Stroke

A stroke happens when:

• A clot blocks a blood vessel in the brain (called an ischemic stroke) or
• A weakened blood vessel in or near the brain bursts and bleeds (called a hemorrhagic stroke).

Both situations interrupt blood flow, starving the area of oxygen and nutrients, and damaging brain cells. Stroke can lead to death or permanent disability.

Diagnosis

Time is of the essence when patients are admitted to the Emergency Room with a suspected stroke. Certain treatments must be given within a few hours, from the start of the first symptom, in order to be effective. Our acute stroke team works together quickly to assess and immediately transport the patient for a CT scan as rapidly as possible.

A computed tomography (CT) scan uses radiation to create detailed images of the brain. This scan helps doctors determine the type of stroke (ischemic vs. hemorrhagic), its location and the extent of brain tissue injury.

Doctors may also order an MRI brain scan. Magnetic resonance imaging, with its large magnetic field, produces a sharper, more detailed image than a CT scan. Using techniques developed here at Nano Hospitals, doctors review the MRI scan to help diagnose small, deep injuries within brain tissue.

There are other imaging tests that help diagnose and assess stroke:

• CTA: A computed tomographic angiography test, which requires an injection of special contrast dye, provides images of blood vessels supplying the brain. Doctors rely on this scan to look for abnormalities such as aneurysms (a blood-filled bulge in the vessel wall).
• MRA: A magnetic resonance angiography test maps blood vessels in the brain. This test can also help doctors pinpoint a cerebral aneurysm (a blood-filled bulge in the vessel wall in the brain).
• Perfusion MRI or CT: These tests map blood flow in the brain, and can help doctors detect brain areas with reduced blood flow.

Besides imaging scans, doctors may order ultrasound blood flow tests to check the condition of the neck and head arteries that supply blood to the brain, or an EEG (electroencephalogram) to assess the brain’s electrical activity.

Stroke is a medical emergency and requires immediate medical treatment. Treatment for an ischemic stroke (dissolving or removing a clot) is different from treatment for hemorrhagic stroke (stopping a brain bleed). An accurate diagnosis is essential before treatment begins.

Beth Israel Deaconess Medical Center offers a number of advanced treatments for stroke, including:

Tissue Plasminogen Activator (tPA)

Our acute stroke team provides rapid diagnostic assessment and intravenous tPA for patients with acute ischemic stroke who present in the Emergency Department within a few hours from symptom onset. This FDA-approved, clot-busting drug can stop a stroke in progress and reduce disability.

Mechanical Clot Disruption

Doctors are now able to treat patients who have an ischemic stroke but arrive in the Emergency Department too late to benefit from tPA, or those who do not respond to tPA. Using specialized neuro-interventional, minimally invasive techniques, doctors can introduce tiny devices through veins and catheters to trap, retrieve and/or suction blood clots blocking vessels in the brain, and/or administer tPA. They can also introduce stents (a miniature mesh tube) to prop open a blocked artery, and coils to deflate blood-filled balloon-like pouches inside an artery (called an aneurysm).

Neurosurgery

Surgery may be needed to stop the bleeding for patients who have a ruptured aneurysm, or to save someone’s life after a stroke, if there is severe swelling of the brain. Our neurosurgeons can position a metal clip at the base of an aneurysm, or remove the abnormal vessels in an arteriovenous malformation (AVM). Sometimes surgeons can coil or clip aneurysms using minimally invasive techniques instead of an open surgical procedure.

Carotid Endarterectomy or Carotid Stenting

Our vascular surgeons are recognized for exemplary results in surgical repair of the carotid artery (endarterectomy) for stroke prevention. In this procedure, doctors surgically remove blockage/fatty deposits from the carotid artery in the neck. Our vascular surgeons and neuro interventionalists are also experienced in performing carotid artery stenting, an endovascular, catheter-based procedure, which unblocks the narrowing of the carotid artery to prevent a stroke in patients who might be at high risk from surgery.

Patent Foramen Ovale (PFO) Closure (for selected patients)

Another stroke prevention treatment, this procedure closes an opening or flap in the wall between the upper two chambers of the heart. This heart defect may cause blood clots, which can move to the brain and cause a stroke.

Clinical Trials

Certain patients who have had a stroke may qualify for treatment in a clinical trial. These are scientific studies that are designed to find better treatments for stroke based on the most updated information from around the world.

Additional Medications

Doctors may also prescribe a number of medications during hospitalization and at discharge to prevent recurrent stroke. These can include:

• Medications to interfere with the blood’s ability to clot, such as anticoagulants (blood thinners like coumadin) or antiplatelets (aspirin)
• Medications to treat risk factors for stroke, such as hypertension (high blood pressure), high cholesterol and diabetes

Rehabilitation

Recovery from stroke depends on which area of the brain was affected and how much brain tissue was damaged. Stroke complications can include paralysis or loss of muscle movement; trouble talking or swallowing; problems with memory or judgment; behavior changes; and pain.

Recovery can be a long, difficult and lifelong process. Our neurologists can help plan your rehabilitation program, which may include:

• Physical therapy to help you regain as much movement as possible
• Occupational therapy to help you in everyday tasks and self-care
• Speech therapy to improve swallowing and speech problems