An ischemic stroke (the most common type) happens when a blood vessel that feeds the brain gets blocked, usually from a blood clot or a piece of arterial plaque shutting off the blood supply to a part of the brain, causing brain cell death. The brain then can’t work properly, and neither can the part of the body it controls, like the ability to walk or talk. A hemorrhagic stroke occurs when a blood vessel within the brain bursts, often the result of uncontrolled high blood pressure.

Tests

Computed Tomography Scan (CT or CAT Scan)
This procedure uses a combination of X-rays and computer technology to produce cross-sectional images both horizontally and vertically, of the body to detect abnormalities and help identify the location or type of stroke.

Magnetic Resonance Imaging (MRI)
MRI uses magnetic fields to detect small changes in brain tissue that help to locate and diagnose stroke.

Radionuclide Angiography
This nuclear brain scan uses radioactive compounds injected into a vein in the arm, and a machine (similar to a Geiger counter) to create a map showing their uptake into different parts of the head, often detecting areas of decreased blood flow and tissue damage.

Computed Tomographic Angiography (CTA)
A CT angiogram uses CT technology to obtain images of blood vessels.

Magnetic Resonance Angiography (MRA)
Using MRI technology, this procedure evaluates blood flow through arteries in a noninvasive way.

Functional Magnetic Resonance Imaging (fMRI)
This variation of MRI is used to determine the specific location of the brain where a certain function, such as speech or memory, occurs.

Electroencephalogram (EEG)
An EEG records the brain's continuous, electrical activity by means of electrodes attached to the scalp.

Evoked Potentials
This test records the brain's electrical response to visual, auditory, and sensory stimuli.

Carotid Phonoangiography
A small microphone is placed over the carotid artery on the neck to record sounds created by blood flow as it passes through a partially blocked artery

Doppler Sonography
A special transducer is used to direct sound waves into a blood vessel to evaluate the sound of blood moving though the vessel, looking for faintness or absence of sound.

Ocular Plethysmography
This test measures pressure on the eyes, or detects pulses in the eyes.

Cerebral Blood Flow Test (Inhalation Method)
This test measures the amount of oxygen in the blood supply that reaches different areas of the brain.

Digital Subtraction Angiography (DSA)
The test involves inserting a small, thin tube (catheter) into an artery in the leg and passing it up to the blood vessels in the brain. A contrast dye is injected through the catheter and X-ray images are taken.

Treatments

Emergency treatments

• Medications called thrombolytics or fibrinolytics, also known as clot busters, are used to dissolve the blood clot(s) that cause an ischemic stroke and reduce the damage to brain cells. These must be given within several hours of a stroke's onset.
• Mechanical thrombectomy has become the standard of stroke care.The use of anti-clotting drugs in combination with a catheter-based system for clearing the blockage that UHealth doctors helped pioneer has enabled seven out of 10 people to walk out of the hospital if they were treated within six hours. After the clot buster is administered, specialists can thread a catheter through blood vessels to the site of the blockage and manually remove the clot.
• While stem cells are still being used in clinical trials, there is evidence that, combined with clot busting and mechanical thrombectomy, therapy enhances recovery. Stem cells injected into distant arteries or veins travel to the site of a stroke in the brain to fuelthe repair process. The optimal time for introducing stem cells seems to be between 36 and 72 hours after the stroke.
• Medications can also be used to control brain swelling. Corticosteroids and special types of intravenous fluids are often used to reduce brain swelling, especially after a hemorrhagic stroke.
• Neuroprotective agents are medications that help protect the brain from damage and ischemia (lack of oxygen). Some are still under investigation in clinical trials.
• Other emergency treatments include life support measures, such as:  ventilators (machines to assist with breathing), IV fluids, adequate nutrition, blood pressure control, and prevention of complications

Recovery or Prevention Medications
In addition to medications used to treat existing medical conditions such as diabetes, heart, or blood pressure problems, recovery or prevention medications include:

• Aanticoagulants, which prevent the coagulation or clotting of the blood and may include heparin and warfarin (Coumadin®) and enoxaparin (Lovenox®).
• Anticlumping medications prevent platelets from sticking together. These may include aspirin, clopidogrel (Plavix®) or dipyridamole (Aggrenox®).

Surgery
Several types of surgery may be performed to help treat a stroke, or help to prevent a stroke from occurring.

• Carotid endarterectomy is a proceduret that removes plaque and clots from the carotid arteries, located in the neck, that supply the brain with blood from the heart.
• During carotid stenting a large metal coil (stent) is placed in the carotid artery to keep it open so blood can flow to the brain.
• A craniotomy is another type of surgery in the brain itself to remove blood clots or repair bleeding in the brain.
• Surgeons may also perform surgery to repair aneurysms and arteriovenous malformations (AVMs). An aneurysm is a weakened, area of an artery wall that could rupture and bleed into the brain. An AVM consists of a disorderly, tangled web of arteries and veins, also with the risk of rupturing and bleeding into the brain. Surgery may help prevent a stroke from occurring.
• Patent foramen ovale (PFO) closure is another type of surgery which aims to prevent strokes.The foramen ovale is an opening that occurs in the wall between the two upper chambers of a baby's heart before birth. It normally closes soon after birth, but if it doesn’t, blood flows from the right atrium directly to the left atrium and out to the central circulation of the body. If this blood contains any clots or air bubbles, they can pass into the brain circulation causing a stroke or transient ischemic attack (TIA). At UHealth, PFO closure procedure can be performed with a through the skin approach.

Stroke Rehabilitation Treatment
Many individuals who have a stroke are left with paralysis of one arm and hand. Constraint-induced therapy (CIT) encourages the use of the stroke-affected limb by preventing the non-affected limb from doing tasks and gradually helping the affected side to take over its function.

Why Choose UHealth?

One of the largest stroke programs in the country. Stroke experts at the University of Miami Health System were the first to demonstrate that stem cells released into distant arteries or veins travel to the site of a stroke in the brain to help magnify the body’s healing.

Pioneers in the use of anti-clotting drugs in combination with a catheter-based system for manually clearing the blockage. The clot-clearing system, called mechanical thrombectomy, has become the standard of care.

Multidisciplinary care by recognized specialists in their fields.  In complex cases, stroke care may require the services of a cardiothoracic surgeon, an interventional cardiologist, a lung specialist, a diabetes specialist and a geneticist. Your doctors talk to each other and make sure all specialties involved in your care are on-board with a unified treatment plan.