Stroke

How Is a Stroke Diagnosed?

A stroke is a medical emergency where every minute counts. Early diagnosis is crucial to determine the type of stroke, whether it is caused by a blockage or bleeding, so the right treatment can begin as quickly as possible.
In Malaysia, advanced hospitals like Subang Jaya Medical Centre (SJMC) use cutting-edge imaging and diagnostic tools to ensure timely and accurate stroke diagnosis.

Key Stroke Diagnosis Tests

For acute stroke management at the emergency room, several tests help doctors quickly diagnose stroke and plan the best course of action:

• Physical Exam for Stroke Symptoms: A healthcare professional will check your heart, blood pressure, and perform a neurological exam to assess how the stroke has affected your nervous system.
• Blood Tests for Stroke Indicators: These tests evaluate clotting speed, blood sugar levels, and the presence of infections.
• CT Perfusion or CT Angiography for Stroke Detection: A CT scan provides detailed images of the brain to detect bleeding, ischemic strokes, or other conditions. A contrast dye may be used for enhanced imaging (CT angiography).
• MRA for Brain Damage Assessment: Magnetic resonance angiography (MRA) scans offer a detailed view of the brain to assess blood flow and identify damage from ischemic strokes or haemorrhages.

Further diagnostic tests may be required to rule out other complications:

• Carotid Ultrasound for Plaque Detection: This test uses sound waves to detect plaque buildup and blood flow in the carotid arteries.
• Cerebral Angiogram for Artery Imaging: A catheter-based procedure that provides a detailed view of brain and neck arteries using contrast dye.
• Echocardiogram for Heart-Related Clots: This test identifies blood clots in the heart that may have travelled to the brain.

Early and precise diagnosis is key to improving stroke outcomes and reducing complications.

Stroke Treatment Options

Emergency treatment for a stroke depends on whether it is ischemic (caused by a blood clot) or hemorrhagic (caused by bleeding in the brain).

Ischemic Stroke: Restoring Blood Flow

The goal of ischemic stroke treatment is to restore blood flow to the brain as quickly as possible:

• Emergency IV Medication: Recombinant tissue plasminogen activator (TPA), such as alteplase or tenecteplase, is administered within 4.5 hours of symptom onset to dissolve blood clots.

Endovascular Procedures:

• Catheter-Delivered Medication: TPA is delivered directly to the cerebral artery that is blocked via a catheter.
• Clot Removal with Stent Retriever: A catheter-based device removes large clots that cannot be dissolved by TPA.

Procedures to Prevent Future Strokes

To reduce the risk of future strokes, your healthcare provider may recommend:

• Carotid Endarterectomy Surgery: Removes plaque from the carotid artery.
• Angioplasty and Stents: A balloon is used to widen the artery, followed by stent placement to keep it open.

Hemorrhagic Stroke: Controlling Bleeding

Treatment for hemorrhagic stroke focuses on controlling bleeding and reducing brain pressure:

• Emergency Measures: Medications to counteract blood thinners, lower brain pressure, and manage seizures.

Surgical Options:

• Surgical Clipping: A clamp is placed at the base of an aneurysm to stop blood flow.
• Coiling (Endovascular Embolisation): Tiny coils are placed in an aneurysm to block blood flow.
• AVM Removal Surgery: Smaller arteriovenous malformations (AVMs) may be surgically removed.
• Stereotactic Radiosurgery: Focused radiation repairs blood vessel malformations.

Stroke Recovery and Rehabilitation Programs

After emergency treatment, stroke recovery focuses on regaining function and returning to independent living. The impact of a stroke depends on the area of the brain affected and the extent of damage.

Stroke Recovery and Rehabilitation

Following emergency treatment, stroke recovery focuses on regaining independence and preventing recurrence. A comprehensive stroke rehabilitation program may include:

• Physical Therapy: To restore strength and mobility.
• Occupational Therapy: To help with daily tasks.
• Speech Therapy: To address communication or swallowing difficulties.
• Psychological Support: To support emotional well-being.

At SJMC, stroke recovery plans are personalised, involving neurologists, physiotherapists, dietitians, and rehabilitation specialists to support every stage of healing.

The Importance of Timely Stroke Care

The sooner a stroke is diagnosed and treated, the greater the chance of survival and full recovery. Advanced imaging technologies such as CT perfusion and MRI allow medical teams to determine the best course of action with precision.

Reference:

• Mayo Clinic Stroke: Diagnosis and Treatment
• National Heart, Lung, and Blood Institute (NHLBI) Stroke Diagnosis
• Johns Hopkins Medicine Rehabilitation for Stroke
• Harvard Health Publishing Benefits of Incorporating More Aerobic Activity into Stroke Rehabilitation
• Columbia Radiology Advanced Imaging and Stroke Treatment
• Massachusetts Government (Mass.gov) Information About Stroke and Stroke Treatment