How Are Strokes Treated?

Matthew Tenser, MD, director of neuro-interventional surgery at USC Arcadia Hospital, shares how specialists treat these life-threatening emergencies.

A stroke is like a heart attack in the brain: A part of the brain doesn’t get the blood flow it needs and is injured as a result. As Matthew Tenser, MD, director of neuro-interventional surgery at USC Arcadia Hospital, points out, “When a part of the brain is injured in a stroke, that tissue doesn’t come back.”

This makes recognizing stroke symptoms early and seeking immediate help crucial. Dr. Tenser discusses the signs to look for, and how the rapid action of an experienced stroke team makes all the difference.

What types of strokes are there?

Two kinds: ischemic and hemorrhagic. An ischemic stroke happens when an artery in the brain is blocked, stopping blood flow to that part of the brain. Meanwhile, in a hemorrhagic stroke, an artery in the brain ruptures, causing bleeding in the brain.

What are common stroke symptoms?

The key sign is a sudden change. One minute everything is fine, and the next, the patient could have a sudden onset of weakness or numbness, vision loss or double vision, facial droop, slurred speech or an inability to speak.

Symptoms also occur on one side of the body because each side of the brain controls the opposite side of the body. For example, if the blockage or bleeding is on the right side of the brain, you might have left-side weakness, numbness or trouble seeing on the left.

If it’s on the left side, you might have the same problems on the right side of the body, often with associated language changes, since the main language centers are usually on the left side of the brain.

When should you seek medical care?

No matter what the symptoms are, if there’s a concern for stroke, call 911. Don’t drive yourself to the emergency room. Let the paramedics take you. They’ll preactivate the emergency department, tell them you’re coming and wheel you right in. The stroke team will start the testing immediately. You save a lot of time.

Every minute an artery is blocked and causing symptoms, neurons are dying. Delays cause more brain injury and can also limit treatment options. The faster we get the artery open, the better the patient fares.

What happens when you arrive at the ER?

As soon as a stroke is suspected, the hospital issues what’s called a “code stroke.” This alerts the ER staff — nurses, neurologists, lab staff, radiologists and radiology techs — so that as soon as the patient hits the door, they’re getting evaluated and studied.

Then we try to figure out when the patient was last without symptoms. Again, that’s because some treatments are time-dependent. We also try to get as much history as we can, like the patient’s medications and preexisting conditions. Then we do a brief but focused neurological exam. This all occurs over a few minutes.

How do you determine treatment?

After the initial exam, we’ll order a series of CT scans to decide next steps. The patient will get a basic CT scan of the head to see if there’s any hemorrhage or a large area of damage, which would be irreversible at that point.

We’ll also get a CT angiogram to look directly at the vessels and see if there’s any blockage or narrowing of an artery causing the delayed blood flow. A CT perfusion scan can then help us better determine the area already injured and the area still salvageable.

What are the treatment options?

For ischemic strokes, there are two emergent options. The first is an intravenous thrombolytic — or clot-busting — medication. These are easy and fast to deliver, but they must be given within four-and-a-half hours of when the stroke began. They also carry a risk of bleeding, so if the patient’s on a strong blood-thinning medication or has an underlying coagulation problem, we can’t use it.

We may also do what’s called an angiogram and thrombectomy. An angiogram is a study of the blood vessel from within. We put a catheter into an artery in the arm or leg and then use fluoroscopy, or continuous X-ray, to navigate it up to the brain.

If we can see the blockage and reach it, then we use a device that grabs onto the clot and pulls it out. Again, the patient must meet certain criteria for this procedure, but if they do, it can be very effective in saving brain tissue.

What new treatments are emerging?

Studies are evaluating newer generations of clot-busting medications, which might be more active in “chewing up” clots, and may last longer in the body and have lower risks.

Treatment time windows are starting to change, too. Clinical trials are using more advanced imaging to identify patients who could safely benefit from thrombolytic medications given later on, expanding the population that could be eligible for treatment.

Every year, researchers are testing new devices and exploring how to make it easier and safer to get into the brain’s blood vessels to remove occlusions. The technology to support these procedures is also always improving, giving us better-quality images and the ability to see vessels from all angles.

What if your stroke symptoms go away?

Still take the situation very seriously. There’s something called a TIA, or transient ischemic attack, which happens when a brain artery is temporarily blocked and causes symptoms, but then opens up without injuring the brain.

TIAs and strokes share the same mechanisms and risk factors. When these patients come to the hospital, we still admit them and do a complete exam. Studies show that if you experience TIA, your risk of stroke during the following week can be 10% or more.

No matter what your symptoms are and if they are still present or not, we encourage you to call 911 and come to the ER. We’re ready to help.

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