Ethan Rhodes
Stroke is a medical emergency that requires immediate attention. The F-A-S-T test is an easy way to remember the signs of a stroke: Face Drooping – Does one side of the face droop or is it numb? Arm Weakness – Is one arm weak or numb? Speech – Does speech sound strange or slurred? Time to call 911 – Stroke is an emergency. Every minute counts. Once at the hospital, doctors will perform a physical exam, neurological exam, and imaging tests such as CT scans, MRIs, and angiograms to determine the type, cause, and location of the stroke. Blood tests will also be conducted to rule out other conditions and determine treatment options.
| Characteristics | Values |
|---|---|
| Ambulance worker or doctor will | Ask about symptoms and medical history |
| Do a physical exam | |
| Take blood pressure | |
| Check for mental alertness, numbness or weakness, or trouble speaking, seeing, or walking | |
| Do a neurological exam | |
| Imaging tests | Computed tomography (CT) scan |
| Magnetic resonance imaging (MRI) | |
| CT or MR angiogram | |
| Digital subtraction angiography (DSA) | |
| Positron emission tomography (PET) | |
| Blood tests | Complete blood count (CBC) |
| Thyroid tests | |
| Blood glucose | |
| Cholesterol tests | |
| C-reactive protein test and blood protein test | |
| Electrocardiogram (ECG or EKG) | |
| Lumbar puncture (spinal tap) |
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What You'll Learn
- Initial stroke exams: checking symptoms, medical history, and physical/neurological exams
- Imaging tests: CT, MRI, angiogram, DSA, and PET scans to look inside the brain
- Electrocardiogram (ECG/EKG): detecting heart electrical activity and atrial fibrillation
- Blood tests: CBC, thyroid, glucose, cholesterol, and clotting tests to determine stroke causes and treatment
- Lumbar puncture: spinal tap to collect fluid and test for hemorrhagic stroke
Initial stroke exams: checking symptoms, medical history, and physical/neurological exams
When checking for a stroke, time is of the essence. Tests usually begin in the ambulance, before the patient even reaches the hospital. The goals of these initial tests are to determine whether the patient has had a stroke, what type of stroke it was, and what caused it. This information will help doctors plan the patient's treatment.
Checking symptoms
The F-A-S-T test is an easy way to remember the signs of a stroke:
- Face: Ask the patient to smile and observe if one side of their face droops.
- Arms: Ask the patient to raise both arms and check if one arm droops or drifts downward.
- Speech: Ask the patient to repeat a simple phrase and listen for any slurring or strange sounds.
- Time: If you observe any of these symptoms, call 911 immediately and note the time the symptoms started.
Other symptoms to check for include:
- Mental alertness
- Numbness or weakness
- Vision or speech problems
- Coordination and balance issues
Medical history
It is important to ask the patient or their family members about their medical history, including any history of transient ischaemic attacks (TIAs). TIAs are caused by a temporary interruption of blood supply to the brain, and their symptoms typically resolve within 24 hours. Ask the patient if they have noticed any changes in sensation in their arms, legs, or face.
Physical/neurological exams
Physical exams typically include checking the patient's vital signs, such as blood pressure, and listening to their heart. Neurological exams assess the functioning of the nervous system, which consists of the brain, spinal cord, and nerves. These exams may include:
- Evaluation of motor and sensory skills
- Balance and coordination tests
- Mental status assessment (level of awareness and interaction with the environment)
- Reflex tests, such as the use of a reflex hammer to evaluate the nerves of the brain
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Imaging tests: CT, MRI, angiogram, DSA, and PET scans to look inside the brain
Imaging tests are a crucial aspect of stroke diagnosis, allowing doctors to visualise the brain and identify the location and extent of the stroke. Computed tomography (CT) scans are often the first test performed, utilising X-rays to capture images of the brain. CT scans can reveal bleeding in the brain, damage to brain cells, and other issues that might be causing stroke-like symptoms. They are widely available and provide rapid results, making them ideal for emergency situations.
Magnetic resonance imaging (MRI) is another imaging technique that employs magnets, radio waves, and computers to generate detailed images of the brain. MRI scans are highly sensitive and can detect even minute abnormalities. They are excellent for differentiating between ischemic and haemorrhagic strokes and can identify issues within an hour of stroke onset. However, MRI scans take longer than CT scans and may not be suitable for individuals with metal implants or claustrophobia.
Digital Subtraction Angiography (DSA) is a fluoroscopic technique used to visualise the vascular system. It involves digitally removing structures like bones from the image to better visualise blood vessels. DSA can be useful in detecting bleeding and visualising blood flow.
Cerebral angiograms are a type of imaging test used to diagnose or confirm blood vessel abnormalities in the brain, including aneurysms, atherosclerosis, and blood clots. This test involves inserting a catheter and releasing contrast dye to visualise blood vessels and identify potential blockages.
Positron emission tomography (PET) imaging, a form of molecular imaging, has shown promise in the field of stroke diagnosis. PET imaging uses radiolabelled ligands to trace and highlight pathologic mechanisms, measure cellular uptake of glucose and oxygen, and target cell surface receptors. It has provided valuable insights into stroke mechanisms, progression, and recovery, aiding in the development of novel treatments.
