Diagnosis & Treatment
Diagnosis
Strokes are diagnosed through neurological examinations followed by an imaging technique (usually MRI or CT). The diagnosis of stroke itself is clinical, with assistance from the imaging techniques. 
Imaging techniques also assist in determining the subtypes and cause of stroke. When a stroke has been diagnosed, various other studies may be performed to determine the underlying aetiology, also it is of particular importance to determine whether there is a peripheral source of emboli. When stroke is suspected, computed tomography (CT scan) is performed as soon as possible. CT scan produces x-ray images of the brain and is used to determine the location and extent of hemorrhagic stroke. CT scan usually cannot produce images showing signs of ischemic stroke until 48 hours after onset, so a repeat scan may be performed.
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Treatment and Rehabilitation
Ideally, people who have had a stroke are admitted to a "stroke unit", a ward or dedicated area in hospital staffed by nurses and therapists with experience in stroke. Ischemic stroke is caused by a thrombus occluding blood flow to an artery supplying the brain. Definitive therapy is aimed at removing the blockage by breaking the clot, thrombolysis, or by removing it mechanically, thrombectomy. Thrombolysis is the breakdown of a clot by stimulating fibrinolysis by plasmin through infusion of analogs of tissue plasminogen activator, the protein that normally activates plasmin. Thrombolysis is usually intravenous. It may also be used during an angiogram when patients present with stroke beyond three hours. A thrombectomy is the excision of the blood clot and is performed directly in the cavity of a vessel using a balloon catheter.
Other medical therapies are aimed at minimizing clot enlargement or preventing new clots from forming with medications such as aspirin, clopidogrel and dipyridamole that may be given to prevent platelets from aggregating. Anticoagulation can prevent recurrent stroke by 60%.
Image courtesy of Wikimedia Commons under the creative commons licence.
Patients with intracerebral haemorrhage require neurosurgical evaluation to detect and treat the cause of the bleeding, although many may not need surgery. Anticoagulants and antithrombotics, can make bleeding worse and cannot be used in intracerebral haemorrhage. Patients are monitored and their blood pressure, blood sugar, and oxygenation are kept at optimum levels.
Stroke rehabilitation is the process by which patients with disabling strokes undergo treatment to help them return to normal life as much as possible by regaining and relearning the skills of everyday living. For most stroke patients, physical therapy and occupational therapy are the cornerstones of the rehabilitation process. Patients may have particular problems, such as complete or partial inability to swallow, which can cause swallowed material to pass into the lungs and cause aspiration pneumonia. The condition may improve with time, but in the interim, a nasogastric tube may be inserted, enabling liquid food to be given directly into the stomach. Stroke rehabilitation should be started as immediately as possible and can last anywhere from a few days to over a year. Most return of function is seen in the first few days and weeks, however patients have been known to continue to improve for years, regaining and strengthening abilities like writing, walking, running, and talking. Complete recovery is unusual but not impossible and most patients will improve to some extent with a correct diet and exercise known to help the brain to self-recover.