments for ischemic stroke
The goal of treatment for an ischemic stroke is to
restore blood flow to the brain. To that end, doctors will typically use
one of two methods to remove the blockage: medication to dissolve it or
surgery to remove it. Much of their decision comes down to how quickly
you get to the hospital.
Typically, if you arrive within 4½ hours from the onset
of stroke symptoms, the team will evaluate you as a candidate for a type
of clot-busting drug called tPA (short for “tissue plasminogen
activator”). There are two forms of tPA, and both are given through an
IV in the arm, but tenecteplase is administered as a quick IV
injection, while alteplase is given intravenously over the course of an
hour. Research shows both are equally effective.
