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Symptoms and Immediate Treatment Options

By Dr. Helmi Lutsep

Stroke Strikes Without Warning

Unfortunately, strokes don’t come with a lot of warning signs. The symptoms usually show up suddenly, as the stroke is taking place. Sudden weakness, especially on one side, numbness, double vision, dizziness, and/or trouble talking can all be signs of stroke. If you suspect someone is having a stroke, think FAST:

  • F stands for face. Ask them to smile, then see if one side of their mouth droops.
  • A stands for arms. Ask them to hold their arms in front of them, then see if one arm drifts down.
  • S stands for speech. Ask them to repeat a sentence after you, then listen for slurs or incorrect words.
  • T stands for time. If any one of these symptoms is present, call 9-11. Do not waste time calling their primary physician first, or trying to drive the stroke victim yourself. Every minute counts.

    • A small percentage of people (about 10%) will have a warning or TIA (Transient Ischemic Attack). A TIA occurs when a blockage in a blood vessel brings on stroke-like symptoms, but then the blockage quickly dissolves on its own without causing damage. A TIA occurrence substantially raises a person’s risk for having a stroke in the future. It’s important to get anyone who has had a TIA to the hospital immediately, so doctors can figure out why it happened and try to prevent a future stroke.

    Treating Stroke

    When someone who has suffered a stroke arrives at the hospital, the first important step is determining whether it was an ischemic stroke, due to a blockage in a blood vessel or a hemorrhagic stroke, due to a rupture. We use a CT or MRI scan to get a clear picture of the brain and see what treatment is needed.

    Ischemic stroke treatment

    The main treatment available for ischemic stroke is a blood-thinning drug called t-PA. It’s given intravenously and works best within three hours of the onset of stroke. We now have a little evidence that we might be able to give it later, but the odds for effective treatment go way down after three hours.

    There are some other treatment options involving angioplasty and other surgical techniques, but they aren’t yet widely available.

    Hemorrhagic Stroke Treatment

    Unfortunately, we don’t have many treatment options for hemorrhagic stroke. We closely monitor the patient in ICU to make sure the blood pressure is well controlled, because if it gets too high, it can cause the bleeding to worsen. Sometimes these patients benefit from surgery to remove the blood. However, in many cases surgery isn’t necessary.

    The treatment a stroke patient receives at the hospital is merely the first step on an often long road to recovery.



    Dr. Helmi Lutsep Dr. Helmi Lutsep serves as the associate director of the Oregon Stroke Center. She received her medical degree from Mayo Medical School in 1988, and completed her residency at the Mayo Graduate School of Medicine, as well as her cerebrovascular disease fellowship at Stanford University. Dr. Lutsep’s clinical area of focus is stroke prevention and acute stroke treatment.
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