Stroke. Diagnostics & Therapy
How is a stroke detected and treated?
Whether a stroke has actually occurred and how great an area of the brain is affected and what caused such an event, needs clarification in a hospital. To this end the patient who has a suspected stroke undergoes a neurological examination in the first instance. The neurologist establishes the symptoms by examining, among other things, the patient's reflexes, coordination, memory, speech and orientation. In order to specify immediate therapeutic procedures, the exact cause of the stroke has to be established, i.e. whether a blood clot or a haemorrhage has been the trigger. This is done with the help of two special methods of examination, so-called imaging procedures - computed tomography and nuclear spin tomography.
A computed tomography (CT) of the head provides specially processed X-ray images of the brain, the bones and the blood vessels. In nearly all cases the doctor will be able to differentiate between a circulatory disorder and a cerebral haemorrhage using this examination. The latter is usually immediately identifiable while a blood flow disruption on the other hand is often only visible after a few hours or even days. All depending on which part of the brain is affected and how large an area it is, it is sometimes not possible to identify with certainty a cerebral infarction using computed tomography. Special reconstruction of the images and after an X-ray contrast medium has been administered it is often possible to find evidence of a vascular occlusion.
Nuclear spin tomography.
Another option for brain imaging with a vascular status is nuclear spin tomography (Magnetic Resonance Tomography, MRT). The tomograms (images in sections) are produced by a strong magnetic field and provide more exact images than computed tomography thus allowing even the smallest changes to be detected. Special weighted images often provide evidence of the extent of tissue which is still recoverable.
Ultrasound examinations if a stroke is suspected
Further examinations involve ultrasound tests (Doppler sonogram) of the blood vessels in the neck and head. In this way the doctor determines whether and how badly the vessels are blocked through arterial calcification or whether the flow of blood to the brain is normal. An ultrasound of the heart (echocardiography) reveals changes in the heart which may cause blood clots to form.
Angiography when a stroke is suspected
In the case of an angiography ("angio" = vessel and "graphy" = process of producing an image) the blood vessels are made visible with X-ray contrast medium. This process can either depict all the vascular systems in all parts of the body as a survey or and/or only blood vessels in certain areas such as the brain. This provides the doctor with information on what has caused the haemorrhage, provides information on the extent of narrowing or occlusion of the blood vessels or whether vessels are already damaged. If the blood vessels are depicted using computed tomography or magnetic resonance tomography, then this is called a CT angiography or a magnetic resonance angiography (MRA).
Examinations of the heart if a stroke is suspected
So that other possible causes of a stroke can be identified, an in-depth examination of the heart is carried out. Using an electrocardiogram (ECG) and a long-term electrocardiogram, it is possible to diagnose dysrhythmias; echocardiography (heart ultrasound) provides information about the possible formation of a blood clot in the heart as the cause of the stroke.
Laboratory tests for a suspected stroke
For the above-mentioned diagnostic procedures the patient has more blood taken for testing in the laboratory. These tests include blood counts (concentration of red and white blood cells), signs of inflammation, electrolyte and sugar (glucose) as well as liver and kidney values. Special attention is paid to platelets (thrombocytes), as they play an important role in coagulation. If this process is abnormal, then platelet aggregation occurs more easily to form clots, which are dangerous as these can block a vessel. Laboratory controls help in the identification of risk factors such as disorders in fat metabolism.
Stroke. Therapy & Treatment
If a stroke is suspected go to hospital immediately.
At any rate if you suffer a stroke you must get to hospital! If you personally have suffered a stroke or have observed the warning signs in someone else and you are concerned about a stroke, there is no time to lose. Call the emergency services coordination centre or the fire service or the emergency doctor.
A stroke cannot be treated by a GP and can only be treated in a hospital, where all the modern diagnostic and treatment options are to hand. The Emergency Response Law specifies that the patient must be taken to the nearest suitable hospital. The choice of the right hospital depends on the patient's condition. Unconscious patients or those who are suffering from an acute or life-threatening illness usually have to be taken to the nearest hospital with an Intensive Care Unit. The typical stroke patient is best cared for in the nearest hospital which has the greatest experience in the treatment of strokes. Such special departments are called "Stroke Units" or in German "Schlaganfall-Einheiten".
