Patient Education Series | Treating Strokes in the ER | Antony Arumairaj, MD

Treating Strokes in the ER: What Happens and What to Expect

When a stroke strikes, every second counts. Once you arrive at the emergency room, a highly trained medical team moves quickly to identify the type of stroke you are experiencing and to start treatment immediately. Here’s what typically happens:

Diagnosing a Stroke

The first priority in the ER is determining whether you're having an ischemic stroke (a blocked blood vessel) or a hemorrhagic stroke (bleeding in the brain). Different strokes require very different treatments, so fast, accurate diagnosis is critical.

You’ll undergo several tests, including:

• Physical Exam: Healthcare providers check your heart, blood pressure, and perform a neurological exam to assess nerve function.
• Blood Tests: These look for clotting issues, blood sugar imbalances, or infections that might mimic stroke symptoms.
• Imaging Tests:
  • A CT scan can quickly spot bleeding, blockages, or tumors.
  • An MRI gives a detailed look at brain damage or hemorrhage.
  • CT Angiography and Magnetic Resonance Angiography may be used to view blood flow in your brain and neck.

Additional tests like carotid ultrasound, cerebral angiograms, and echocardiograms can uncover narrowed arteries or heart-related causes of stroke.

Emergency Stroke Treatment

Ischemic Stroke Treatment

If the stroke is caused by a blocked artery, the focus is on restoring blood flow:

• IV Medication: A clot-busting drug, called tissue plasminogen activator (TPA), may be administered. This needs to happen within 4.5 hours of symptom onset. The earlier it's given, the better the outcomes.
• Endovascular Procedures:
  • Sometimes, TPA is delivered directly to the brain through a catheter.
  • Large clots may be physically removed using a stent retriever, particularly when TPA alone isn’t enough.

Additionally, for long-term stroke prevention, procedures like carotid endarterectomy or angioplasty with stenting may be recommended to open narrowed arteries.

Hemorrhagic Stroke Treatment

For strokes caused by bleeding, the goal is to control bleeding and relieve pressure on the brain:

• Medications may counteract blood thinners, lower blood pressure, and reduce swelling.
• Surgical Options:
  • Clipping or coiling of aneurysms to stop further bleeding.
  • Surgical removal of AVMs (arteriovenous malformations) if they’re accessible.
  • Stereotactic radiosurgery for non-invasive repair of blood vessel malformations.

Recovery and Rehabilitation

After the initial emergency is over, focus shifts to recovery. Your rehabilitation plan depends on how much brain damage occurred and which parts of the brain were affected.

Most stroke survivors start rehab within days, working with a team that may include:

• Neurologists
• Physical and occupational therapists
• Speech pathologists
• Dietitians and psychologists
• Rehabilitation nurses

Recovery might continue in an inpatient facility, outpatient center, or at home, depending on your needs.

Coping After a Stroke

A stroke doesn’t just affect your body—it also impacts your emotions, relationships, and sense of identity. Mood changes, depression, and communication challenges are common.

Helpful strategies include:

• Celebrating small victories and allowing time for healing.
• Joining support groups for encouragement and shared experiences.
• Communicating openly with family and friends about your needs.
• Practicing conversations daily to rebuild speech and confidence.

Bottom Line: In the ER, stroke treatment is a race against time. Early, precise care can save lives, minimize brain damage, and dramatically improve recovery outcomes. If you or someone around you shows signs of a stroke—act fast and call 911 immediately.

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