Emergency intervention for symptoms of cerebral vessel occlusion or hemorrhage. Diagnosis and treatment are initiated within the first minutes to limit tissue damage.
Indication
- Facial asymmetry, arm weakness, speech disturbance (FAST symptoms)
- Sudden one-sided numbness or paralysis
- Sudden loss of vision, double vision, or visual field defect
- Unexplained sudden severe headache
- Sudden imbalance, dizziness, or gait disturbance
- Altered consciousness with neurological findings
Preparation
- Symptom onset time must be recorded (critical for the treatment window)
- IV access is established; blood samples (blood glucose, coagulation, kidney function) are drawn
- Patient or family members provide information about current medications (including blood thinners)
How it's performed
- ABC (airway, breathing, circulation) is rapidly assessed; oxygen and monitoring are initiated
- Neurological examination is performed using the NIHSS score
- Brain CT (and CT angiography/perfusion if needed) is obtained to differentiate ischemic from hemorrhagic stroke
- For ischemic stroke and if eligible, intravenous thrombolytic therapy (IV tPA / tenecteplase) is administered within 4.5 hours of symptom onset
- For large vessel occlusion, mechanical thrombectomy via catheter may be considered up to 24 hours
- In hemorrhagic stroke, blood pressure control and neurosurgical consultation are arranged
Post-procedure
- Close monitoring in the intensive care unit or stroke unit for 24-72 hours
- Early physical therapy, speech, and swallowing assessment are initiated
- Blood pressure, cholesterol, blood glucose, and arrhythmia are controlled to prevent recurrent stroke
- Antiplatelet or anticoagulant therapy is planned
- Outpatient follow-up with neurology and rehabilitation after discharge
Risks
- Brain hemorrhage after thrombolytic therapy (approximately 2-7%)
- Vessel injury or new embolism during mechanical thrombectomy
- Aspiration pneumonia, deep vein thrombosis, pressure ulcers
- Permanent neurological deficit (paralysis, loss of speech, cognitive problems)
- Risk of recurrent stroke despite treatment
FAQ
What should we do when we observe stroke symptoms?
Call emergency services (112) immediately. Note the time symptoms began; the time window for thrombolytic therapy is limited. Do not give the patient food or drink.
Is thrombolytic therapy given to every patient?
No. Eligibility is assessed based on symptom onset time, bleeding risk, current medications, and imaging findings.
What is the time limit for thrombectomy?
Selected patients with large vessel occlusion may benefit up to 24 hours after symptom onset; the decision is made based on imaging findings.
How long does recovery after a stroke take?
Recovery is generally fastest in the first 3-6 months, but rehabilitation can produce gains over months and years.
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