What treatment and care is usual for people who have a stroke?

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If you suspect that you (or a person you are with) is having a stroke, then call for an ambulance immediately. You should be admitted to hospital.

Immediate care

Ideally, you will be assessed quickly by a doctor. Commonly, a scan of the brain is organised as soon as possible (an MRI or CT scan). The aim of the scan is to confirm the diagnosis and to tell whether the stroke is an ischaemic or haemorrhagic (bleeding) stroke. This is very important to know as the initial treatment of the two is very different.

If an ischaemic stroke is diagnosed, and it has been less than three hours since symptoms started, you may be given a drug directly into as vein called alteplase. This is a 'clot busting' drug which aims to 'dissolve' the blood clot (The medical word for this is thrombolysis.) If the blood clot that caused the stoke can be dissolved shortly after symptoms begin, it can improve the eventual outcome as brain cells that would have died can survive.

Further early treatment

A plan for any other treatments should be devised and started as soon as possible. Treatments should be tailored to the particular need of the individual. The treatment plan can depend on factors such as the severity of the stroke, the effects it has, the cause of the stroke, and other diseases that may be present. Treatments that my be considered include the following:

* Antiplatelet medication. Platelets are tiny particles in the blood which help blood to clot. Antiplatelet medication is usually advised if you have had an ischaemic stroke (due to a blood clot). Antiplatelet medication reduces the 'stickiness' of platelets. This helps to prevent blood clots forming inside arteries, which helps to prevent a further stroke. Aspirin (low dose) is the most commonly used antiplatelet drug. Other antiplatelet drugs that may be used include clopidogrel and dipyridamole.
* If you are unable to swallow you will be given food and fluids via a tube that is passed into your stomach. (As mentioned earlier, a swallowing test is usually done early after being admitted to hospital.)
* Medication may be advised to reduce any risk factors for having a further stroke (as discussed later in this article). For example, medication to lower a raised blood pressure, sugar level, or cholesterol level.
* If you have atrial fibrillation you have an increased risk of a blood clot forming in a heart chamber and travelling to the brain to cause a stroke. If you have atrial fibrillation (or certain other heart conditions) a drug called warfarin may be prescribed. Warfarin helps to prevent blood clots forming. (It is an 'anticoagulant'.)
* If you have carotid stenosis then you have an increased risk of having a stroke. Carotid stenosis means a narrowing of one of your carotid arteries due to atheroma. If the narrowing is severe you may be advised to have surgery to 'strip out' the atheroma. Your doctor will advise if this is an option.
* If you have a haemorrhagic (bleeding) stroke and are taking an anticoagulant drug such as warfarin then treatment to reverse the effect of the anticoagulation is given.
* If a subarachnoid haemorrhage is the cause of the stroke then an operation to fix the leaking artery is sometimes an option.
* Other operations are occasionally done. For example, sometimes surgery is considered to ease the pressure within the skull if the pressure becomes high following certain types of stroke.
* As soon as possible after having a stroke you should be helped to sit up in bed, and to get out of bed and move around if you are able to do so. This is to start the process of rehabilitation as soon as possible. Also, this reduces the risk of having a deep vein thrombosis (DVT) in a leg vein which is a risk if you are inactive in bed for long periods.