About Stroke
Stroke is always a Medical Emergency
Stroke is always a medical emergency. Even if the symptoms don’t cause pain or go away quickly, call 111 immediately.
Emergency intervention improves chances of survival and successful rehabilitation. Emergency medical treatment is crucial for three reasons:
- You need to be assessed by a doctor who will look at treatments to prevent another stroke, as well as treatment for any existing stroke
- Some treatments for stroke must be given within three hours of the stroke starting. The longer a stroke remains untreated, the greater chance there is of stroke-related brain damage
- Only a doctor can decide whether you are having a stroke or have had one. A number of conditions can look like a stroke and need to be ruled out urgently.
Hospital Stroke Assessment and Management
All people with a suspected stroke should expect to be admitted to hospital for assessment and treatment.
Hospital Treatment
What to expect
The person with a suspected stroke is usually admitted to an acute medical ward or specialised stroke unit for initial testing and treatment. Later they may be transferred to a rehabilitation ward or a separate stroke rehabilitation unit. If the hospital is smaller, they may stay in the same ward for rehabilitation or be transferred to a specialised unit in another town. The doctors, nurses, therapists or social worker in the acute ward where the person is first admitted, will give information about where the rehabilitation is to be carried out.
Some people with quite mild strokes may have initial tests at the hospital and then can go home. The hospital team organises ongoing therapy, which the person will have either as an outpatient or in their home.
When released from hospital, the emphasis at home will be on encouraging the stroke survivor to do activities without the physical assistance of a therapist. This is called a self-directed, home-based rehabilitation programme. The rehabilitation therapist will instruct the survivor and caregiver/s, and will be in touch regularly to check progress, upgrading exercises when necessary.
Length of hospital stay
How long the person stays in hospital depends on many factors including the speed of recovery from the stroke, how independent the person was before their stroke, how much support they have at home, how appropriate their house is for someone with a disability and how bad the stroke is. Some strokes involve an initial period of altered or lost consciousness, and the depth and length of unconsciousness can indicate stroke severity.
In a small number of cases, people with a stroke are unable to return home and will need long-term care in a private hospital or rest home. This is more likely in those who show little sign of any recovery within the first week, are older or already have disability from previous strokes or other illnesses.
Assessments and tests
When in hospital, the doctor will make a clinical diagnosis by getting the patient’s medical history followed by a physical examination. A number of tests may be used to help make the diagnosis and to treat the patient effectively. The purpose of assessment and testing is to find out:
- Whether the person has a stroke and not some other disorder
- What caused the stroke and which part of the brain is affected
- Whether the person has an underlying disorder that contributed to the stroke
- What risk factors are present.
Tests may include
- Blood tests for cholesterol, diabetes, abnormal clotting or other diseases that may cause stroke
- Electrocardiogram (ECG) to test heart function and to look for atrial fibrillation, an irregular heart rhythm that can cause clots that result in strokes
- CT scan and/or MRI scan of the brain to look for any bleeding on the brain and to exclude other conditions that may mimic a stroke
- Carotid Ultrasound scan of the neck to test if the main carotid artery is severely blocked as this may require surgery
- Echocardiogram to image the heart (if a clot is suspected to have come from a heart valve or chamber)
- Tests to find out what functions (such as movement) may have been affected
- Other tests may be needed, if the cause of the stroke is not obvious or there are unusual aspects. On the basis of the information gained from the assessment and tests, a treatment programme is worked out.
Please remember: Stroke Foundation Field Officers are available to support families/whanau and caregivers.
See Stroke Prevention for ways to reduce your future risk of stroke.
Stroke Foundation of N.Z. Inc (National office)
P O Box 12482
L1, Federation House
95-99 Molesworth Street
WELLINGTON
Tel: 04 472 8099
0800 STROKE (0800 78 76 53)
E-mail: strokenz@stroke.org.nz
© 2007 New Zealand Stroke Foundation Inc. All Rights Reserved.