Getting To A Stroke Center: Time Sensitivity And Treatment

A stroke is a life-threatening medical emergency that requires immediate attention to prevent permanent damage or death. The faster a person receives treatment, the better their chances of recovery without disability. Recognizing the signs of a stroke and acting quickly is crucial, as every minute that passes, the brain loses necessary blood flow, resulting in the death of approximately 1.9 million brain cells. Therefore, knowing how long it takes to get to a stroke center is of paramount importance, as it can significantly impact the outcome for the patient.

Recognising stroke symptoms

Recognising the signs of a stroke is critical. Acting fast can reduce the risk of death and long-term disability. The FAST acronym is an easy way to remember the most common symptoms:

Face Drooping

One side of the face may droop or feel numb. Ask the person to smile—if their smile is uneven, this could indicate a stroke.

Arm Weakness

Check if the person can raise both arms. If one arm is weak and drifts downward, this could be a sign of one-sided body weakness.

Speech Difficulty

People having a stroke may slur their words or have trouble speaking. Ask them to repeat a simple sentence and check for any abnormalities.

Time to Call 911

If someone is exhibiting any of the above symptoms, call 911 immediately. It is crucial to act quickly, as every minute counts when treating a stroke. Make a note of when the symptoms first appeared.

While the FAST checklist covers the most common symptoms, there are other possible indicators of a stroke:

• Numbness, especially on one side of the body
• Confusion, disorientation, or trouble understanding speech
• Poor coordination or balance issues
• Severe headache with no known cause
• Vision problems in one or both eyes
• Difficulty swallowing
• Involuntary eye movements

Calling emergency services

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

• Face: Check for any weakness or drooping on one side of the face. Ask the person to smile and observe if their smile is straight or lopsided.
• Arms: Ask the person to raise both arms. Observe if they can hold them up or if one arm drifts downward.
• Speech: Check for slurred speech or difficulty in understanding speech. Ask the person to repeat a simple sentence.
• Time: If the person exhibits any of these signs, call 911 (or your local emergency number) immediately.

Make the call: When calling 911, notify the operator that you suspect the person is having a stroke. This will help paramedics prepare and ensure the hospital is ready for their arrival. Provide the address or location of the stroke victim and answer any questions the operator may have.

Keep track of symptoms: Note the person's symptoms and any changes in their condition. If possible, try to remember the time the symptoms started. This information will be crucial for medical personnel. Also, note any known medical conditions, such as high blood pressure, heart disease, sleep apnea, or diabetes.

Talk to the person: While waiting for the ambulance, gather as much information from the person as possible. Ask about any medications they are taking, health conditions, and known allergies. This information will be valuable for medical personnel and doctors.

Encourage the person to lie down: If the person is sitting or standing, encourage them to lie down on their side with their head elevated. This position promotes blood flow to the brain. However, do not move the person if they have fallen. Instead, loosen any tight clothing to keep them comfortable.

Perform CPR if needed: If the person becomes unconscious, check their breathing and pulse. If they are not breathing, start performing CPR. If you don't know how, the 911 operator can guide you through the process until help arrives.

Remember, time is critical in responding to a stroke. Calling emergency services and acting quickly can significantly impact the person's recovery and reduce the risk of permanent disability.

Stroke diagnosis

Recognising the Signs and Calling for Help:

The first step in stroke diagnosis is recognising the signs and calling for emergency medical assistance. A stroke is a life-threatening condition where the brain doesn't receive enough blood and oxygen due to a blocked or burst blood vessel. It is important to remember the acronym BE FAST or FAST:

• Balance: Watch for a sudden loss of balance.
• Eyes: Look for sudden loss of vision or double vision.
• Face: Ask the person to smile and observe if one side of the face droops, indicating muscle weakness or paralysis.
• Arms: Check if the person can raise both arms evenly or if one arm droops due to muscle weakness.
• Speech: Observe if the person has difficulty speaking or slurs their words.
• Time: Act quickly and call 911 or emergency services, as time is critical in stroke treatment.

Initial Assessment by Ambulance Crew:

When the ambulance arrives, the crew will initiate a stroke exam, including a physical and neurological assessment. They will:

• Ask about your symptoms and medical history.
• Perform a physical exam to check vital signs, mental alertness, numbness, weakness, and speech, vision, or walking difficulties.
• Conduct a neurological exam to test reflexes and perform simple actions to assess different parts of the brain.

