Investigation and treatment

In order to look into the cause of your stroke or transient ischaemic attack (TIA), the following tests may be performed:

  • Blood tests, including checking for diabetes and high cholesterol
  • A brain scan – usually a CT scan first, sometimes with dye in the blood vessels called a CT angiogram, and more frequently an MRI brain scan
  • An ECG (heart tracing) to measure the electrical activity of the heart and check for an irregular heart rhythm.
  • A carotid doppler scan (neck ultrasound) to assess for narrowing of the blood vessels in the neck, which if present, may require an operation to remove the narrowing and prevent further potential strokes.
  • An echocardiogram (heart ultrasound) to look at the heart valves and function of the heart.
  • Cardiac monitoring in the form of a heart monitor which may be for 24hrs, but often up to two weeks and patients are often discharged from hospital whilst wearing the monitoring device.

Treatment

Lifestyle management

If you smoke we can give you advice on where to get support to help you successfully stop. We will also give you advice on healthy eating and weight control, how to cut down on alcohol intake and to adopt a regular exercise programme.

Blood thinning medication

If you have had a TIA, you may be treated with medication such as aspirin or clopidogrel. These are called antiplatelet medications. If you have a history of an irregular heart beat (atrial fibrillation) or we find evidence of this during your admission, we may recommend starting alternative medication such as anticoagulants. These include dabigatran, apixaban, edoxaban and rivaroxaban, and occasionally, warfarin.

Blood pressure lowering treatment

High blood pressure is a risk factor for TIAs and strokes. If your blood pressure is more than 140/80 we may discuss starting blood pressure lowering treatment. We strongly recommend patients who have had a TIA or stroke buy their own blood pressure monitor, record their blood pressure at home 3-4 times a week at different times of the day, and write down or note the readings to discuss with their GP. This is so high blood pressure can be identified and treated, and the right dose of medication prescribed to ensure good control.

Cholesterol lowering treatment

High cholesterol levels also contribute to strokes. You will usually be started on a cholesterol lowering tablet (a statin) as statins not only lower cholesterol, but reduce inflammation in the arteries leading to a build-up of the fatty deposits which can then go on to cause a stroke. We may start them at lower doses to prevent side effects, which are rare, and we would recommend lifelong statin treatment after an ischaemic stroke or TIA regardless of a patient’s cholesterol levels.

Carotid endarterectomy (surgery on a blocked carotid artery)

If your neck ultrasound scan shows you have a significant blockage to one of your carotid arteries, and it is felt that this has contributed to your symptoms, you will be referred to the vascular team for consideration for surgery to unblock the artery (carotid endarterectomy). The vascular surgery team will discuss the pros and cons of surgery with you and will advise if this may be a suitable option for you. Usually they will want to act quite quickly if this is identified, and most patients have an operation within 2 weeks of their stroke or TIA.

Driving

All patients who have had a TIA or stroke must not drive for one month. This is a DVLA guideline. If you have made a good recovery, then you can resume driving after this time. Some patients have ongoing problems with arm and leg weakness or co-ordination and visual loss which mean they are unsafe to drive after this time. Discuss the impact of your stroke with your doctor, who will be able to give you further advice about when it is safe to consider resuming driving again, and what further assessments might need to be done.

For further information please see the DVLA website.

Follow-up

You will be followed up at six weeks and six months by one of our community specialist stroke, TIA nurses or stroke consultants who will contact you with an appointment. This might be a face to face clinic visit, a telephone call or a video consultation. 

If you think you have not been followed up, please contact the community stroke specialist nurse in your area. Please refer to meet the team pages for contact details.