Having a stroke, emergency and how to treat?

Professionally consulted by Master, Doctor Bui Ngoc Phuong Hoa - General Internal Medicine - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.

Cerebral stroke including cerebral bleeding and ischemic stroke is one of the 3rd leading causes of death and the 1st cause of disability among all diseases. Currently, medicine has made many advances in diagnosis and treatment, but saving stroke no longer depends on many factors.

Stroke is a cardiovascular disease defined by the World Health Organization (WHO) as a syndrome consisting of signs of brain dysfunction (focal or general), characterized by rapid development. , which usually lasts 24 hours or more or can lead to death when no cause other than a vascular one can be identified.
According to WHO (2015,) stroke is the main cause of death in Vietnam (accounting for 21.7%) with 150,000 patients dying each year.
Stroke is the most common cause of severe disability in adults worldwide. Only 15-30% of stroke patients survive, so can the stroke be saved?
The recovery of patients after a stroke depends a lot on medical interventions, natural recovery, rehabilitation therapies... The recovery process after a stroke is different for each person. on a case-by-case basis.
1.1 Classification of stroke and cerebrovascular accident Intracerebral hemorrhage:
Intracranial bleeding Intraventricular bleeding Subarachnoid space bleeding. Cerebral ischemia:
Cerebral infarction Transient cerebrovascular accident.

Timely stroke recognition is one of the factors that help increase the patient's survival. A stroke is a disease that usually has a sudden onset with any of the following neurological signs including:
Numbness or weakness in the limbs, numbness may appear in the face (especially may appear only on one side of the body) Patients with language disorders, abnormalities in speech or understanding Visual disturbances, abnormalities in the ability to see in one or both eyes Balance disorders: loss of balance, feeling dizzy Facial pain or decreased coordination Patient has severe headache of unknown etiology.

When you see a patient having a stroke, call the nearest ambulance immediately or take the patient to the nearest hospital (capable of treating acute stroke), as soon as possible, try to keep the patient awake by way of talking, constantly asking questions for the patient to answer until the medical staff can reach the patient.
First aid stroke treatment measures:
Ensure the patient's airway and ventilation The safe position is to lie on the side, especially in patients with severe vomiting. sputum suction Indication for intubation to protect the airways when respiratory secretions stagnate, decreased consciousness with a Glasgow score of less than 8. For stroke patients and the first aid treatment of medical staff will depend on the conclusion. of the evaluation signs:
Patients with suspected transient ischemic attack and at high risk of stroke should:
Take Aspirin (300 mg dose) immediately Evaluation and continuous specialist visit within 24 hours hours after onset of symptoms Apply treatment and prevention measures as soon as diagnosis is confirmed Note: Patients with 2 or more transient ischemic attacks within 1 week are classified as group at high risk of stroke. Persons suspected of having a transient ischemic attack and at low risk of stroke should:
Take Aspirin (300mg dose) immediately Evaluation and specialist investigation as soon as possible, preferably within 1 week after the onset of symptoms. Apply treatment and prevention measures as soon as the diagnosis is confirmed Note: Patients who have had 1 transient ischemic attack but presented late (more than 1 week after the last symptom disappeared) should be classified as a low-risk group. Indications for brain imaging for the following groups of subjects:
People who are suspected of having a transient ischemic attack (symptoms and signs disappear completely within 24 hours) should be examined and evaluated by a specialist. clinic (within 1 week of symptom onset) before deciding to have brain imaging; Persons at high risk of stroke who are uncertain about the diagnosis or zoning of the lesion receive urgent brain imaging (preferably magnetic resonance imaging) People suspected of having a low stroke risk without diagnostic certainty brain imaging should be considered.

