Stroke

Overview

A stroke occurs when the blood supply to part of your brain is interrupted or reduced,
depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.

A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize
brain damage and potential complications.

The good news is that strokes can be treated and prevented, and many fewer
Americans die of stroke now than in the past.

Symptoms

Watch for these signs and symptoms if you think you or someone else may be having a
stroke. Pay attention to when the signs and symptoms begin. The length of time they
have been present can affect your treatment options:

 Trouble with speaking and understanding. You may experience confusion. You
may slur your words or have difficulty understanding speech.

 Paralysis or numbness of the face, arm or leg. You may develop sudden
numbness, weakness or paralysis in your face, arm or leg. This often happens just
on one side of your body. Try to raise both your arms over your head at the same
time. If one arm begins to fall, you may be having a stroke. Also, one side of your
mouth may droop when you try to smile.

 Trouble with seeing in one or both eyes. You may suddenly have blurred or
blackened vision in one or both eyes, or you may see double.

 Headache. A sudden, severe headache, which may be accompanied by vomiting,

dizziness or altered consciousness, may indicate you're having a stroke.

 Trouble with walking. You may stumble or experience sudden dizziness, loss of
balance or loss of coordination.

When to see a doctor

Seek immediate medical attention if you notice any signs or symptoms of a stroke,
even if they seem to fluctuate or disappear. Think "FAST" and do the following:

 Face. Ask the person to smile. Does one side of the face droop?

 Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one
arm unable to rise up?

 Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or
strange?

 Time. If you observe any of these signs, call 911 immediately.

Call 911 or your local emergency number right away. Don't wait to see if symptoms
stop. Every minute counts. The longer a stroke goes untreated, the greater the potential
for brain damage and disability.

If you're with someone you suspect is having a stroke, watch the person carefully while
waiting for emergency assistance.

Causes

A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting
of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary
disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn't
cause permanent damage.

Ischemic stroke


Ischemic stroke

About 80 percent of strokes are ischemic strokes. Ischemic strokes occur when the
arteries to your brain become narrowed or blocked, causing severely reduced blood
flow (ischemia). The most common ischemic strokes include:

 Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus)

forms in one of the arteries that supply blood to your brain. A clot may be caused
by fatty deposits (plaque) that build up in arteries and cause reduced blood flow
(atherosclerosis) or other artery conditions.

 Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms
away from your brain — commonly in your heart — and is swept through your
bloodstream to lodge in narrower brain arteries. This type of blood clot is called an
embolus.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain
hemorrhages can result from many conditions that affect your blood vessels. These
include:

 Uncontrolled high blood pressure (hypertension)

  Overtreatment with anticoagulants (blood thinners)

 Weak spots in your blood vessel walls (aneurysms)

A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled

blood vessels (arteriovenous malformation). Types of hemorrhagic stroke include:

 Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the

brain bursts and spills into the surrounding brain tissue, damaging brain cells.
Brain cells beyond the leak are deprived of blood and are also damaged.

High blood pressure, trauma, vascular malformations, use of blood-thinning

medications and other conditions may cause an intracerebral hemorrhage.

 Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near

the surface of your brain bursts and spills into the space between the surface of
your brain and your skull. This bleeding is often signaled by a sudden, severe
headache.

A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-

shaped or berry-shaped aneurysm. After the hemorrhage, the blood vessels in
your brain may widen and narrow erratically (vasospasm), causing brain cell
damage by further limiting blood flow.

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) — sometimes known as a ministroke — is a temporary

period of symptoms similar to those you'd have in a stroke. A temporary decrease in
blood supply to part of your brain causes TIAs, which may last as little as five minutes.

Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of
your nervous system — but there is no permanent tissue damage and no lasting
symptoms.

Seek emergency care even if your symptoms seem to clear up. Having a TIA puts you
at greater risk of having a full-blown stroke, causing permanent damage later. If you've
had a TIA, it means there's likely a partially blocked or narrowed artery leading to your
brain or a clot source in the heart.
It's not possible to tell if you're having a stroke or a TIA based only on your symptoms.
Even when symptoms last for under an hour, there is still a risk of permanent tissue
damage.

