Stroke

Understanding Stroke

After a stroke begins, you have a narrow window of time to obtain the most effective treatments. Call 911 immediately if you think you may be having a stroke.

Stroke Symptoms

If you know the signs of a stroke, you can avoid delays in immediate care and medical attention. Your symptoms can include:

• Numbness and/or weakness, usually one-sided, in the face, arm or leg
• Severe headache
• Trouble walking or other signs of loss of coordination
• Difficulty seeing
• Confusion
• Dizziness

Stroke Types

Two main types of strokes include:

• Ischemic stroke: caused by a blood clot that blocks a blood vessel in the brain.
• Hemorrhagic stroke: caused by a burst blood vessel in the brain.

Hemorrhagic strokes can occur in the brain (intracerebral) or in the space surrounding the brain (subarachnoid).

A transient ischemic attack (TIA), or “ministroke,” often resembles a stroke, but typically lasts less than an hour and does not cause permanent damage. You should still treat this type of stroke as an emergency, as you do not know how long it will last. You can think of a TIA as a warning sign that you may have an ischemic stroke later.

Stroke Risk Factors

Risk factors for ischemic stroke include:

• Hypertension (high blood pressure)
• Diabetes
• Cardiovascular disease
• Smoking

Diagnosis

At the emergency department, you will receive diagnostic and imaging tests to help your physicians determine the presence of a stroke, along with its type. This will ensure that your treatment begins immediately. Diagnostic tests can include:

• Computed tomography (CT)
• Computed tomography angiography (CTA)
• Computed tomography perfusion (CTP)
• Magnetic resonance imaging (MRI)
• Cerebral angiography (CA)

How We Can Help

The emergency, cardiovascular and neurovascular experts of Indiana University Health can diagnose and treat your condition any time of day. Your IU Health physicians’ comprehensive approach ensures that you receive high-quality care starting with emergency services and continuing through to rehabilitation.

IU Health physicians provide your care in a high-volume center with the expertise and resources you need to successfully treat your stroke. Your team of experts includes:

• Neurologists
• Neurosurgeons
• Emergency medicine physicians
• Neuroradiologists
• Nurses
• Rehabilitation specialists
• Pharmacists
• Technologists

If you cannot get to an IU Health location, your physicians can help care for you through the IU Health Stroke Virtual Visit program, which uses advanced videoconferencing technology to connect community hospitals with our neurologists.

The IU Health affiliation with the Indiana University School of Medicine Department of Neurology gives physicians access to the latest innovations in stroke diagnosis and treatment. They constantly seek ways to improve your care through the cerebrovascular outcomes center and other clinical and research efforts. IU Health physicians take an active role in preparing the next generation of physicians.

IU Health Methodist is the first Comprehensive Stroke Center in the state, as certified by The Joint Commission, a national accrediting body for healthcare organizations. This designation is the highest level of accreditation reserved for facilities that focus on stroke care. Comprehensive Stroke Center certification means we meet strict performance and outcome standards while providing 24/7 access to specialists and advanced technologies.

Stroke Treatment

We offer a variety of treatment options depending on the type of stroke you have and your individual needs.

Ischemic Stroke

For this type of stroke, we dissolve or remove the clot that blocks blood flow to the brain. Options include:

• Intravenous tissue plasminogen activator (tPA). This medicine dissolves a clot causing an ischemic stroke and may increase your chance of a full recovery. However, it generally requires administration within three hours of the beginning of a stroke. In some cases, physicians inject tPA directly into a clot using a catheter.
• Mechanical thrombectomy. In this treatment, a physician known as a neurointerventional radiologist uses a catheter to physically remove a clot.

Hemorrhagic Stroke

Treatment for a hemorrhagic stroke varies depending on several factors, including type and severity.

Subarachnoid Hemorrhagic Strokes

For subarachnoid hemorrhagic strokes, your treatment generally centers on repairing the ruptured aneurysm or arteriovenous malformation (tangled blood vessels) that causes the stroke. Options include:

• Coil embolization. A physician uses a catheter to thread a metal coil into the aneurysm. When the coil releases, it blocks the aneurysm’s blood supply.
• Stereotactic radiosurgery. Targeted radiation can shrink an arteriovenous malformation while leaving the surrounding tissue intact.
• Other surgical procedures. Your surgeon can clip an aneurysm or remove an arteriovenous malformation.

Intracerebral Hemorrhagic Stroke

Treatment for intracerebral hemorrhagic stroke consists mainly of supportive care, including managing blood pressure and keeping your airway open. In some cases, your physician may suggest surgery to relieve pressure on your brain by removing blood.

Transient Ischemic Attack

Transient ischemic attack (TIA) generally resolves itself, but physicians cannot know in advance whether this will occur. These attacks warn you that a possible future stroke could occur. They require your physicians to perform the same series of tests for an ischemic stroke. Your treatment focuses on preventing future strokes. Options include:

• Medicine. Antiplatelet and anticoagulant medicines (known as blood thinners) can reduce your chance of a stroke, including aspirin and warfarin.
• Surgery. Your surgeon may perform a carotid endarterectomy to clear blocked carotid arteries (major arteries in the neck).