The most impressive improvement can be obtained
by giving intravenous (IV) thrombolytic drugs to dissolve
the clot. 'Clot busters' or tissue plasminogen activators,
such as alteplase, can make a dramatic difference but
are dangerous if inappropriately used. They increase
bleeding so it is vital that haemorrhagic stroke is
excluded before they are offered. This can be confirmed
by ordering a CT scan (DH 2007). The CT scan can
also give information about the position of the stroke
and the size of the penumbra. Haemorrhagic stroke can
be excluded with some confidence, but it is not easy
to visualise
ischaemic changes. Magnetic resonanceimaging (MRI)
can give a clearer picture but it is not as
readily available and its use is contraindicated in people
who have cardiac pacemakers and those who are
confused and unable to co-operate (Warren ei
al
2010).
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