Imaging Tests at the Hospital:

Once you reach the hospital, doctors will perform imaging tests to visualise the brain and understand the extent and location of the stroke:

• Computed Tomography (CT) Scan: This is usually one of the first tests, using X-rays to detect bleeding in the brain, damage to brain cells, and other issues causing stroke symptoms.
• Magnetic Resonance Imaging (MRI): MRI uses magnets and radio waves to produce more detailed images of the brain, helping diagnose small, deep injuries.
• CT or MR Angiogram: A dye is injected into the veins to visualise blood vessels and identify abnormalities like aneurysms.
• Carotid Ultrasound: This test uses sound waves to examine the carotid arteries supplying blood to the brain, checking for plaque buildup that may block blood flow.
• Trans-cranial Doppler (TCD) Ultrasound: TCD helps identify the blocked artery in the brain by measuring blood flow using sound waves.

Blood Tests:

In addition to imaging tests, doctors will also perform a series of blood tests to understand the cause of the stroke:

• Complete Blood Count (CBC): This measures overall blood health and helps diagnose infections, clotting problems, anaemia, etc.
• Serum Electrolytes: Electrolytes can indicate confusion, muscle weakness, dehydration, or kidney problems, which may contribute to stroke-like symptoms.
• Blood Clotting Tests: These tests determine if the stroke was caused by a clot (ischemic stroke) or bleeding (haemorrhagic stroke) by assessing how quickly the blood clots.
• Heart Attack Tests: Examinations to determine if there are any heart attack symptoms or underlying heart problems that may have led to the stroke.
• Thyroid Tests: Measuring thyroid hormone levels to check for hyperthyroidism, which increases the risk of atrial fibrillation and stroke.
• Blood Glucose: This test measures blood sugar levels, as low blood sugar can cause stroke-like symptoms, especially in diabetics.
• Cholesterol Tests: Examining if high blood cholesterol is a contributing factor to the stroke.

Final Diagnosis and Treatment:

Based on the results of the imaging tests and blood work, the stroke emergency team will finalise the diagnosis and determine the best course of treatment. They will:

• Ask about the onset of symptoms and medical history.
• Perform a physical and neurological examination.
• Review the results of imaging tests and blood work.
• Determine the type of stroke (ischemic or haemorrhagic) and the appropriate treatment.

It is crucial to act quickly and seek medical attention if you or someone you know is exhibiting signs of a stroke. The faster the diagnosis and treatment, the better the chances of recovery without disability.

Stroke treatment

A stroke is a life-threatening medical emergency that requires immediate attention. The faster a person having a stroke gets medical care, the more likely it is that the effects of the stroke will be limited or even reversible. Here is a general guide on what to expect during stroke treatment and the recovery process.

Day 1: Initial Treatment

When a patient arrives at the hospital, they will be taken to the emergency department to stabilize their condition and determine the type of stroke. This is done through a series of tests, including a CT scan, blood tests, and neurological examinations. The two main types of strokes are ischemic and hemorrhagic. Ischemic strokes, which account for about 80% of all strokes, occur when a blood clot blocks blood flow in the brain. Hemorrhagic strokes are caused by a blood vessel rupture in the brain, resulting in bleeding in or around the brain.

If the stroke is ischemic and the patient arrives at the hospital within 3 hours of the first symptoms, they may be administered a "clot-busting" drug called a thrombolytic to break up blood clots. This medication can significantly improve the chances of recovery and reduce long-term disabilities. For hemorrhagic strokes, the treatment focuses on controlling the bleeding, and surgery may be required to repair a weak spot or break in a blood vessel or to stop the bleeding.

The First Week After a Stroke

During the first week after a stroke, the patient will be discharged from the hospital to a rehabilitation facility or their home, depending on the severity of the stroke and their recovery progress. The patient will begin their initial rehabilitation plan, which may include physical therapy, occupational therapy, and speech therapy. Physical therapy helps patients regain motor skills and prepare for life after a stroke, while occupational therapy focuses on improving daily activities such as eating, drinking, and dressing. Speech therapy is crucial for helping patients regain their ability to speak, communicate, and swallow.

The First Three Months of Recovery

The first three months after a stroke are crucial for recovery, and most patients will enter and complete an inpatient rehabilitation program or make significant progress in their outpatient therapy sessions. The goal of rehabilitation is to restore function as closely as possible to pre-stroke levels or develop compensation strategies to work around any remaining impairments. It is not uncommon for patients to experience setbacks during this time, such as pneumonia, a heart attack, or another stroke, which may require adjustments to the rehabilitation goals.

The First Six Months and Beyond

During the first six months after a stroke, many patients have completed at least one rehabilitation program and may continue with additional therapies at home. While improvements are possible after this period, they will typically be much slower. Most stroke patients reach a relatively steady state by the six-month mark, with some achieving a full recovery while others experience ongoing impairments, known as chronic stroke disease. The severity of the stroke, the speed of initial treatment, and the intensity of rehabilitation all play a role in determining the long-term outcome.

