Stroke (Infarction and Hemorrhage)

If any of this happens suddenly

• One side of the face droops — ask the person to smile, and one corner of the mouth does not lift
• One arm or leg goes weak — ask the person to hold both arms out in front, and one arm drops
• Speech is slurred — the words get tangled, or the person cannot understand what you say
• Loss of sight on one side, or seeing double
• Dizziness that makes it impossible to keep your balance
• A severe headache unlike anything you have felt before

If even one of these fits

# Call 119 right away

The Korean Stroke Society (대한뇌졸중학회) advises that "if even one of these signs feels wrong, you should go to a stroke center at once by calling 119".

Please do not do this

• ❌ "It will get better if I rest a little" — with a stroke, the damage spreads as time passes
• ❌ Going to a local clinic or a Korean medicine clinic (한의원) first — you lose time while you are moved again to a hospital that can treat stroke
• ❌ Driving there yourself — 119 looks for a hospital that can treat you and takes you there. If you simply go to the nearest hospital, you may have to be moved again
• ❌ Giving medicine or water — if swallowing is impaired, it goes into the airway
• ❌ Pricking the fingers with a needle or rubbing the hands — it does nothing at all and only costs time

Why time matters

• Treatment that opens the blocked vessel with a drug (intravenous thrombolysis) can be given within 4.5 hours of the symptoms starting.
• Treatment that pulls the clot out with a device (intra-arterial thrombectomy) is usually recommended within 6 hours, and for some patients it is possible up to 24 hours.
• The Korean Stroke Society advises that "you have to arrive within at least 3 hours of the symptoms starting for treatment to begin within 4.5 hours". This is because time is also needed for tests after you reach the hospital.

One thing to keep in mind

Please make sure you remember when the symptoms started.
Knowing "the hour and minute it began" decides which treatment can be used.
If it began while the person was asleep, tell the staff the last time the person was clearly well.

Even if the symptoms came for a moment and then went away, do not let it pass.
It can be a warning sign before a large stroke, so it is best to have tests and treatment.

At a glance

A stroke is a disease in which the brain is damaged because something goes wrong with the blood vessels that carry blood to it.
It splits into two main types, and the treatments are the exact opposite of each other.

• Cerebral infarction (ischemic stroke) — a vessel is blocked, so part of the brain is damaged. A blood clot or fatty debris blocks the vessel.
• Brain hemorrhage (hemorrhagic stroke) — a vessel bursts, so brain tissue is damaged. High blood pressure or a brain aneurysm is the main cause.

A blockage has to be opened, and a burst vessel has to be stopped from bleeding.
You cannot tell the two apart from the symptoms alone.
That is why a CT scan is the very first thing done when you arrive at the hospital.

This is the reason for "not deciding at home, but going to a hospital".
If you get it wrong, the treatment is the exact opposite of what is needed.

Why after-effects remain

Once brain cells die, they do not come back.
So with a stroke, how quickly blood flow was restored decides the outcome.

With the same illness, the result differs between a person who arrives in 3 hours and a person who arrives the next day.
If treatment is late, after-effects such as paralysis or trouble with speech can remain.

Risk factors you can control

• High blood pressure — the most important one
• Diabetes
• High cholesterol
• Smoking
• Atrial fibrillation — an irregular heartbeat. A clot formed in the heart travels to the brain
• Obesity and lack of exercise

Things you cannot control include older age, being male, and family history.

If several of the items above apply to you,
talk to an internal medicine or neurology department even if you have no symptoms now.
With a stroke, stopping it before it comes is the best treatment.

If the symptoms are happening now — do not pick a department

Call 119.
119 looks for a hospital that can treat stroke and takes the person there.
What matters is going to a hospital where treatment is possible, not to the nearest one.

Once you arrive at the emergency room, the hospital calls the right department itself.
The family does not need to choose a department.

If the symptoms have passed, or you are here for prevention and follow-up

• Neurology — the central department for diagnosing stroke, treating it with medicine, and preventing another one
• Neurosurgery — when surgery for a brain hemorrhage or treatment of an aneurysm is needed
• Rehabilitation medicine — handles rehabilitation for paralysis and trouble with speech
• Cardiology — when a heart problem such as atrial fibrillation is the cause
• Internal medicine / family medicine — managing high blood pressure, diabetes and high cholesterol

Do I have to go to a large hospital

Stroke can only be treated where CT and MRI equipment and 24-hour staff are in place.
So treatment in the acute phase is done at general hospitals and tertiary hospitals.

Some hospitals run a 'stroke center'.
It helps to find out in advance which stroke center you can reach from home.
Families of people with several risk factors should be sure to check this.

After discharge, you can carry on with prescriptions and follow-up at a hospital that is easy for you to visit.
Once the acute phase is over, it does not have to be a large hospital.

You can look for local clinics and large hospitals together on the map.

When you arrive at the emergency room

The very first thing is a brain CT scan.
Treatment cannot start until the staff know whether it is a blockage (cerebral infarction)
or a burst vessel (brain hemorrhage).

This test is over within a few minutes. It is a step that buys time for treatment.

Tests that follow

• Brain MRI — shows the damaged area and how far it reaches in more detail than CT
• Brain vessel imaging (CT angiography / MR angiography) — shows which vessel is blocked and whether any vessel is narrowed
• Electrocardiogram / heart ultrasound — checks whether the cause came from the heart, such as atrial fibrillation
• Carotid ultrasound — shows whether the vessels in the neck are narrowed
• Blood tests — check blood sugar, cholesterol, clotting function and so on

Why look for the cause as well

With a stroke, you can only prevent another one if you know why it happened.

