On admission to hospital, you will be assessed, screened and problems identified so that the appropriate management can be started as soon as possible.
The initial assessment will take into account:
• Orientation – are you able to answer three simple question, who are you, where are you and what time is it? – this helps to determine the degree of the damage and some clue as to wherethe damage might be.
• Positioning, moving and handling – assessment of extent of any weakness or paralysis of the limbs
• Swallowing – can you safely take solids and fluids normally? This will impact your nutrition
• Transfers (for example, from bed to chair) – this will help with actual nursing and rehabilitation of the patient towards independance
• Pressure area risk – if the patient s unable to move and they are bedbound there is a risk of developing pressure sores which are preventable with appropriate care
• Continence – will they need a urinary catheter so that they are not lying in a wet bed
• Communication, including the ability to understand and follow instructions and to convey needs and wishes
• Nutritional status and hydration – poor nutritional status leads to slower recovery and other complications.
This initial assessment is going along side the clinical assessment / examination which include CT brain scan, maybe a MRI scan, ECG and blood tests.Once it is determined what type of stroke has occurred, i.e. is it an ischaemic (blockage) or is it a haemorrhagic stroke, only then can the appropriate treatment may begin.
The main goal in treating ischemic stroke/TIA is to restore the blood flow to brain. This goal can be achieved in a variety of ways. The best patient outcomes are in dedicated stroke units, where the assessment and treatments are streamlined.
Most recently, clot-busting drugs such as tissue plasminogen activator (tPA) can be given into the arteries through a drip. However, these drugs can only be used if the patient presents to an appropriate hospital within around 4.5 hours, sooner the better. When given, they are extremely effective but, as they are blood thinners, they do have the potential to cause side-effects such as abnormal bleeding haemorrhage, both intracranial or else where, which could be minor or major; anaphylaxis and angiodema. Therefore, they are only given by experts in dedicated stroke centres. Unfortunately there are some situations when this option is not appropriate or you for example if you have already received a “clot-busting” drug with the previous 3 months or you have had major surgery recently or you have bleeding disorder to name a few.
Anti-platelet drugs (e.g. aspirin, clopidogrel) are also often used for secondary prevention, to prevent further Stroke/TIAs. They are usually given for life.Anti-cholesterol drugs (statins) are also often used and given for life. These drugs are often given no matter what the cholesterol measurements are, as there is some evidence that their beneficial effect extends beyond that of simply reducing cholesterol.
Arteries in neck that are shown by scanning to be narrowed can be widened by removal of plaque using a surgical procedure called carotid endarterectomy. Angioplasty can also be used where a balloon is inserted that widens the carotid artery and holds it open with a metallic mesh tube called a stent.
It is important in hemorrhagic stroke to ensure BP is fully controlled.Depending on the size and location of the bleed, surgery can be used to remove (evacuate) it. A search is often made to determine whether there is an underlying vessel abnormality such as, an aneurysm (which could be clipped or embolised) or arteriovenous malformation (AVM) (which could be removed surgically or treated with the latest gamma knife therapy).
If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, clipping could fix it by placing a small clamp at the base of the aneurysm, isolating it from the brain circulation and preventing it from bursting again.Aneurysm embolisation (coiling) can also be used to treat this type of aneurysm. Here, a catheter is inserted into the aneurysm to deposit a tiny coil that fills the aneurysm, causing clotting and sealing off the aneurysm off from arteries.