Risk factors

Many factors can increase your stroke risk. Some factors can also increase your
chances of having a heart attack. Potentially treatable stroke risk factors include:

Lifestyle risk factors

 Being overweight or obese

 Physical inactivity

 Heavy or binge drinking

 Use of illicit drugs such as cocaine and methamphetamines

Medical risk factors

 Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg)

 Cigarette smoking or exposure to secondhand smoke

 High cholesterol

 Diabetes

 Obstructive sleep apnea

 Cardiovascular disease, including heart failure, heart defects, heart infection or

abnormal heart rhythm

 Personal or family history of stroke, heart attack or transient ischemic attack.

Other factors associated with a higher risk of stroke include:

 Age —People age 55 or older have a higher risk of stroke than do younger people.

 Race — African-Americans have a higher risk of stroke than do people of other

races.
  Sex — Men have a higher risk of stroke than women. Women are usually older
when they have strokes, and they're more likely to die of strokes than are men.

 Hormones — use of birth control pills or hormone therapies that include estrogen,
as well as increased estrogen levels from pregnancy and childbirth.

Complications

A stroke can sometimes cause temporary or permanent disabilities, depending on how

long the brain lacks blood flow and which part was affected. Complications may include:

 Paralysis or loss of muscle movement. You may become paralyzed on one side
of your body, or lose control of certain muscles, such as those on one side of your
face or one arm. Physical therapy may help you return to activities affected by
paralysis, such as walking, eating and dressing.

 Difficulty talking or swallowing. A stroke might affect control of the muscles in

your mouth and throat, making it difficult for you to talk clearly (dysarthria), swallow
(dysphagia) or eat. You also may have difficulty with language (aphasia), including
speaking or understanding speech, reading, or writing. Therapy with a speech-
language pathologist might help.

 Memory loss or thinking difficulties. Many people who have had strokes
experience some memory loss. Others may have difficulty thinking, making
judgments, reasoning and understanding concepts.

 Emotional problems. People who have had strokes may have more difficulty
controlling their emotions, or they may develop depression.

 Pain. Pain, numbness or other strange sensations may occur in the parts of the
body affected by stroke. For example, if a stroke causes you to lose feeling in your
left arm, you may develop an uncomfortable tingling sensation in that arm.

People also may be sensitive to temperature changes, especially extreme cold,

after a stroke. This complication is known as central stroke pain or central pain
syndrome. This condition generally develops several weeks after a stroke, and it
may improve over time. But because the pain is caused by a problem in your brain,
rather than a physical injury, there are few treatments.
  Changes in behavior and self-care ability. People who have had strokes may
become more withdrawn and less social or more impulsive. They may need help
with grooming and daily chores.

As with any brain injury, the success of treating these complications varies from person
to person.

Prevention

Knowing your stroke risk factors, following your doctor's recommendations and adopting
a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a
stroke or a transient ischemic attack (TIA), these measures might help prevent another
stroke. The follow-up care you receive in the hospital and afterward also may play a role
as well.

Many stroke prevention strategies are the same as strategies to prevent heart disease.
In general, healthy lifestyle recommendations include:

 Controlling high blood pressure (hypertension). This is one of the most

important things you can do to reduce your stroke risk. If you've had a stroke,
lowering your blood pressure can help prevent a subsequent TIA or stroke.

Exercising, managing stress, maintaining a healthy weight and limiting the amount
of sodium and alcohol you eat and drink can all help to keep high blood pressure in
check. In addition to recommending lifestyle changes, your doctor may prescribe
medications to treat high blood pressure.

 Lowering the amount of cholesterol and saturated fat in your diet. Eating less
cholesterol and fat, especially saturated fat and trans fats, may reduce the plaque
in your arteries. If you can't control your cholesterol through dietary changes alone,
your doctor may prescribe a cholesterol-lowering medication.

