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Stroke/tPA

Main Points

  • Learn the symptoms of stroke: sudden weakness on one side of the body, sudden blinding headache, sudden loss of balance or coordination, loss of vision in one eye.
  • If you experience any symptoms, go to the nearest emergency department, even if the symptoms go away.  
  • Stroke is a medical emergency and the fifth leading cause of death in the United States, affecting about 800,000 people each year.[i]
  • ACEP believes that the best care should be made available to stroke patients in a timely fashion and that all hospitals should have procedures in place to handle stroke patients as soon as they arrive.

What is stroke?

Stroke occurs when blood flow to the brain is interrupted by a clogged or burst artery. [ii] The interruption deprives the brain of blood and oxygen and causes brain cells to die.  Time equals brain cells:  Every minute of delay in treatment can cost a patient 2 million brain cells.  Stroke strikes quickly, you should act quickly, too:  Call 911.

What makes stroke so dangerous?

  • One American dies from a stroke every 4 minutes on average. [iii]
  • Stroke is the third leading cause of death for women.  Each year 55,000 more women than men have strokes. 
  • Even children, especially those with chronic diseases, can have strokes. 
  • Stroke is stealthy, and sometimes symptoms go away, tricking people into delaying care.  Symptoms that last for only a few minutes and then subside may indicate a mini-stroke, or a transient ischemic attack (TIA).  TIAs are serious medical events and require evaluation by a physician. They can also be a warning sign of a more dangerous stroke in the future.  A 2008 study in Annals of Emergency Medicine [iv] reports that one in 20 patients who have had a TIA will have another stroke within 48 hours.  Half of all TIA patients have brain damage, which can be reversible if they seek treatment immediately.  If you think you are having a stroke or TIA, call 911.

What are the symptoms of stroke?

  • Sudden numbness, weakness or paralysis of the face, arm or leg, especially on one side of the body;
  • Sudden blurred or decreased vision in one or both eyes;
  • Difficulty speaking or understanding simple statements; and
  • Loss of balance or coordination when combined with another warning sign.
  • Other symptoms include headache, face pain and limb pain; disorientation and change in consciousness; various neurological symptoms such as hiccups, nausea and general weakness.

    Also, symptoms are less likely to occur in the brain — instead you could experience chest pain, shortness of breath or palpitations.

What are the types of stroke?[v]

  • Ischemic stroke:  These occur as a result of an obstruction within the blood vessel (clots) supplying blood to the brain.  It accounts for about 87 percent of all stroke cases.
  • Hemorrhagic stroke: These occur when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and Arteriovenous Malformations (AVMs).  But the most common cause of hemorrhagic stroke is uncontrolled hypertension (high blood pressure).
  • Transient Ischemic Attack (TIA): Transient Ischemic Attack (TIA) is caused by a temporary clot.  It is often referred to as a “mini-stroke.”  These warning signs should be taken very seriously and never ignored.

What is F.A.S.T.?

Developed by the Centers for Disease Control and Prevention, acting F.A.S.T. [vi] can help someone that may be having a stroke:

F—Face:        Ask the person to smile.  Does one side of the face droop?
A—Arms:       Ask the person to raise both arms. Does one arm drift downward?
S—Speech:    Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time:        If you observe any of these signs, call 9-1-1 immediately.

How is stroke treated?

Treatment of ischemic stroke (from a blood clot in the brain) may include medications that thin the blood, prevent clot formation, and “bust” through clots (thrombolytic medication).  Patients may also need surgery.

Treatment of hemorrhagic stroke (from a broken and bleeding blood vessel in the brain) may include medications and surgery.  Depending on the severity of the stroke, medications may include those that reduce blood pressure and swelling or reverse the effects of anticoagulant, to prevent seizures.   

What is tPA?

Tissue plasminogen activator (tPA) is a clot-busting drug that is effective in treating acute ischemic stroke when given within specific timeframes.  It was approved by the Food and Drug Administrations in 1996.

What is ACEP’s position on the use of tPA— the clot-busting drug?

Emergency physicians act in the best interest of each patient.  The clinical policy on stroke and tPA issued by the American College of Emergency Physicians [vii] recommends shared decision-making between the doctor, the patient and patient’s family when choosing tPA for treatment.

While tPA has been used successfully for treating stroke, the use of tPA also remains controversial. Some studies show that certain stroke victims, when given tPA within a specific timeframe, are more likely to have minimal or no disability.  It does not guarantee success, and there are significant risks to using it, including bleeding in the brain, which can cause long-term damage.  Oftentimes, patients tend to overestimate the benefits of medical interventions and underestimate the harms. 

Because brain cell injury during stroke is progressive, and a narrow window of opportunity exists for acute treatment, recognizing the warning signs of a stroke is essential. However, there are risks associated with “clot busting” therapy (e.g., bleeding in the brain).  

How do I reduce my risk of stroke?

The American College of Emergency Physicians recommends taking following steps to reduce the risk of stroke:

  • Control your blood pressure.
  • Don’t smoke.  Eat a healthy diet. 
  • Have your cholesterol checked; if it is high; follow your doctor’s instructions on how to control it.  Exercise regularly. 
  • Control diabetes.
  • Manage heart disease.
  • Be aware of your family’s medical history of stroke.
  • Promptly report warning signs to your doctor.

For more information on health and safety issues, visit EmergencyCareforYou.org.


[i] Centers for Disease Control and Prevention http://www.cdc.gov/stroke/.

[ii] Centers for Disease Control and Prevention http://www.cdc.gov/stroke/about.htm .

[iii] Centers for Disease Control and Prevention http://www.cdc.gov/stroke/.

[iv] Annals of Emergency Medicine, “Transient Ischemic Attack Overview: Defining the Challenges for Improving Outcomes,” 2008, Jagoda, Andy  http://www.annemergmed.com/article/S0196-0644(08)00803-2/abstract?cc=y.

[vi] Centers for Disease Control and Prevention, http://www.cdc.gov/stroke/signs_symptoms.htm.

[vii] Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic 2 Stroke in the Emergency Department, http://www.acep.org/workarea/DownloadAsset.aspx?id=102612


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