First Step: Diagnosis
The first step in the correct management of a patient with suspected stroke is to get the diagnosis correct. This will involve the doctor examining the patient and possible further tests like:
- blood evaluation,
- a chest X-ray, and
- brain scan - CT (computerized tomographic) scan or MRI (magnetic resonance imaging).
The initial diagnosis of stroke by the attending doctor is often a clinical diagnosis supported by brain scan findings (ideally a cranial MRI).
Next Steps: Treatment and Rehabilitation
Once the diagnosis of stroke is determined, treatment in the early initial stage often requires hospital admission. Time is of the essence. “Clot busters” (in the form of “tPA” - tissue plasminogen activator) may be used to treat stroke if the cause of stroke is a blocked blood vessel in the brain and the patient’s scenario satisfies stringent criteria including initiation of treatment within 4.5 hours of first symptoms of stroke. This treatment is not without risk, and in general, only a minority of all ischaemic stroke patients will qualify for such treatment.
If the stroke is due to the bleeding in the brain, the cause, often being hypertension and less often rupture of abnormal blood vessels in the brain that the patient is born with, effective treatment involves appropriate control of blood pressure and possible surgical evacuation of the blood clot (or other neurosurgical procedures as determined on a case-by-case need).
Besides treatment with drugs and by surgery, the treatment of stroke involves proper rehabilitation, including physiotherapy, occupational therapy and speech therapy (in patients with speech disruption caused by the stroke.) Helping the patient and family, care-givers, and loved ones to understand and cope with the “calamity” of stroke is equally important.