Brain imaging should be performed immediately for patients with stroke and cerebrovascular accident if any of the following conditions are met:
There is indication for thrombolytic therapy or anticoagulation therapy early On treatment with anticoagulants History of easy bleeding Decreased consciousness (Glasgow score less than 13) Symptoms tend to worsen or fluctuate without explanation such as papilledema, neck stiffness, fever or headache intense at the onset of stroke symptoms. As soon as the diagnosis is confirmed, the patient should be evaluated for nutritional status, swallowing ability, risk factors for respiratory complications, and risk of developing pressure ulcers.
For patients with acute ischemic stroke, intravenous thrombolytic therapy (rtPA) is the most effective intervention in the early stages. In addition, a number of other interventions are also promising, such as arterial thrombolytic drugs and mechanical interventions.
3.1. Thrombolytic therapy for patients with acute ischemic stroke Consider patients with indications for fibrinolytic therapy. Dose of fibrinolytics: in Europe and the United States, a dose of 0.9 mg/day is used. kg, 10% bolus, the rest by slow intravenous infusion over 60 minutes. In Japan and some Asian countries, a dose of 0.6 mg/kg is used, bolus 15%, the rest is maintained intravenously for 60 minutes. 3.2. Indication of anticoagulants and antiplatelet drugs in patients with cerebral infarction If the patient has no economic conditions: Use Aspirin has more advantages than Aspirin allergy patients, use Clopidogrel (Plavix). Aspirin dose: 100-300mg/day. Clopidogrel dose: 75mg/day; Aspirin and clopidogrel should not be combined for prophylaxis with dual antiplatelet therapy only in patients with ischemic stroke with concomitant coronary artery disease. Low-molecular-weight heparin anticoagulants should only be used if there is an indication for prevention of deep vein thrombosis. 3.3. Treatment of subarachnoid hemorrhagic stroke Endovascular and surgical interventions:
Aneurysm clamp surgery, endovascular intervention to place coils should be performed as soon as possible Aneurysm clamp surgery should be performed in patients with Cerebral parenchymal blood volume >50ml and aneurysm in the middle cerebral artery Coil placement should be performed in patients over 70 years of age with severe clinical symptoms and aneurysms at the apex of the basilar artery. Management of cerebral vasospasm Treatment of dilated ventricles Management of convulsions associated with subarachnoid hemorrhage.

3.4. Treatment of hypertension in patients with stroke and ischemic stroke Up to 80% of stroke patients have hypertension and blood pressure readings usually decrease gradually within 24-48 hours from the time of onset of stroke. Stroke Causes of hypertension: Mostly physiological response to acute brain injury, possibly with pre-existing hypertensive disease Reactive hypertension can occur when the patient has difficulty urinating, development of a bladder bridge, due to pain, hypoxia, or increased intracranial pressure Most patients will experience a drop in blood pressure in the first hours after a stroke without specific treatment. Blood pressure will decrease spontaneously when the patient is in a quiet room, resting, bladder empty, pain is controlled, treatment for raised intracranial pressure According to American Heart Association recommendations AHA Should only lower blood pressure about 20% when the diastolic blood pressure is above 140mmHg or the systolic blood pressure is above 220mmHg; For patients with acute cerebral infarction who are indicated for fibrinolytic therapy: Maintain blood pressure below 180/110 mmHg. Stroke is a dangerous disease with a high mortality rate, so when the body shows any signs related to stroke and stroke, the patient should see a doctor to be discussed and timely intervention.

Currently, Magnetic Resonance Imaging - MRI/MRA is considered a "golden" tool to screen for brain stroke. MRI is used to check the condition of most organs in the body, especially valuable in detailed imaging of the brain or spinal nerves. Due to the good contrast and resolution, MRI images allow to detect abnormalities hidden behind bone layers that are difficult to recognize with other imaging methods. MRI can give more accurate results than X-ray techniques (except for DSA angiography) in diagnosing brain diseases, cardiovascular diseases, strokes,... Moreover, the process MRI scans do not cause side effects like X-rays or computed tomography (CT) scans.\
Vinmec International General Hospital currently owns a 3.0 Tesla MRI system equipped with state-of-the-art equipment by GE. Healthcare (USA) with high image quality, allows comprehensive assessment, does not miss the injury but reduces the time taken to take pictures. Silent technology helps to reduce noise, create comfort and reduce stress for the client during the shooting process, resulting in better image quality and shorter imaging time. With the state-of-the-art MRI system With the application of modern methods of cerebral vascular intervention, a team of experienced and well-trained neurologists and radiologists, Vinmec is a prestigious address for stroke risk screening and screening. reliable goods.
In the past time; Vinmec has successfully treated many cases of stroke in a timely manner, leaving no sequelae: saving the life of a patient suffering from 2 consecutive strokes; Responding to foreign female tourists to escape the "death door" of a stroke;...