The diagnosis of a stroke is usually made with close examination and history taking by a medical professional. In an emergency stroke hospital, a physician will perform a rapid history and focused neurological examination and then order some basic tests. These tests start with blood work, an EKG, and a head CT to determine whether the stroke appears to be hemorrhagic or embolic.

If indicated, a brain MRI is extremely useful to more accurately assess the brain tissue, and the blood vessels of the neck and brain. Also, ultrasound imaging of the blood vessels of the neck and base of the brain is quite useful.

Lastly, the most accurate imaging of blood vessels is an invasive procedure called a cerebral angiogram, in which catheters are placed in the arteries of the brain to look for possible blockages.

The management of a stroke depends on whether the cause is hemorrhagic or embolic in nature. Regardless of the mechanism, time is critical in making the diagnosis of a stroke and initiating appropriate care.

For embolic strokes, the culprit is commonly a blood clot obstructing down stream blood flow.

Therefore, the goal of therapy is to break up and dissolve the clot. This is done with blood thinners, and in cases when the time of onset of symptoms is close enough to the time of medical attention, patients can be treated with an injection of a potent clot buster called a thrombolytic.

Rarely, physicians are able to remove the blood clot during the cerebral angiogram, yet this is rarely attempted.

Unfortunately, only a small fraction of all patients with embolic strokes reach medical attention in the allowed time window for administration of thromobolytics. The long-term care of embolic strokes is focused on minimizing the risk of future embolic strokes with the anti-platelet agents aspirin and Clopidogrel, or commonly with the anti-coagulant Coumadin.

The management of hemorrhagic strokes is completely the opposite. As bleeding is the problem, the goal of therapy is to stop the bleeding as quickly as possible and decompress the surrounding brain tissue. As AV malformations and aneurysms are the most common causes of hemorrhagic strokes, neurosurgeons can place a surgical clip at the base of the AVM and aneurysm and then drain the accumulating blood. A non-surgical technique employs catheters that are introduced into the blood vessels, allowing placement of a coil into the AV malformation or aneurysm, thus preventing expansion and reducing the risk of rupture.

A stroke is a lethal and commonly debilitating condition that is all too prevalent in the United States.

As only medical professionals can initiate treatment for a stroke, it remains critical that Americans be mindful of the clues of a stroke and always remember to act “FAST.”

Dr. David M. Donaldson is an Auburn native and currently a

cardiologist at Massachusetts

General Hospital in Boston