Stroke

Diagnosis:

1. In the initial assessment:

• Checks for the onset of stroke symptoms
• Patient’s medical history
• Patient’s current medication
• Any drug allergy
• Past history of stroke
• Risk factors of stroke
• Past surgery, or bleeding problems

2. Conducts physical and neurological examinations

3. Orders laboratory tests (e.g. blood test)

4. Runs CT (Computerized Tomography) scan or CTA (Computed Tomography Angiography) scan

• CT or CAT scan – uses electromagnetic radiation (such as X-rays) to form cross sectional images of the brain.
• CTA – injection of a special dye into the patient’s vein, and photograph an image of blood vessels to identify anything unusual, such as the enlargement of a blood vessel (aneurysms).

5. Runs other potentially useful diagnostic tests

Treatment

How is an ischemic stroke treated? During the stroke, the goal is to restore the blood supply to the brain as soon as possible by dissolving blood clots. This will minimize the damage to the brain.

The only US Food and Drug Administration (FDA) approved drug treatment of ischemic stroke is Tissue Plasminogen Activator (tPA). tPA is a clot dissolving drug. It must be taken within 4.5 hours after the onset of stroke symptoms.

Emergency procedure:

Call 911 immediately at the first sign of stroke!

FAST is an easy way to remember the major signs of stroke. FAST stands for:

• Face – is it drooping?
• Arms – can you raise both them?
• Speech – is it slurred or jumbled?
• Time – to call 9-1-1 right away.

How is an ischemic stroke treated? During the stroke, the goal is to restore the blood supply to the brain as soon as possible by dissolving blood clots. This will minimize the damage to the brain.

DO: call 911, arrive at the emergency department within two hours!

DO NOT: simply monitor the symptoms

ics can immediately begin treatment on the way to the hospital. They can also notify the physicians at the ER, to make sure immediate examin

Key Event in the Emergency Room:

• Patient – describes symptoms
• Patient – provides details about onset of the stroke
• Physician – conducts a quick examination
• Physician – orders a CT scan
• Physician – contacts the stroke expert team

Why is a CT scan so urgent? It provides the following information:

• The size and abnormal changes of the brain
• Whether there is bleeding or not
• Size of the area of change
• Other changes

Family members should help to provide the following information:

• Details about the onset of the stroke
• Symptoms (sudden onset, first or previous occurrences, normal state)
• Other diseases
• Medications and allergies (blood thinning medication, Chinese medicine, etc.)
• Resuscitation rescue performed: CPR, AED?

Recovery assessments by health care workers typically include:

• The recovery of the nerves (specifically motor neurons) for the hand, arm, leg, and feet. Shoulder pain. Posture control.
• The ability to move, – e.g. sit, stand, turn the body, walk, and use the stairs.
• Communication, e.g. comprehension, expression, interaction, problem solving and memory.
• Bladder and bowel control.

After the stroke, will I still be mobile?

After suffering brain injury, the brain can recover. The nervous system and motor movements of the affected side of the body typically recover in a predictable way. The degree of recovery depends on a number of different factors, such as, the position and area of brain damage, the age of the patient, etc.

Helpful exercise to do after a stroke:

Treatment will vary based on individual assessment but usually focuses on:

• Range of motion exercises
• Upper limb function training
• Torso control exercises
• Bed mobility training
• Body rotation exercises
• Balance exercises
• Walking posture training
• Using the stairs training
• Aerobic exercises

Mental or emotional health problems:

After a stroke, it is common to have some mental and psychological problems.

• Depression (One-third of stroke patients will have depression, often occurring 3-6 months after onset
• Anxiety
• Post-traumatic stress syndrome (PTSS)
• Unstable emotion
• Irritability, change in reasoning
• Loss of emotional control, memory loss 
• Etc.

Cause of mental or emotional health problems

The physical changes that occur due to the brain being damaged during the stroke cause the loss of daily functional ability. Physical and mental disability will indirectly affect mental health and mood.

Mental and emotion problems usually go undetected by the patient so detection will rely on the family and caregivers. Some common symptoms are:

• Disinterest in doing things, bored, lack of joy
• Low spirit, feels of despair
• Tired, low on energy, a constant lack of sleep (insomnia), or feeling sleepy all day
• Poor appetite and weight loss
• Unable to concentrate, feeling less important than others (inferior) and guilty, cannot pull oneself together
• Very slow in movement, feel fidgety
• Have suicidal thoughts

If any of the above symptoms are observed, seek help from physicians and health care professionals immediately to increase chance of recovery.

Content by Dr. Samuel Yip (Neurologist), Dr. Thomas Ho (Family Physician), Dr. Kendall Ho (Emergency Physician)