The German Stroke Society (Die Deutsche Schlaganfallgesellschaft) and the German Stroke Aid Foundation (Stiftung Deutsche Schlaganfall-Hilfe) have developed a certification procedure for the assurance of quality standards in treatment. This certificate is comparable with a product testing seal of approval or a TÜV badge on a car.
Every stroke is a medical emergency!
In recent times great progress has been made in the acute treatment of strokes. Every stroke is a medical emergency! The earlier treatment is started after a stroke, the greater the chance of the stroke victim surviving and that fewer impediments will remain. Of first and foremost importance are the immediate life-saving procedures i.e. keeping the patient breathing and his heart beating and stabilising and monitoring his condition in intensive care. This standard treatment applies to all patients irrespective of what type of stroke. Further treatment is orientated by the cause i.e. it has to be clarified as to whether the stroke was caused by a blocked blood vessel or a brain haemorrhage. Furthermore other aspects also play a role in treatment such as the severity of the stroke or cerebral infarction.
Treatment of a cerebral infarction (ischaemic stroke).
Since 2000 a therapy for treating the cause of ischaemic strokes has been approved in Germany. The blood clot which is blocking the cerebral vessel is dissolved by a special medication (lysis therapy). In this way the regions of the brain around the actual focal area of the stroke, which, it is true to say in the first few hours after onset of symptoms only receive a poor supply of blood but which nonetheless have not died irrecoverably, can, by opening up blood vessels, be salvaged. This lysis therapy is not suitable for all patients, for instance a cerebral haemorrhage must be ruled out. Lysis therapy usually has to be carried out in the first three hours after onset of symptoms, but in exceptional cases even up to six hours later. This has led to a good outcome especially with respect to the degree of disablement after the stroke. The earlier such a therapy is started, the greater the success. Up to now only 2 per cent of all stroke patients receive this treatment in Germany. It is assumed that up to 10 per cent of patients could be considered for this therapy.
Treatment of a stroke in the Stroke Unit.
If it is impossible to carry out lysis therapy, the patient is continuously monitored in a Stroke Unit. Optimum adjustment of blood pressure, body temperature, oxygen content in the blood and heart rhythm are extremely important. The nigh on immediate start of rehabilitative measures is another important treatment factor in a Stroke Unit. Swallowing and speech disorders, paralyses and other deficits should be treated as soon as possible by experienced therapists. This treatment is then carried on and intensified during subsequent rehabilitation.
Treatment of a cerebral haemorrhage (haemorrhagic stroke).
If the cause of the stroke is a cerebral haemorrhage the prime objective is to lower blood pressure. The patient then receives medication to lower blood pressure. In the case of major cerebral haemorrhages an emergency operation is frequently necessary, in which the leakage of blood is removed and cerebral pressure lowered. With subarachnoid haemorrhages the source of bleeding is localised and is either sealed off during an operation or sealed off by a suitable catheter angiography process.
Rehabilitation after a stroke.
In the ideal case rehabilitation takes place immediately after the initial intensive medical care. In many cases the problems caused by the stroke remain. Faculties lost can sometimes be completely or partly regained by means of suitable rehabilitative measures. In such cases intact areas of the brain take on the task of the damaged areas. So for instance regression of paralysis may occur because other muscles are activated by the right exercises and take on the function of the paralysed muscles. The patient therefore under the instruction of specially trained therapists can relearn certain physical functions or adapt to other patterns of movement. If there are any remaining deficits, rehabilitation is intended to help the patient achieve the most independence possible for everyday living and the best possible quality of life. In the case of severe strokes, the aim of rehabilitation is often the option of care at home. All depending which deficits are present, physiotherapy, ergotherapy, neuropsychological or logopaedic procedures may be used. The training programme, which is tailor-made, should be started as early as possible and be carried out over a long period of time. The dovetailed units of therapy are continued on an outpatient or part inpatient basis and if there is a need for care at home, often through home visits.
A stroke usually causes drastic changes in the lives of the patient and family members. Read more about definition, symptoms and causes.
Stroke. Precautionary measure
There is no sure option for preventing a stroke. However there are things you personally can do to minimise...
These clinics specialize in the treatment of a stroke and neurological diseases.