Stroke Patients: When To Visit An Urgent Care Center

Stroke is a life-threatening medical emergency that requires immediate attention. It is the third leading cause of death in the nation and can lead to incapacitation or death within minutes. When a person experiences a stroke, blood flow to the brain is interrupted by a clogged or burst artery, depriving the brain of oxygen and causing brain cells to die. This can result in permanent brain damage or even death, with the risk increasing every minute that passes without treatment. Therefore, it is crucial to recognise the signs of a stroke and act quickly by calling 911 to seek emergency medical care.

Recognising stroke symptoms

Recognising the signs of a stroke and acting quickly are crucial to achieving the best treatment outcomes. The National Stroke Association, American Heart Association, and others use the acronym FAST to educate the public on how to detect stroke symptoms. This includes:

• Facial drooping: Is one side of the person's face drooping or numb? Ask them to smile; their smile may appear uneven.
• Arm weakness: Is one arm weak or numb? Ask the person to raise both arms; if one arm drifts downward, this could indicate a stroke.
• Speech difficulties: Is the person's speech slurred or garbled? Are they struggling to find commonly used words or having other difficulties talking? Ask them to repeat a simple sentence.
• Time to call 911: Stroke is a medical emergency. Every minute counts, so call 911 immediately if you recognise any of the above symptoms. Note the time the symptoms first appeared.

Other possible stroke symptoms include:

• Numbness or weakness in the face, arm, or leg, especially on one side of the body
• Confusion, trouble speaking or understanding speech
• Vision problems in one or both eyes
• Dizziness, loss of balance or coordination, or trouble walking
• A sudden, severe headache with no known cause

These symptoms can come on suddenly and without warning, so it's important to act FAST. If you or someone else is experiencing any of these symptoms, don't wait or try to drive yourself to the hospital. Call 911 immediately to ensure you get the urgent care you need.

Immediate action to take if a stroke is suspected

If you suspect that someone is having a stroke, it is important to act quickly and calmly. Here are the immediate steps you should take:

Recognise the signs and call emergency services

Use the acronym FAST to help you recognise the signs of a stroke:

• Face: Check for facial weakness, such as a drooping mouth or uneven smile.
• Arms: Ask the person to raise both arms. They may only be able to raise one arm if they are experiencing arm weakness.
• Speech: Look for speech problems, such as slurred or difficult-to-understand speech.
• Time: If you observe any of the above signs, it is time to call emergency services immediately.

Call 911 in the US or 999/112 in the UK, and inform them that you suspect a stroke. Do not try to drive the person to the hospital yourself, as their symptoms could worsen on the way.

Make the person comfortable and keep them safe

While waiting for emergency services to arrive, ensure the surrounding area is safe and keep the person comfortable and supported.

• Place the person in a comfortable position, lying on their side with their head and shoulders slightly raised.
• Loosen any tight clothing, such as scarves or tight collars.
• Keep them warm with a blanket or coat if they feel cold.
• Check and monitor their airway and breathing.
• Reassure the person that help is on the way.

Do not give food or water

Do not give the person any food or liquids, as they may have difficulty swallowing.

Monitor and note symptoms

Note the person's symptoms and look for any changes in their condition. It is important to provide emergency personnel with as much information as possible. Try to remember the time the symptoms started by checking a clock.

Prepare to treat an unresponsive person

If the person becomes unresponsive, prepare to treat them as an unresponsive casualty. This may include placing them in the recovery position and performing cardiopulmonary resuscitation (CPR) if necessary.

Treatment options for stroke patients

Stroke patients require immediate medical attention to prevent long-term damage to the brain and body. The treatment options depend on the type of stroke, which can be categorised as either ischemic or hemorrhagic. Ischemic strokes are caused by a blood clot blocking blood flow to the brain and account for approximately 87% of strokes. Hemorrhagic strokes, on the other hand, are caused by bleeding in the brain and account for about 13% of strokes but are more lethal. Here are the treatment options for stroke patients:

Emergency Treatment for Ischemic Stroke:

• Thrombolytic Therapy: The primary treatment option for ischemic stroke is thrombolytic therapy, which breaks down blood clots. Tissue plasminogen activator (tPA) is the most frequently used thrombolytic. It is a protein that catalyzes the conversion of plasminogen to plasmin, the enzyme that breaks down clots. Alteplase (Activase) is the only FDA-approved tPA for stroke, but tenecteplase (TNKase) is also used due to its success in clinical trials and cost-effectiveness.
• Blood Thinners: If a patient cannot receive tPA, blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin) may be administered 24-48 hours after a stroke to reduce the risk of new blood clots.
• Statins: These medications are given to reduce the risk of future strokes.
• Thrombectomy: If drugs do not adequately break up the blood clot, a thrombectomy may be performed. This involves using a catheter to manually remove the clot. The procedure must be initiated within 3 hours, or in some cases, up to 4.5 hours of symptom onset.
• Carotid Endarterectomy: If the ischemic stroke is due to a blocked carotid artery, surgeons may recommend a carotid endarterectomy to remove plaques and blockages from these arteries to improve blood flow and reduce the risk of future strokes.