 Quitting tobacco use. Smoking raises the risk of stroke for smokers and
nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your
risk of stroke.

 Controlling diabetes. You can manage diabetes with diet, exercise, weight
control and medication.
  Maintaining a healthy weight. Being overweight contributes to other stroke risk
factors, such as high blood pressure, cardiovascular disease and diabetes. Losing
as little as 10 pounds may lower your blood pressure and improve your cholesterol
levels.

 Eating a diet rich in fruits and vegetables. A diet containing five or more daily
servings of fruits or vegetables may reduce your risk of stroke. Following the
Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole
grains, may be helpful.

 Exercising regularly. Aerobic or "cardio" exercise reduces your risk of stroke in

many ways. Exercise can lower your blood pressure, increase your level of high-
density lipoprotein cholesterol, and improve the overall health of your blood
vessels and heart. It also helps you lose weight, control diabetes and reduce
stress. Gradually work up to 30 minutes of activity — such as walking, jogging,
swimming or bicycling — on most, if not all, days of the week.

 Drinking alcohol in moderation, if at all. Alcohol can be both a risk factor and a
protective measure for stroke. Heavy alcohol consumption increases your risk of
high blood pressure, ischemic strokes and hemorrhagic strokes. However, drinking
small to moderate amounts of alcohol, such as one drink a day, may help prevent
ischemic stroke and decrease your blood's clotting tendency. Alcohol may also
interact with other drugs you're taking. Talk to your doctor about what's appropriate
for you.

 Treating obstructive sleep apnea (OSA). Your doctor may recommend an

overnight oxygen assessment to screen for OSA — a sleep disorder in which the
oxygen level intermittently drops during the night. Treatment for OSA includes
oxygen at night or wearing a small device in your mouth to help you breathe.

 Avoiding illegal drugs. Certain street drugs, such as cocaine and

methamphetamines, are established risk factors for a TIA or a stroke. Cocaine
reduces blood flow and can narrow the arteries.

Preventive medications

If you've had an ischemic stroke or TIA, your doctor may recommend medications to
help reduce your risk of having another stroke. These include:

 Anti-platelet drugs. Platelets are cells in your blood that form clots. Anti-platelet
drugs make these cells less sticky and less likely to clot. The most commonly used
 anti-platelet medication is aspirin. Your doctor can help you determine the right
dose of aspirin for you.

Your doctor might also consider prescribing Aggrenox, a combination of low-dose

aspirin and the anti-platelet drug dipyridamole to reduce the risk of blood clotting. If
aspirin doesn't prevent your TIA or stroke, or if you can't take aspirin, your doctor
may instead prescribe an anti-platelet drug such as clopidogrel (Plavix).

 Anticoagulants. These drugs, which include heparin and warfarin (Coumadin,

Jantoven), reduce blood clotting. Heparin is fast acting and may be used over a
short period of time in the hospital. Slower acting warfarin may be used over a
longer term.
Warfarin is a powerful blood-thinning drug, so you'll need to take it exactly as
directed and watch for side effects. Your doctor may prescribe these drugs if you
have certain blood-clotting disorders, certain arterial abnormalities, an abnormal
heart rhythm or other heart problems. Other newer blood thinners may be used if
your TIA or stroke was caused by an abnormal heart rhythm. Diagnosis

To determine the most appropriate treatment for your stroke, your emergency team
needs to evaluate the type of stroke you're having and the areas of your brain affected
by the stroke. They also need to rule out other possible causes of your symptoms, such
as a brain tumor or a drug reaction. Your doctor may use several tests to determine
your risk of stroke, including:
Stroke consultation

Stroke consultation at Mayo Clinic

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CT scan of brain tissue damaged by stroke

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Cerebral angiogram

 Physical examination. Your doctor will ask you or a family member what
symptoms you've been having, when they started and what you were doing when
they began. Your doctor then will evaluate whether these symptoms are still
present.

