Stroke

Stroke signs and symptoms

If you're experiencing symptoms of stroke, go to a doctor or hospital immediately, preferably by dialing 911.

Stroke symptoms generally appear suddenly (seemingly out of the blue) and can include:

• Paralysis of a leg, arm or one side of the face
• Trouble speaking or understanding speech
• Vision problems, such as blurred or double vision
• Loss of coordination or problems with balance
• Severe headache without apparent cause
• Numbness, weakness or dizziness

Temporary stroke-like symptoms can indicate a TIA. These often occur hours or days before an actual stroke, so even if the symptoms go away, you should seek medical attention right away.

Stroke diagnosis

If a stroke is suspected, your doctor will make a diagnosis based on your symptoms, medical history, physical and neurological exams, and the results of blood and imaging tests.

Your doctor will want to determine not only whether you had a stroke but the cause (a blockage or bleeding) and what part of the brain is affected. All of these factors determine your treatment.

Diagnostic tests you may undergo include:

• Blood tests. Used to check your blood sugar levels, how quickly your blood clots and whether you have an infection.
• Electrocardiogram (EKG). Measures electrical activity in the heart to detect problems that may have led to a stroke.
• Electroencephalogram (EEG). Detects abnormal electrical activity in the brain that can result from brain injury.
• Angiogram. Uses X-rays and a special dye to produce detailed images of arteries, including those in the brain. It may be performed if other tests don't reveal the stroke's cause. The doctor makes a small incision, usually in your groin, and then threads a catheter (a thin, flexible tube) through your arteries and into one of your carotid or vertebral arteries. A harmless dye is then injected into the catheter to enhance the X-ray image of your cranial arteries.
• Carotid ultrasound. High-frequency sound waves create detailed images of the interior of major neck arteries to determine whether fatty deposits are narrowing or blocking blood flow.
• Computed tomography (CT) scan. A rotating X-ray beam takes multiple images to create a detailed three-dimensional image of the brain. This shows the brain's blood vessels and blood flow, revealing areas that may be blocked or leaking blood.
• Magnetic resonance imaging (MRI). Uses a strong magnetic field to create a detailed image of the brain, allowing a specialist to detect brain tissue damaged by an ischemic stroke or a hemorrhage.
• Magnetic resonance angiography (MRA). An MRI that focuses on blood vessels. It's a noninvasive way to obtain detailed images of arteries in the neck and brain and show blockages or ruptures.

Stroke treatments

A stroke is an emergency, so head to the emergency department (ED) immediately. Certain treatments must be given within hours of the stroke to reduce (or possibly reverse) injury to the brain.

Treatment starts in the ED. You may then be admitted to the hospital for further treatment from our stroke center's inpatient service or asked to return for additional treatments as an outpatient. The kind of treatment you need depends on the type of stroke you had.

When your condition is stable, we'll address the risks that led to your stroke. For most patients, that starts with monitoring and controlling their blood pressure.

Once blood pressure is under control, we focus on getting bloodstream cholesterol to better levels, smoking cessation for patients who smoke, control of blood sugar levels for those with diabetes, and analysis of any existing heart conditions. Our neurovascular team will work with your primary care doctor to tailor treatment to your physical condition and individual needs.

Ischemic stroke

The main treatment for an ischemic stroke is a medication called tissue plasminogen activator (tPA) or a related medication called tenecteplase, which dissolves the blood clots that are blocking blood flow to the brain. It's administered through an IV (into a vein) and should be given as soon as possible – usually within four and a half hours from the time symptoms started, though some patients may be able to be treated beyond that time window.

The sooner treatment begins, the better your chances of recovery. Your doctor may also recommend one of the following procedures to treat blood vessel blockages and prevent future strokes:

• Carotid endarterectomy. If your stroke was caused by a blockage in a carotid artery, this surgery may be used to remove the plaque there. The surgeon makes an incision to open the artery, removes the plaque and closes the vessel.
• Angioplasty and stenting. Used to widen blocked vessels. The surgeon makes a small incision in the groin and threads a catheter, conveying a tiny deflated balloon, through blood vessels to the blocked artery in your neck or brain. The balloon is then inflated to widen the artery. A small, expandable tube called a stent may be permanently placed inside the widened artery to help it stay open.
• Transcarotid artery revascularization (TCAR). This minimally invasive procedure places a stent in a narrowed carotid artery to stabilize the plaque and stop it from causing a stroke.
• Thrombectomy. Used to safely remove blood clots in people having a stroke. As in angioplasty, a catheter is threaded through blood vessels. It conveys a tiny device – which UCSF doctors helped develop – that traps the blood clot and removes it.

Hemorrhagic stroke

Treatment for hemorrhagic stroke is designed to allow the brain to heal safely and prevent further bleeding. The specific treatment depends on the cause of the bleeding, its severity and which part of the brain is affected.

You may be given medications to reduce brain tissue swelling; drugs that lower blood pressure to reduce the strain on the brain's blood vessels; and vitamin K, which can stop bleeding related to certain blood thinners by helping your blood clot. Your doctor will discontinue any anticoagulant or blood-thinning medicines that may have led to bleeding.

Depending on the cause of your bleeding, you may undergo one of these procedures:

• Aneurysm clipping. To curtail bleeding from an aneurysm and prevent it from bursting again, a surgeon places a tiny clamp at its base.
• Coil embolization. To block blood flow to an aneurysm or seal it, a surgeon inserts a catheter into an artery in your groin and threads it through blood vessels to the aneurysm in your brain. A tiny coil pushed through the tube and into the aneurysm causes a blood clot to form, blocking blood flow through the aneurysm and preventing it from bursting again.
• Embolization. This technique cuts off the blood flow to an arteriovenous malformation (AVM), a tangle of arteries and veins that can break open in the brain. A surgeon fills the AVM with specially designed coils, glues or superabsorbent microspheres to plug its vessels. (Radiation may also be used to shrink an AVM.)
• Open surgery. Traditional surgery to remove an aneurysm or AVM.
• Radiosurgery. Certain types of AVMs are treated with a noninvasive tool called a Gamma Knife, which delivers a single high dose of radiation precisely to its target while causing little to no damage to surrounding tissue. The damage caused by that focused radiation seals the AVM.

If bleeding has stopped but your condition is getting worse, you may need surgery to remove clotted blood near damaged brain tissue. Or, if there's a dangerous amount of swelling, surgery may be required to reduce pressure on the brain by temporarily removing part of your skull.

Stroke resources and support

At UCSF Health, we understand that while patients value our specialized, cutting-edge treatments, they also have emotional and practical needs related to healing. We therefore strive to provide a variety of support services to ensure that patients and families in our care are fully supported. We have a team of experienced social workers and condition-specific support groups as well as classes to help patients and families navigate their experiences while receiving care in our clinics and hospitals.