Stroke Prevention and Long-Term Care

It is important to note that having a stroke is a major risk factor for experiencing another one. Therefore, long-term care and lifestyle changes are crucial to prevent recurrent strokes. This may include taking medications, such as blood thinners, and adopting a healthier lifestyle with a focus on improving diet, exercise, and sleep habits. Additionally, ongoing medical care from a vascular neurologist, primary care doctor, and mental health professional can help manage stroke risk factors and provide emotional support during the recovery process.

In summary, the treatment and recovery process for a stroke is complex and varies depending on the type and severity of the stroke, the speed of initial treatment, and the patient's overall health. A multidisciplinary team of healthcare professionals is typically involved in stroke treatment and rehabilitation, and ongoing care is essential to prevent recurrent strokes and manage any long-term effects.

Stroke recovery

The recovery timeline for a stroke is complex and unpredictable as every stroke is different and can cause a wide range of secondary effects. However, there are some common trends in the stroke recovery timeline.

Day 1: Initial Treatment and Diagnosis

The first few hours after stroke symptoms begin are critical for successful treatment. When a patient arrives at the hospital, they will be taken for a CT scan to identify the type of stroke. Once identified, treatment can begin. Most strokes are ischemic strokes, caused by a blood clot, and can be treated with clot-busting medication. Hemorrhagic strokes, caused by a ruptured blood vessel, may require surgery.

Week 1: Rehabilitation Begins

The stroke recovery process begins as soon as the patient is stable, usually within 24 hours of a stroke. The rehabilitation team includes neurologists, physical and occupational therapists, speech-language pathologists, and nurses. During the first week, the team will evaluate the effects of the stroke and create a rehabilitation plan. The patient may begin physical therapy, occupational therapy, speech therapy, and cognitive and emotional activities.

Weeks 1-3: Discharge from Hospital

Depending on the severity of the stroke and any medical complications, a patient will typically spend 1-3 weeks in acute care. The medical team will assess the patient's condition and identify any secondary effects, such as physical or cognitive impairments. The team will also determine the patient's ability to care for themselves and create a discharge plan.

Post-Acute Rehabilitation Options

After leaving the hospital, patients have several rehabilitation options, including inpatient rehabilitation, subacute rehabilitation, outpatient therapy, and home health therapy. The choice depends on the patient's unique needs and abilities. Inpatient rehabilitation is intensive acute care with therapy at least 5 days a week for 3 or more hours per day. Subacute rehabilitation is a lower-intensity option with 1-2 hours of therapy daily. Outpatient therapy is for patients who have returned home but require continued therapy a few hours per week. Home health therapy involves therapists and nurses providing care and treatment in the patient's home.

1-3 Months: Notable Recovery

During the first three months, patients should see notable improvements as the brain is still highly receptive to rehabilitation. Spontaneous recovery, where lost skills suddenly return, is common during this period. Inpatient therapy is ideal for capitalizing on this period of rapid improvement. Most patients will complete an inpatient rehabilitation program or make significant progress in outpatient therapy during this time.

6 Months: Gait Improvement

By the six-month mark, improvements will likely slow down, but functional recovery is still possible. Around 60% of survivors who were non-ambulatory and participated in inpatient rehabilitation were able to walk at this point. Recovery of walking ability may be quicker for those with smaller strokes and less severe effects.

1 Year: Individualized Recovery

At the one-year mark, some survivors have fully recovered, while others are still pursuing rehabilitation. Improvements in motor function and self-reported health have been observed even one year after inpatient rehabilitation. Over 50% of stroke survivors were able to recover the capacity to perform activities of daily living.

5 Years and Beyond: Continued Functional Recovery

Recovery continues to vary widely for individuals in the years following a stroke. Functional improvements may come slowly, but it is still possible to enhance daily life. There is documented proof of chronic stroke recovery as many as 23 years after the initial event. Consistent rehabilitation and healthy daily habits are crucial for continued progress.

Factors Impacting Recovery

The recovery timeline is influenced by factors such as the size and location of the stroke, age, overall health, and speed of treatment. Larger strokes tend to have greater secondary effects and require intensive rehabilitation. Age and overall health before the stroke also play a significant role, with younger and healthier individuals typically experiencing faster recovery.

Rehabilitation Boosts Recovery

Dedicated rehabilitation is a crucial factor in the recovery timeline. The more consistently individuals participate in prescribed therapy exercises, the greater their potential for recovery. Rehabilitation after a stroke typically involves physical therapists, occupational therapists, and speech therapists, who help create personalized programs to reach post-stroke goals.

Frequently asked questions