Time is essential.  You have a very limited period of time to restore blood flow to the brain before the injury is irreversible.  You must know what a stroke looks like and get to a hospital.

The sudden occurrence of one or more of the following may be symptoms of a stroke:

• Numbness, weakness, or tingling in the face, arm or leg (especially on one side of the body)
• Changes in vision, double vision, blurriness, loss of vision in one or both eyes
• Confusion or problems with judgment, memory, spatial orientation, or perception
• Difficulty with or inability to walk, loss of balance, and dizziness
• Difficulty with or inability to speak or understand
• Difficulty with swallowing
• Dizziness, loss of balance, coordination or consciousness
• Drowsiness or lethargy
• Mood changes (sudden depression or apathy)
• Severe, sudden headache, possibly along with pain between the eyes, in the face, or a stiff neck, and vomiting or altered consciousness

Note that the key words for all symptoms are sudden onset.  Slowly developing problems in any of these areas are probably not symptoms of a stroke.  Furthermore, a condition called a transient ischemic attack or TIA creates symptoms that mimic a stroke, but they usually last for less than 24 hours (possibly as short as a few minutes).  A TIA is a temporary loss of or disturbance in brain function.  In itself it may not be serious, but it is a warning sign that you could have stroke in the future.

A number of tests can be used to decide the type and cause of a stroke, and the specific areas of the brain that have been affected. Most of these tests create images of the brain and the arteries that feed it.  They could also be used before a stroke to look for blockages in the carotid arteries.  Among the imaging techniques used are arteriography, computerized tomographic angiography (a form of CT scanning with a dye injected into the vein), MRI, and ultrasound.  For information about them, go to Key Point #2.

One of the most effective ways to limit the effects of a stroke is to begin treatment as quickly as possible.  A stroke is the interruption of the flow of blood to any part of the brain, which damages brain tissue.  The longer the delay before treatment begins, the more damage to the brain tissue.  The interruption in blood flow is caused either by a blood clot or other particles blocking the arteries that carry blood to the brain (an ischemic stroke) or by bleeding in the brain, caused by a ruptured blood vessel or an injury (a hemorrhagic stroke). So the goal of emergency treatment is to find out what kind of stroke the person is having and then take appropriate measures to stop it by dissolving the blood clot or stopping the bleeding.

Ischemic strokes can be stopped by using a class of drugs known as thrombolytics or clot busting medicines.  Injected directly into a vein, they can break up or dissolve blood clots, thus removing the blockage and restoring blood flow to the brain.  The most widely used is called TPA (for tissue plasminogen activator).  However, TPA must be given within three hours of the start of symptoms.  After three hours, the benefits of dissolving the clot no longer outweigh the risk of hemorrhage (N.B. There really is no debate about IV TPA after 3 hours-it is contraindicated. )  

Further, because of potential side effects and risks, some people who have had an ischemic stroke are not ideal candidates for thrombolytics even within three hours. Doctors must understand the details of each individual case before giving the drugs. For example, if your blood pressure is uncontrollable when they're being considered, your doctor may not use them. Finally, before any thrombolytics can be given, it must be certain that the person is having an ischemic stroke.  If the stroke is caused by bleeding, the drugs could make things worse.

Other possible drugs to treat ischemic strokes include blood thinners, such as heparin and coumadin, and aspirin and other anti-platelet agents.

Hemorrhagic strokes are caused by bleeding. One of the most common types of hemorrhagic stroke is due to high blood pressure.  Tiny blood vessels deep in the brain can rupture, causing bleeding into the brain tissue.  This type of bleeding is often called "intracerebral hemorrhage".  Another type of  bleeding may be caused by a ruptured.(broken), badly formed blood vessel.  This type of blood vessel is called an AVM, for "arteriovenous malformation."  Some AVMs can be removed by surgery, and that may be a way of preventing a possible stroke.  But if an AVM is too large or found deep within the brain, surgery may not be possible.  There are other possible treatments for AVMs, including procedures that shrink them by blocking the arteries that supply them with blood. 

Another possible cause of a hemorrhagic stroke is an aneurysm, a localized, blood-filled dilatation (swelling) of a blood vessel caused by a disease or the weakening of the vessel's wall.  Again, there are a number of surgical treatments for aneurysms, including aneurysm clipping (the aneurysm is clamped shut, preventing it from getting blood from the artery it's attached to) and aneurysm embolization (a tiny coil is put into the aneurysm which makes it clot, preventing blood from nearby arteries getting into it). 

A hemorrhagic stroke may also require surgery to remove blood that has pooled in the brain during the stroke. 

After a stroke, the emphasis should be on preventing a second stroke (about 25 % of people who recover from a first stroke will have a second within 5 years) and rehabilitation.  Rehabilitation obviously depends on the type of disability the person has, and can include speech, occupational, and physical therapy.  About 10% of those who have had a stroke recover most or all of their abilities; 50% can remain at home with medical assistance; 40% move to long-term care facilities.  Unquestionably, however, 
a supportive family, friends and environment can help stroke patients in their recovery.

For links to information about long-term recovery go to Resources.