Your doctor will want to know what medications you take and whether you have
experienced any head injuries. You'll be asked about your personal and family
history of heart disease, transient ischemic attack and stroke.
 Your doctor will check your blood pressure and use a stethoscope to listen to your
heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries,
which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope
to check for signs of tiny cholesterol crystals or clots in the blood vessels at the
back of your eyes.

 Blood tests. You may have several blood tests, which tell your care team how fast
your blood clots, whether your blood sugar is abnormally high or low, whether
critical blood chemicals are out of balance, or whether you may have an infection.
Managing your blood's clotting time and levels of sugar and other key chemicals
will be part of your stroke care.

 Computerized tomography (CT) scan. A CT scan uses a series of X-rays to

create a detailed image of your brain. A CT scan can show a hemorrhage, tumor,
stroke and other conditions. Doctors may inject a dye into your bloodstream to
view your blood vessels in your neck and brain in greater detail (computerized
tomography angiography). There are different types of CT scans that your doctor
may use depending on your situation.

 Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and
magnets to create a detailed view of your brain. An MRI can detect brain tissue
damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a
dye into a blood vessel to view the arteries and veins and highlight blood flow
(magnetic resonance angiography, or magnetic resonance venography).

 Carotid ultrasound. In this test, sound waves create detailed images of the inside
of the carotid arteries in your neck. This test shows buildup of fatty deposits
(plaques) and blood flow in your carotid arteries.

 Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter)
through a small incision, usually in your groin, and guides it through your major
arteries and into your carotid or vertebral artery. Then your doctor injects a dye into
your blood vessels to make them visible under X-ray imaging. This procedure
gives a detailed view of arteries in your brain and neck.

 Echocardiogram. An echocardiogram uses sound waves to create detailed

images of your heart. An echocardiogram can find a source of clots in your heart
that may have traveled from your heart to your brain and caused your stroke.
 You may have a transesophageal echocardiogram. In this test, your doctor inserts
a flexible tube with a small device (transducer) attached into your throat and down
into the tube that connects the back of your mouth to your stomach (esophagus).
Because your esophagus is directly behind your heart, a transesophageal
echocardiogram can create clear, detailed ultrasound images of your heart and
any blood clots.

Treatment

Emergency treatment for stroke depends on whether you're having an ischemic stroke
blocking an artery — the most common kind — or a hemorrhagic stroke that involves
bleeding into the brain.

Ischemic stroke

To treat an ischemic stroke, doctors must quickly restore blood flow to your brain.

Emergency treatment with medications. Therapy with clot-busting drugs must start
within 4.5 hours if they are given into the vein — and the sooner, the better. Quick
treatment not only improves your chances of survival but also may reduce
complications. You may be given:

 Intravenous injection of tissue plasminogen activator (tPA). This injection of

recombinant tissue plasminogen activator (tPA), also called alteplase, is
considered the gold standard treatment for ischemic stroke. An injection of tPA is
usually given through a vein in the arm. This potent clot-busting drug ideally is
given within three hours. In some instances, tPA can be given up to 4.5 hours after
stroke symptoms begin.

This drug restores blood flow by dissolving the blood clot causing your stroke, and
it may help people who have had strokes recover more fully. Your doctor will
consider certain risks, such as potential bleeding in the brain, to determine if tPA is
appropriate for you.

Emergency endovascular procedures. Doctors sometimes treat ischemic strokes with

procedures performed directly inside the blocked blood vessel. These procedures must
be performed as soon as possible, depending on features of the blood clot:
  Medications delivered directly to the brain. Doctors may insert a long, thin tube
(catheter) through an artery in your groin and thread it to your brain to deliver tPA
directly into the area where the stroke is occurring. This is called intra-arterial
thrombolysis. The time window for this treatment is somewhat longer than for
intravenous tPA, but is still limited.

 Removing the clot with a stent retriever. Doctors may use a catheter to
maneuver a device into the blocked blood vessel in your brain and trap and
remove the clot. This procedure is particularly beneficial for people with large clots
that can't be completely dissolved with tPA, though this procedure is often
performed in combination with intravenous tPA.