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Electrocardiogram (ECG/EKG): detecting heart electrical activity and atrial fibrillation
When a patient is suspected of having a stroke, it is crucial to act quickly and seek medical attention. Tests for stroke usually commence in the ambulance, even before reaching the hospital. These preliminary assessments are crucial for understanding the patient's condition and planning their treatment. Once the patient arrives at the hospital, doctors will perform further examinations and tests to confirm the diagnosis and determine the type and cause of the stroke.
One of the critical tests performed at the hospital is the Electrocardiogram (ECG or EKG). This non-invasive test helps detect and record the electrical activity of the heart. It is a valuable tool for diagnosing heart problems, including atrial fibrillation, which is a common cause of stroke. During an ECG, electrodes are attached to the patient's arms, legs, and chest. These electrodes detect the weak electrical currents generated by the heart cells, which are then amplified and recorded by a machine, creating a graphic representation of the heart's electrical activity.
The ECG can identify abnormalities in the heart's rhythm, such as arrhythmias, and can also help detect previous heart attacks or myocardial infarctions. It is often used as a preliminary test to determine if a patient has heart disease. Additionally, it can be performed during physical activity or under light stress to monitor how the heart behaves when working harder. This type of ECG is known as a stress test.
The interpretation of an ECG involves analyzing specific components, such as the presence or absence of regular P waves, the duration of QRS complexes, and the correlation between P waves and QRS complexes. These features help identify the origin of any arrhythmias and determine if they originate in the atria or ventricles. For example, in atrial fibrillation, the very fast atrial activity results in the absence of distinct P waves, leading to an irregularly irregular rhythm.
In addition to the ECG, doctors may also order imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), to visualize the brain and assess the damage caused by the stroke. These imaging tests help determine the location and extent of the stroke, identify bleeding or blood flow problems, and rule out other conditions with similar symptoms.
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Blood tests: CBC, thyroid, glucose, cholesterol, and clotting tests to determine stroke causes and treatment
Blood tests are an important part of diagnosing and treating strokes. While there is no blood test that can directly diagnose a stroke, they can be used to identify the cause of stroke symptoms and determine treatment options. Here are some common blood tests performed when checking for a stroke:
Complete Blood Count (CBC)
This test assesses red blood cell and platelet counts, as well as glucose (sugar) levels in the blood. Ensuring stable glucose levels is crucial, as low blood sugar can sometimes cause stroke-like symptoms.
Thyroid Test
Thyroid function can impact stroke risk. Doctors may measure thyroid hormone levels to check for hyperthyroidism, which increases the risk of atrial fibrillation and, subsequently, stroke.
Cholesterol Test
High blood cholesterol is a risk factor for stroke as it can lead to plaque buildup in the arteries, known as atherosclerosis or "hardening of the arteries". A clot can form in these narrowed arteries, blocking blood flow to the brain.
Clotting Tests
These tests assess how quickly your blood clots. This is important because it helps doctors determine if anticoagulants, or blood thinners, are a suitable treatment option. Anticoagulants are used to prevent further clotting and reduce the risk of additional strokes.
Additional Tests
Doctors may also perform an electrocardiogram (ECG or EKG) to detect heart problems, such as atrial fibrillation or a previous heart attack, which could have led to the stroke. Imaging tests, such as CT scans and MRIs, are also commonly used to visualise the brain and identify the type and location of the stroke.
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Lumbar puncture: spinal tap to collect fluid and test for hemorrhagic stroke
A lumbar puncture, also known as a spinal tap, is a procedure used to diagnose or treat a condition. It is often used to help diagnose conditions that affect the brain, nerves, and spinal cord. During a lumbar puncture, a healthcare provider inserts a hollow needle into the lower back to remove a sample of cerebrospinal fluid (CSF). CSF is a clear fluid that surrounds and cushions the brain and spinal cord. It is composed of cells, water, proteins, sugars, and other substances essential for maintaining balance in the nervous system.
A lumbar puncture may be performed to collect CSF for testing if imaging scans show no bleeding in the brain, but a hemorrhagic stroke is still suspected. The fluid is examined for substances that indicate the presence of damaged blood cells. This procedure can also help diagnose other conditions, such as meningitis, encephalitis, certain cancers, myelitis, and neurosyphilis.
The lumbar puncture procedure typically lasts 15 to 30 minutes, and local anesthesia is administered to ensure the patient feels no pain. After the procedure, patients may experience side effects such as spinal headaches, a fast heart rate, or low blood pressure. It is recommended to drink plenty of fluids and take over-the-counter pain medications to manage these side effects.
When diagnosing a stroke, doctors rely on a combination of the patient's symptoms, medical history, physical exams, and test results. Tests for stroke typically begin in the ambulance and continue at the hospital. Physical exams may include checking blood pressure, mental alertness, numbness, weakness, and speech, vision, or walking impairments. Neurological exams are also conducted to assess the functioning of the nervous system. Imaging tests such as CT scans, MRI scans, and angiograms are commonly used to visualize the brain and detect bleeding or damage. Additionally, electrocardiograms (ECG or EKG) are employed to detect heart problems that may have contributed to the stroke.
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