Diagnosis of Stroke

When you are experiencing the symptoms of a stroke, an emergency diagnosis must be made as quickly as possible. Time is critical in preventing further damage to your brain and in reversing the damage already done. For this reason, you should get to an emergency room as quickly as possible.

After an initial review of your symptoms and medical history, a physical examination will focus on identifying the area of your brain that is being damaged. Your condition will be stabilized with regard to your blood pressure and any other medical problems you may have. An intravenous (IV) line will be started; blood and urine tests will be collected; and you will most likely have an examination of your head by computerized imaging—either an MRI or a CT scan.

The diagnosis evaluation includes:

  • Neurological exams
  • Blood and urine tests
  • Imaging scans

If the type of stroke can be identified within three hours of the beginning of your symptoms, you may be treated with "clot-busting" drugs to prevent worsening and possibly restore blood flow to the involved areas of your brain.

Tests to determine the cause, location, and amount of damage include:

CT Scan—This is a type of x-ray that uses a computer to make pictures of the brain.

MRI Scan—This uses magnetic fields to make pictures of the brain.

Arteriography (Angiography)—This test shows arteries in the brain after an injection of x-ray dye.

Magnetic Resonance Angiography (MRA)—The MRA shows brain blood vessels using the MRI machine. A dye called “gadolinium” may be injected in your vein.

Functional MRI—This shows brain activity by picking up signals from oxygenated blood in the brain.

Doppler Ultrasound or Carotid Ultrasonography—The doppler ultrasound shows narrowing of the carotid arteries in the neck that supply the brain.

Many strokes are due to heart problems, so be prepared to have heart function tests, as well. Possible tests include:

Electrocardiogram (ECG)—The ECG records the heart’s activity by measuring electrical currents through the heart muscle. This test is used to determine your heart rhythm and the health of your heart.

Cardiac Ultrasound (Echocardiogram)—This test uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart. This test is used to look inside your heart for defects that could launch a blood clot into your brain. The cardiac ultrasound may be performed by putting the transducer on the outside of your chest, or by putting a tiny transducer down your throat (transesophageal echocardiogram).

References:

Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill; 2004.



Last reviewed May 2007 by J. Thomas Megerian, MD, PhD, FAAP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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