A stroke is a medical emergency and if you have one you should go to hospital immediately. It's likely that you will have a series of scans and tests to find out what has happened and the best way to treat it.
Being taken to a stroke unit
If you have a stroke, you should be taken to hospital as soon as possible.
You may start off in accident and emergency or another assessment ward, but it's likely that you will be quickly admitted to an acute (or hyper-acute) stroke unit.
At first you will need to have tests to confirm that you have had a stroke and make sure that you recive the right emergency treatment. The quicker your stroke is diagnosed and treated, the better your recovery will be.
Brain scans and tests
It's likely that you'll need to have a number of scans and tests to confirm whether you have had a stroke and rule out other conditions.
You should have a brain scan as soon as possible after your stroke. For people with acute stroke this should be within an hour of arriving at hospital. The scan can be:
- a computed tomography or CT scan, which is an x-ray of the brain to show doctors which part of the brain has been damaged, and whether the damage was caused by a clot or a bleed
- a magnetic resonance imaging or MRI scan, which is taken in a large tunnel-shaped scanner that uses waves to produce more detailed image of blood vessels in the brain.
The results of your brain scan will help your doctors to identify what may have caused your stroke and ensure you get the right emergency treatment.
Thrombolysis and other treatments
If your stroke is caused by a blood clot, you may be treated with a clot-busting drug to try to disperse the clot and return the blood supply to your brain.
The medicine itself is called alteplase, or recombinant tissue plasminogen activator (rt-PA). The process of giving this medicine is known as thrombolysis.
Thrombolysis can break down and disperse a clot that is preventing blood from reaching your brain.
For most people thrombolysis needs to be given within four and a half hours of your stroke symptoms starting. In some circumstances, your doctor may decide that it could still be of benefit within six hours. However the more time that passes, the less effective thrombolysis will be. This is why it’s important to get to hospital as quickly as possible when your symptoms start.
Thrombolysis doesn’t work every time – one in ten people who receive it benefit from the treatment. There is also a risk that thrombolysis can cause harmful bleeding in your brain. This happens in approximately 7% of cases.
Who can have thrombolysis?
Unfortunately not everyone who has an ischaemic stroke is suitable for thrombolysis. At present only 15% of people who are admitted to hospital with a stroke are eligible to receive it. If you are not suitable, it may be because:
- you had a bleed in in the brain
- you do not know or cannot tell doctors when your symptoms began
- you do not reach hospital in time
- you have a bleeding disorder
- you have recently had major surgery
- you have had another stroke or head injury within the past three months
- your current medication is not compatible with alteplase.
Other early treatments
Unless your stroke has been caused by a bleed it is likely that you will be given aspirin or an alternative anti-platelet drug like clopidogrel as soon as possible, and certainly within 24 hours of being diagnosed. This makes the blood less sticky and stops clots forming, which helps to prevent another stroke.
Other hospital tests
There are a number of other tests that you may receive during your first few days in hospital. These will be to find out more about what caused your stroke, or to see what effects it has had. These are some of the tests you may undergo:
- blood pressure test: These should be taken as soon as you get to hospital. They reveal if your stroke may have been caused by high blood pressure, and whether you may need medication to help lower it.
- an electrocardiogram (ECG): can show if an irregular heart beat called atrial fibrillation may have caused your stroke. Atrial fibrillation can increase your risk of stroke, but can also be managed with medication.
- blood test: this will check your cholesterol and blood sugar levels and check for clots.
- swallowing test: someone in your stroke team will need to check whether your stroke has made it difficult for you to swallow. If swallowing problems aren't addressed they can lead to complications such a chest infections or pneumonia.
- mobility assessment: your stroke team will need to assess how your stroke has affected you physically and what help you need with positioning and moving around
- pressure area risk assessment: to make sure that you don't develop any sores or ulcers whilst you can't move about.
- continence assessment: you will be assessed to see if you have any continence problems, and if so, what can be done to help you manage them.
- communication and cognitive assessments: to find out if your stroke may have caused any communication or cognitive problems and what help you may need with them.
- nutritional status and hydration: to make sure that you are getting the right nutrition and that you aren't becoming dehydrated.