A stroke is any process that reduces blood flow to part of your brain enough that the brain tissue begins to die.  Most strokes are caused by blockage of the blood flow leading to the brain.  This is called an ischemic stroke.  Less frequently one of these vessels may rupture leading to both bleeding and stroke.  This is called a hemorrhagic stroke.

How do we diagnose a stroke?

Carotid Ultrasound

Carotid Ultrasound is a simple test that can be used to assess the blood flow to the brain through the arteries in the neck called the carotid arteries.  Sometimes these arteries become narrowed or occluded resulting in symptoms of a stroke.

Computed Tomography (CT)

CT or CT Angiography (CTA) scans are usually the first test to look for a stroke.   CT is most useful to look for a hemorrhagic stroke as blood is typically well seen on a CT scan.  Excluding a bleeding vessel means that any blocked vessel can be safely treated with medications to restore normal blood flow.   A CTA uses contrast to very accurately show the blood vessels in the head and neck.  This is the most accurate test to look for an occluded blood vessel.

Magnetic Resonance Imaging (MRI)

MRI or MR Angiography (MRA) is another important tool for diagnosing strokes. Just after a stroke occurs the CT scan of the brain is usually normal.  An MRI however can easily show the early stroke which can help doctors know when to treat with medications that may restore normal blood flow.  MRA is also a good test to look at the blood vessels in the head and neck.

Cerebral Angiography

Cerebral angiography is the best test to look for a common source of brain bleeding (aneurysm) and is used both in the process of treating an aneurysm or treating a focal blood clot in the brain.  Angiography is usually performed by a specially trained neuroradiologist.

How do we treat a stroke?

Strokes are best treated by a multidisciplinary team including emergency physicians, neurologists, radiologists, and neurosurgeons. Time is of the essence in the management of strokes, and protocols have been developed to promote efficiency in this process. The slogan, “Time is brain,” truly applies, and the goal of treatment is to restore blood flow to the affected part of the brain as rapidly as possible before cell death occurs. Depending on the timing and location of the stroke and the patient’s overall health, this can be accomplished in several ways, including anti-clotting medications such as tissue plasminogen activator (tPA), thrombectomy, or stenting. Occasionally, open surgery is required for severe strokes if a large amount of bleeding occurs following the stroke or if there is high concern for such bleeding.

Endovascular mechanical thrombectomy is a minimally invasive procedure which involves placing one or more catheters in a patient’s groin to remove the clot that is blocking blood flow. This procedure is performed with the use of cerebral angiography. The clot can either be removed directly using small tools in the artery, or the artery can be reopened through the deployment of a stent at the site of the clot.