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The brain is the most sensitive organ to the lack of oxygen and nutrients carried by the blood. When a stroke occurs, every minute counts—the longer treatment is delayed, the greater is the damage to the brain. This is why it is essential to recognise the symptoms early on and administer specific treatment to restore blood flow and prevent further damage to the brain tissue.
Acting quickly, within minutes of symptom onset significantly improves the chances of recovery and reduces both the sequelae and the risk of death.
Acting quickly, within hours of symptom onset significantly improves the chances of recovery and reduces both the sequelae and mortality.
In Catalonia, an emergency protocol called the “Code Stroke” has been developed to ensure that patients suspected of having a stroke receive immediate medical attention. This system allows for:
- Rapid identification of suspected stroke cases.
- Activation of a medical alert to mobilise specialised health resources.
- Immediate transfer to the most appropriate referral hospital.
- Early and accurate diagnosis to determine the most effective treatment in each case.
Reducing the time between the onset of symptoms and the start of treatment is key. It is estimated that during a stroke, approximately 2 million neurons and 14 billion synapses (connections between neurons) are lost every minute that passes without restoring blood flow. Therefore, activating the Code Stroke gives patients the best chance at recovery and minimises the impact of the disease.
Whenever a stroke is suspected, the doctor must assess the symptoms very accurately and rule out any other conditions which can mimic stroke, for example a decrease in blood sugar (hypoglycaemia).
Emergency tests are used to diagnose the stroke and determine whether it is an infarction or haemorrhage. The aim is to guide initial treatment and limit the after-effects.
The main tools used for emergency diagnosis of stroke are neuro-imaging techniques, such as computed tomography (brain CT scan) or magnetic resonance imaging (brain MRI scan).
Tests that offer a direct visualisation of blood vessels, such as computed tomography angiography (CTA), are usually performed. An angiography provides a detailed image of flow through the body’s blood vessels. A CTA scan of the brain can locate a blockage or check whether blood is reaching all areas of the brain correctly.
Once stroke is diagnosed, most cases generally require additional tests to determine the cause. The main objective is to guide post-stroke prevention treatment and prevent recurrence, but the treatment will vary in function of the cause:
Doppler ultrasound is a type of ultrasound used to determine the volume, rate and thickness of blood flowing through arteries and veins at a given moment. The technique can also be used to detect alterations (e.g., arteriosclerosis plaques) in the major arteries, principally those in the neck, carrying blood from the heart to the brain.
Echocardiography is another commonly practised test that is used to study any anatomical changes in the heart.
Cardiac rhythm studies, such as an electrocardiogram or a Holter test, may also be appropriate.
Some of the indicators measured in laboratory tests include sugar and cholesterol levels, plus counts of platelets and other types of blood cell which can induce thrombosis. More specific laboratory tests are sometimes conducted in search of hidden tumours, coagulation disorders predisposing thrombosis or genetic alterations that may increase the chance of stroke, amongst others.
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Substantiated information by:
Antonia Fernández
Nurse
Neurology Department
Arturo Renú Jornet
Neurologist
Neurology Department
Xabier Urra Nuin
Neurologist
Neurology Department
Ángel Chamorro Sanchez
Head of the Cerebral Vascular Pathology Unit
Published: 20 February 2018
Updated: 27 December 2022
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