Several large and recent studies suggest that, depending on the location of the clot and
other factors, endovascular therapy might be the most effective treatment.
Endovascular therapy has been shown to significantly improve outcomes and reduce
long-term disability after ischemic stroke.

Other procedures. To decrease your risk of having another stroke or transient

ischemic attack, your doctor may recommend a procedure to open up an artery that's
narrowed by plaque. Doctors sometimes recommend the following procedures to
prevent a stroke. Options will vary depending on your situation:

 Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes

plaques from arteries that run along each side of your neck to your brain (carotid
arteries). In this procedure, your surgeon makes an incision along the front of your
neck, opens your carotid artery and removes plaque that blocks the carotid artery.

Your surgeon then repairs the artery with stitches or a patch made from a vein or
artificial material (graft). The procedure may reduce your risk of ischemic stroke.
However, a carotid endarterectomy also involves risks, especially for people with
heart disease or other medical conditions.

 Angioplasty and stents. In an angioplasty, a surgeon usually accesses your

carotid arteries through an artery in your groin. Here, your surgeon can gently and
safely navigate to the carotid arteries in your neck. A balloon is then inflated to
expand the narrowed artery. Then a stent can be inserted to support the opened
artery.

Hemorrhagic stroke
Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and
reducing pressure in your brain. You might also need surgery to help reduce future risk.

Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet drugs

such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or
transfusions of blood products to counteract the blood thinners' effects. You may also
be given drugs to lower pressure in your brain (intracranial pressure), lower your blood
pressure, prevent vasospasm or prevent seizures.

Once the bleeding in your brain stops, treatment usually involves supportive medical
care while your body absorbs the blood. Healing is similar to what happens while a bad
bruise goes away. If the area of bleeding is large, your doctor may perform surgery to
remove the blood and relieve pressure on your brain.

Surgical blood vessel repair. Surgery may be used to repair blood vessel
abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of
these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM)
or other type of vascular malformation caused your hemorrhagic stroke:

 Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to
stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can
prevent re-bleeding of an aneurysm that has recently hemorrhaged.

 Coiling (endovascular embolization). A surgeon inserts a catheter into an artery

in your groin and guides it to your brain using X-ray imaging. Tiny detachable coils
are guided into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which
blocks blood flow into the aneurysm and causes the blood to clot.

 Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an
accessible area of your brain, to eliminate the risk of rupture and lower the risk of
hemorrhagic stroke. However, it's not always possible to remove an AVM if its
removal would cause too large a reduction in brain function, or if it's large or
located deep within your brain.

 Stereotactic radiosurgery. Using multiple beams of highly focused radiation,

stereotactic radiosurgery is an advanced minimally invasive treatment used to
repair vascular malformations.

Stroke recovery and rehabilitation


Brain hemisphere connections

After emergency treatment, stroke care focuses on helping you recover as much
function as possible and return to independent living. The impact of your stroke
depends on the area of the brain involved and the amount of tissue damaged.

If your stroke affected the right side of your brain, your movement and sensation on the
left side of your body may be affected. If your stroke damaged the brain tissue on the
left side of your brain, your movement and sensation on the right side of your body may
be affected. Brain damage to the left side of your brain may cause speech and
language disorders.

In addition, if you've had a stroke, you may have problems with breathing, swallowing,
balancing and vision.

Most stroke survivors receive treatment in a rehabilitation program. Your doctor will
recommend the most rigorous therapy program you can handle based on your age,
overall health and degree of disability from your stroke. Your doctor will take into
consideration your lifestyle, interests and priorities, and the availability of family
members or other caregivers.

Your rehabilitation program may begin before you leave the hospital. After discharge,
you might continue your program in a rehabilitation unit of the same hospital, another
rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.

Every person's stroke recovery is different. Depending on your condition, your treatment
team may include:

 Doctor trained in brain conditions (neurologist)

 Rehabilitation doctor (physiatrist)

 Nurse

 Dietitian

 Physical therapist

 Occupational therapist
  Recreational therapist

 Speech pathologist

 Social worker

 Case manager

 Psychologist or psychiatrist

 Chaplain

Speech therapy is often a part of stroke rehabilitation.

