DEAR MAYO CLINIC: My neighbor had a stroke and received a "clot buster" medication. Then, I found out my uncle had a surgery after a stroke. Can you help me understand different kinds of stroke treatments? My neighbor seems almost back to normal, but my uncle is still in rehabilitation because of some paralysis on his left side.

ANSWER: We have excellent treatments to reverse stroke symptoms, but these treatments are incredibly time dependent. This is a good opportunity to remind people to seek emergency medical care — call 911 — as soon as possible at the first sign of a stroke.

Treatments also depend on the type of stroke. During an ischemic stroke, blood vessels in the brain are blocked or narrowed. During a hemorrhagic stroke, there's bleeding into the brain.

The first treatment for stroke is to potentially offer a medication called tissue plasminogen activator (TPA) that helps dissolve blood clots. This often is called a clot buster. It has to be given within 4.5 hours from when symptoms began.

These drugs are administered by IV, and they can help dissolve blood clots in the brain and restore blood flow. The faster you're able to restore blood flow, the less likely that the stroke symptoms are permanent. 

Another treatment for stroke is a flexible tube called a catheter that is placed in the blood vessels at the groin. The catheter is navigated up to that clot in the brain using X-ray. A device can be administered to help remove that blood clot. This procedure can help with large clots that can't be dissolved with TPA. This procedure often is performed in combination with TPA that's injected into the bloodstream.

Hemorrhagic stroke is treated by lowering blood pressure to help prevent continued bleeding. So if people are on blood thinners, we use other medications to try to reverse the blood thinner medications. If patients have a coagulopathy, or a tendency to bleed, medication is used to try to reverse that. 

Then there are surgical interventions that potentially help remove that blood in the brain to prevent the downstream swelling that can occur after a brain bleed.

Unfortunately, stroke outcomes are incredibly variable. We'd love to have excellent outcomes for every patient who experiences an acute stroke. But with timeliness of treatment, we are much more likely to have a favorable outcome. 

The goal is to keep people independent after their stroke. So the faster someone arrives to the hospital, the more likely to achieve that outcome. 

Stroke symptoms include trouble speaking and understanding others; numbness or weakness, often on one side of the face, arms or legs; vision problems; a severe headache; and trouble walking. 

We use an acronym you may have heard previously to help people recognize warning signs of a stroke:

FAST

• F = Face drooping: Ask the person to smile. Does one side of the face droop?
• A = Arm weakness: Ask the person to raise both arms and see if one arm drifts down or if one arm is unable to be lifted.
• S = Speech difficulty: Ask the person to speak and see if the speech is slurred.
• T = Time to call 911: Stroke is an emergency.

With any of these signs, call 911 or emergency medical care at once to allow for the treatment of stroke. Note the time when any of the symptoms first appear. — Stephen English Jr., M.D., Neurology, Mayo Clinic, Jacksonville, Florida

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