• If it was atrial fibrillation → anticoagulant medicine
• If a vessel was narrowed → antiplatelet medicine and a vessel procedure
• If it was high blood pressure → blood pressure control

The medicine you will take from now on is completely different depending on the cause.
That is why there are several tests.

Someone who has had one stroke has a high risk of having another.
The tests that look for the cause are there to stop the next one.

Treatment is completely different depending on whether it is a cerebral infarction or a brain hemorrhage.

Cerebral infarction — opening the blocked vessel

• Intravenous thrombolysis — a drug that dissolves the clot is given into a vein. It can be given within 4.5 hours of the symptoms starting.
• Intra-arterial thrombectomy — a thin device is passed in through a vessel in the groin to pull the blocking clot out directly. It is done when a large vessel is blocked, and is usually recommended within 6 hours, though for some patients it is possible up to 24 hours.
• Medicine — antiplatelet medicine (which makes the blood clump less) or anticoagulant medicine prevents another stroke.
• Rehabilitation — started as early as possible.

Brain hemorrhage — settling the place that burst

• Blood pressure lowering medicine — lowers the blood pressure so the bleeding does not get larger.
• Medicine to lower pressure inside the skull — lowers the pressure in the swollen brain.
• Hematoma removal / skull opening surgery — when there is a lot of bleeding or the pressure in the brain is dangerous, surgery drains the blood or makes space.

Things to know

When you are told "treatment is finished", it means the acute phase is over.
With a stroke, two things remain after that.

1. Rehabilitation — the process of regaining the functions that were damaged. It takes time.
2. Preventing another stroke — keeping on with the medicine and managing the risk factors

Stopping the medicine on your own is the most dangerous thing of all.
Some people stop because the blood seems slow to stop, or because they feel better,
and this is a common reason strokes come back. Always talk to your medical team first.

It differs by hospital and by how the patient is, but the flow is usually like this.

The acute phase (the first part of the stay)

1. A CT scan is done in the emergency room and the treatment method is decided.
2. If thrombolysis or thrombectomy is to be done, it goes ahead straight away.
3. For the few days when the condition can get worse, the patient is watched closely.
4. Once stable, the tests that look for the cause (heart, vessels, blood) follow.

Rehabilitation

Once the condition is stable, rehabilitation starts as early as possible.

• It goes in order: sitting up in bed, standing, then walking
• If there is trouble with speaking or swallowing, training for that is done as well
• Depending on the hospital, some patients move to a rehabilitation hospital or a long-term care hospital to carry on

Rehabilitation takes time. You should think in terms of months.
It is better for the family to know about this period in advance.

Useful things for the family to know

• Tell the medical team exactly what time the symptoms started. The treatment method depends on this.
• Bring a list of the medicines the person usually takes, especially blood thinners, blood pressure medicine and diabetes medicine.
• Do not give water or food before swallowing has been checked. It can go into the airway.
• It helps to look over the home layout (door sills, bathroom, handrails) before discharge.

The length of stay and the rehabilitation process differ a great deal by hospital and by person.
For exact details, ask at the hospital where you are being treated.

Someone who has had one stroke has a high risk of having another.
And most of the risk factors are things that can be managed.

What to manage

• High blood pressure — the most important one. Do not stop the medicine even without symptoms.
• Diabetes
• High cholesterol
• Atrial fibrillation — an irregular heartbeat. If you have been diagnosed with it, taking anticoagulant medicine is very important.
• Stopping smoking
• Weight and exercise

About the medicine

The medicines taken after a stroke (antiplatelet medicine, anticoagulant medicine, blood pressure medicine, cholesterol medicine)
are medicines you keep taking even when you have no symptoms.

• Stopping because you feel better ❌
• Cutting down on your own because you bruise easily ❌
• When you have a procedure or a tooth taken out at another hospital, always say that you are taking these medicines

If something bothers you, do not put up with it; tell your medical team.
Sometimes the medicine can be changed or adjusted.

Things the family can prepare

• Check in advance which stroke center you can reach from home
• Make sure everyone in the family knows the signs of stroke (face, arm, speech)
• If an older family member spends long hours alone, set up a way for them to call for help

Just knowing the signs changes the outcome.
Please show this page to your family once.

The special cost-sharing program

Cerebrovascular disease can qualify, depending on the conditions, for the special cost-sharing program for serious illness (본인일부부담금 산정특례).
But unlike cancer, the conditions and the period are set differently.

For exactly who qualifies and for how long, check with the hospital's administration office
or with the National Health Insurance Service (국민건강보험공단).
If you are already an inpatient, asking at the hospital is the fastest way.

About rehabilitation

• For rehabilitation therapy, what national health insurance (건강보험) covers differs by the timing and the type of therapy.
• The cost structure changes when you move to a rehabilitation hospital or a long-term care hospital. Check before you move.
• If the hospital has a social work team (사회사업팀), ask them for advice. They will help you look for support programs.

Other things

• If a lasting disability remains, you can get advice about disability registration and the support that goes with it.
• There are medical cost support programs based on income level.

Programmes and out-of-pocket rates change.
What follows is a summary as of the reference date, so always check the latest rules
with the National Health Insurance Service.