Treatment outcomes

One way to evaluate the care of patients diagnosed with stroke is to look at the
percentage of patients receiving the timely and effective care measures that are
appropriate. The goal is 100 percent.

The graphs below display the percentage of eligible Mayo Clinic patients diagnosed with
stroke receiving all of the appropriate care measures.
Stroke Core Measure

See related graph.

Carotid Endarterectomy Mortality

See related graph.

Carotid Stenting Mortality

See related graph.

Comprehensive Stroke Measure

See related graph.

Comprehensive Stroke – Arrival Time to Skin Puncture

See related graph.

Comprehensive Stroke – Post Thrombolysis Revascularization Rate

See related graph.

Comprehensive Stroke – Timeliness of IV t-PA Therapy

See related graph.

For additional information and data visit Medicare Hospital Compare.

Clinical trials
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means
to prevent, detect, treat or manage this disease.

Coping and support

A stroke is a life-changing event that can affect your emotional well-being as much as
your physical function. You may experience feelings of helplessness, frustration,
depression and apathy. You may also have mood changes and a lower sex drive.

Maintaining your self-esteem, connections to others and interest in the world are
essential parts of your recovery. Several strategies may help you and your caregivers,
including:

 Don't be hard on yourself. Accept that physical and emotional recovery will
involve tough work and that it will take time. Aim for a "new normal," and celebrate
your progress. Allow time for rest.

 Get out of the house even if it's hard. Try not to be discouraged or self-
conscious if you move slowly and need a cane, walker or wheelchair to get around.
Getting out is good for you.

 Join a support group. Meeting with others who are coping with a stroke lets you
get out and share experiences, exchange information and build new friendships.

 Let friends and family know what you need. People may want to help, but they
may not know what to do. Let them know how they can help, such as by bringing
over a meal and staying to eat with you and talk, or attending social events or
religious activities.

 Know that you are not alone. Nearly 800,000 Americans have a stroke every
year. Approximately every 40 seconds someone has a stroke in the United States.

Communication challenges

One of the most frustrating effects of stroke is that it can affect your speech and
language. Here are some tips to help you and your caregivers cope with communication
challenges:
  Practice helps. Try to have a conversation at least once a day. It will help you
learn what works best for you, feel connected and rebuild your confidence.

 Relax and take your time. Talking may be easiest and most enjoyable in a
relaxing situation when you're not rushed. Some stroke survivors find that after
dinner is a good time.

 Say it your way. When you're recovering from a stroke, you may need to use
fewer words, rely on gestures or use your tone of voice to communicate.

 Use props and communication aids. You may find it helpful to use cue cards
showing frequently used words or pictures of close friends and family members, a
favorite television show, the bathroom or other regular wants and needs.

Preparing for your appointment

A stroke in progress is usually diagnosed in a hospital. If you're having a stroke, your

immediate care will focus on minimizing brain damage. If you haven't yet had a stroke,
but you're worried about your future risk, you can discuss your concerns with your
doctor at your next scheduled appointment.

What to expect from your doctor

In the emergency room, you may see an emergency medicine specialist or a doctor
trained in brain conditions (neurologist), as well as nurses and medical technicians.

Your emergency team's first priority will be to stabilize your symptoms and overall
medical condition. Then the team will determine if you're having a stroke. Doctors will try
to find the cause of your stroke to determine the most appropriate treatment.

If you're seeking your doctor's advice during a scheduled appointment, your doctor will
evaluate your risk factors for stroke and heart disease. Your discussion will focus on
avoiding these risk factors, such as not smoking or using illegal drugs. Your doctor also
will discuss lifestyle strategies or medications to control high blood pressure, cholesterol
and other stroke risk factors.
In some cases, your doctor may recommend certain tests and procedures. These will
help the doctor to better understand your risk of stroke. They may also help treat
underlying conditions that can increase your risk.

By : https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-
20350119