Emergency Treatments for Stroke

Stroke is marked by an obstruction in the cerebral arteries of the brain that causes an interruption of blow flow to brain cells. This is called an ischemic stroke. Another type of stroke causes bleeding into the brain due to a ruptured artery. This is called a hemorrhagic stroke which represents 10-15% of all stroke occurrences, and is more lethal than ischemic stroke. Both types require immediate medical treatment to prevent extensive damage and death.

Before treatment can begin, diagnostic tests need to be administered to determine which type of stroke it is, its location, and extent of damage.

Diagnostic tests include:

• Neuro exam


• Blood tests


• CT scan


• MRI


• Arteriogram


• EEG


• EKG

Ischemic and hemorrhagic strokes are treated in different ways because they have different pathologies. One is a bleeder and the other is a blockage.

Emergency Treatment for Ishemic Stroke:

Currently, there is only one FDA approved medication for emergency treatment of ischemic stroke, called tPA. Tissue Plasminogen Activator is a protein that has the ability to dissolve blood clots, but must be given within three hours of start of symptoms in order to give it intravenously. tPA can be given past this time frame, up to 6 hours, but must be administered via a small catheter inserted into the artery and threaded to the point of the occlusion. tPA is then injected into the clot dissolving it, and phagocytic cells clean up the debris.

How tPA Works:

Blood clots have fibrin strands that hold them together. tPA, a thrombolytic agent, acts on these strands by breaking them up, thus dissolving the clot. Human tPA is manufactured in minute amounts in the body, and is responsible for breaking up the clot that causes a TIA. Transient ischemic attack is the temporary loss of blood flow to the brain. This explains why symptoms of TIA come and go quickly. Even though TIA leaves no brain damage, it still requires immediate medical attention. tPA is used for clot busting purposes in stroke, as well as heart attack.

Tissue Plasminogen Activator is contraindicated in hemorrhagic strokes due its potential to cause bleeding. Therefore, it must be used with caution even in the event of an ischemic event. It is interesting to note that the amount of tPA used is a factor in clot lysis. More is not better. Clots are dissolved quicker with smaller of amounts of tPA. It was found that a larger injection of tPA actually worked slower than smaller amounts.

Other Emergency Treatments:

Surgery sometimes is implicated when there is bleeding present to repair damaged vessels that have ruptured, or to manually remove a clot lodged in the carotid arteries that feed the brain directly.

by Barb Hicks, RN/LMT