Emergency Treatment for Hemorrhagic Stroke:

• Medications to Stop Bleeding: Unlike ischemic strokes, treatment for hemorrhagic strokes does not involve blood thinners as they would worsen the bleeding. Instead, medications such as vitamin K or antihypertensives may be given to help stop bleeding in the brain and lower blood pressure.
• Antiepileptics: If the stroke leads to seizures, antiepileptic medications may be administered.
• Surgery: Depending on the damage to the blood vessel in the brain, surgery may be required. Options include endovascular repair (coiling), aneurysm clipping, arteriovenous malformation (AVM) surgery, and decompressive craniectomy to relieve pressure and swelling in the brain.

Supportive Treatments Following Stroke:

• Feeding Tube: Some stroke patients may require a feeding tube, especially if they have dysphagia (difficulty swallowing).
• IV Fluids: IV fluids are given to prevent dehydration.
• Supplemental Oxygen: If the patient has hypoxemia (low blood oxygen), supplemental oxygen may be provided.
• Nutritional Supplements: Nutritional supplements are given to support the patient's recovery.
• Compression Stockings: These are used to prevent blood clots from forming.

Rehabilitation:

Rehabilitation after a stroke depends on the extent of the damage and the area of the brain affected. It may include physical rehabilitation, such as routines that the patient can do at home, as well as corrective measures to help with fine motor activities, bowel or bladder control, and speech and language therapy.

Risk factors and prevention methods

Strokes are a leading cause of adult disability and the fifth most common cause of death in the US. They occur when a blood vessel in the brain either bursts or becomes blocked by a clot, cutting off the blood supply to the brain. This quickly results in the death of brain cells, which can lead to permanent brain damage or even death.

There are several risk factors for strokes that are beyond an individual's control. For example, people of colour are disproportionately affected by strokes due to social factors such as a lack of access to quality healthcare and nutritious food. Other factors include living in a poor or rural area, low education or income level, and a lack of health insurance. Additionally, women are at a higher risk of stroke than men, with around 55,000 more women suffering strokes each year.

However, there are also many risk factors that can be controlled or treated. The most significant risk factor is high blood pressure, which doubles or quadruples the likelihood of a stroke. Lowering blood pressure through medication, diet, and exercise can significantly reduce the risk of stroke. Obesity is another factor that increases the risk of stroke, and losing weight can help mitigate this risk.

A person's diet also plays a crucial role in stroke prevention. A healthy, balanced, and low-fat diet that includes plenty of fruits and vegetables, whole grains, and low-fat dairy products can help maintain healthy blood pressure and cholesterol levels. It is also important to limit salt and alcohol intake, as both can contribute to high blood pressure.

In addition to diet, regular exercise is essential for stroke prevention. Moderate-intensity aerobic activity, such as cycling or fast walking, for at least 150 minutes a week can help lower cholesterol and blood pressure. For those who have had a stroke, it is important to consult with a rehabilitation team before starting an exercise routine.

Finally, smoking is a significant risk factor for stroke, as it narrows the arteries and makes blood more likely to clot. Quitting smoking can greatly reduce the risk of stroke and improve overall health.

Long-term effects and recovery

The long-term effects of a stroke depend on the stroke's severity, the area of the brain affected, and the patient's overall health. The location and extent of the damage to the brain tissue are the primary factors determining how a stroke affects a person.

Physical Effects

Paralysis, or loss of voluntary muscle movement, is a common long-term physical effect of a stroke. This usually occurs on the side of the body opposite to the side of the brain that has been damaged. For example, a person who has experienced a left hemisphere stroke may have impaired muscle movement on the right side of their body.

Other physical effects include:

• Sensory loss, where patients may no longer be sensitive to touch, pain, or temperature, and may also be unable to recognize objects they are holding.
• Limb numbness.
• Reduced bowel control, with patients experiencing difficulty controlling bowel movements.
• Chronic pain syndrome, resulting from muscle weakness, particularly in those who have not moved their joints for a long time.
• Persistent headaches, which can affect up to 23% of people who have experienced a stroke.

Emotional and Personality Effects

Emotional disturbances are common post-stroke symptoms that can significantly impact a person's quality of life. Depression is often experienced by stroke patients, and they are more likely to express negative thoughts due to brain damage. This depression may also be a reaction to the permanent damage caused by the stroke.

Post-stroke anxiety is also common, with symptoms including extreme worry and difficulty controlling anxiety.

Cognitive Effects

Cognitive effects of a stroke can include memory loss and trouble speaking. There is a high risk of developing dementia within a year of a stroke, particularly with left-hemisphere strokes, which affect how a person thinks or plans.

Aphasia, a language disorder that results from damage to the area of the brain that controls language expression, reading, and writing, can also occur after a stroke.

Recovery

The recovery process after a stroke varies for each person, but it often involves rehabilitation and therapy to help improve movement and address other long-term effects. Rehabilitation should start as soon as possible, ideally within 24 hours after a stroke, and should include physical, occupational, and speech-language therapy.

The first three months after a stroke are the most critical for recovery, with most patients entering and completing an inpatient rehabilitation program or making significant progress in their outpatient therapy sessions. During this time, patients may experience spontaneous recovery, where skills or abilities that seemed lost suddenly return as the brain finds new ways to perform tasks.

However, setbacks can also occur, such as pneumonia, a heart attack, or a second stroke, which may require adjustments to rehabilitation goals.

While physical, occupational, and speech therapies are the key components of stroke rehabilitation, new treatments are constantly being explored, such as noninvasive brain stimulation and technology-assisted rehabilitation.

Frequently asked questions