Hailey Tran
Stroke diagnosis begins with a physical exam, which includes taking the patient's blood pressure and checking for mental alertness, numbness or weakness, or trouble speaking, seeing, or walking. Doctors also perform neurological exams to check how well the nervous system is working. Next, doctors conduct imaging tests such as computed tomography (CT) scans, magnetic resonance imaging (MRI), and angiograms to visualize the brain and blood vessels. Blood tests, including complete blood counts and cholesterol tests, are also used to determine the cause and type of stroke. Electrocardiograms (ECG or EKG) are employed to detect heart problems that may have led to the stroke. The combination of these tests helps doctors diagnose the type of stroke, its cause, and the appropriate treatment plan.
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What You'll Learn
- Physical exam: checking for mental alertness, numbness, weakness, and trouble speaking or seeing
- Neurological exam: testing how well the nervous system is working
- Electrocardiogram (ECG or EKG): recording electrical activity in the heart to detect atrial fibrillation
- Imaging tests: CT scans, MRIs, angiograms, and ultrasounds to see inside the brain and blood vessels
- Blood tests: checking glucose levels, cholesterol, clotting, and kidney function
Physical exam: checking for mental alertness, numbness, weakness, and trouble speaking or seeing
A physical exam for stroke in a hospital typically involves checking for mental alertness, numbness, weakness, and trouble speaking or seeing. This includes evaluating the patient's mental status, motor function, sensory abilities, and cranial nerves.
During the mental status examination, clinicians assess the patient's level of alertness, orientation, concentration, memory, and abstract reasoning. This involves observing the patient's level of consciousness, which can range from being fully alert to a comatose state. Clinicians also evaluate the patient's cognition, speech, mood, thought process, and perceptual disturbances.
Motor function and balance are assessed through physical interactions, such as having the patient push and pull against the examiner's hands with their arms and legs. Balance tests may include observing the patient's gait and stance, as well as testing their ability to maintain balance with their eyes closed.
The sensory exam evaluates the patient's ability to feel through touch, temperature, or pain sensation. This is often done using various instruments, such as dull needles, tuning forks, or alcohol swabs.
Cranial nerve function is also assessed, particularly those involved in vision and eye movement. For example, the healthcare provider may examine the patient's eyes with a special light, testing the optic nerve (Cranial nerve II), which carries vision to the brain. They may also assess the oculomotor nerve (Cranial nerve III) by examining the pupil's response to light and its ability to move in various directions.
Additionally, as part of the physical exam, the patient's vital signs, medical history, and current symptoms will be reviewed. This comprehensive approach helps clinicians determine the presence and extent of a stroke, as well as inform treatment decisions.
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Neurological exam: testing how well the nervous system is working
A neurological exam is an evaluation of a person's nervous system, which consists of the brain, spinal cord, and nerves from these areas. It is done to test how well the nervous system is working and can help determine whether symptoms are due to a nervous system disorder or another medical issue.
The exam can be done with instruments such as lights and reflex hammers, and it usually does not cause any pain to the patient. The extent of the exam depends on factors including the initial problem the patient is experiencing, their age, and their condition. A complete neurological exam may be done to test the functioning of the nervous system, which is very complex and controls many parts of the body. The areas that may be tested and evaluated during a neurological exam include:
- Mental status: The patient's level of awareness and interaction with the environment may be assessed by conversing with the patient. This may also involve testing cognition, providing helpful information about thinking, memory, and the patient's emotional state.
- Reflexes: In infants, reflexes are usually examined by stroking the sole of the foot, placing the infant on their stomach, and performing Moro's reflex. In older children and adults, reflexes are examined using a reflex hammer at different points on the body.
- Cranial nerves: During a complete neurological exam, most of the 12 main nerves of the brain are evaluated to help determine the functioning of the brain. This may include testing the patient's sense of smell, taste, and hearing, as well as the movement of the eyes, tongue, shoulders, and neck.
- Sensory functions: This involves assessing the patient's ability to perceive pain, temperature, and other sensations. It may include touching different areas of the body with a pin or a vibrating tuning fork, or lightly stroking the skin with a cotton ball and asking if the patient can feel it.
- Motor skills: The patient may be asked to perform tasks such as closing their eyes and moving their toes, or putting warm or cold objects against their skin.
- Balance and coordination: The patient's ability to maintain balance and coordinate their movements may be assessed.
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Electrocardiogram (ECG or EKG): recording electrical activity in the heart to detect atrial fibrillation
An electrocardiogram (ECG or EKG) is a test that measures the electrical activity of the heartbeat. It can help find heart problems that may have led to a stroke. This test can be carried out in hospital or even before the patient arrives, in the ambulance.
The test involves placing small stickers on the patient's chest to record the electrical activity of the heart. There is no pain or risk associated with having an ECG. The machine does not send electricity into the body.
An ECG can help diagnose atrial fibrillation by measuring the rate and rhythm of the contractions in the upper and lower chambers of the heart. A normal heartbeat will show a regular rhythm. A normal sinus rhythm produces the prototypical pattern of P wave, QRS complex, and T wave. An "irregularly irregular" QRS complex without P waves is the hallmark of atrial fibrillation.
ECGs can be interpreted in isolation but should be applied in the context of the patient. For example, an ECG can be used to diagnose hyperkalemia, but this should be verified by measuring blood potassium levels.
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Imaging tests: CT scans, MRIs, angiograms, and ultrasounds to see inside the brain and blood vessels
Imaging tests are crucial for diagnosing a stroke and understanding its extent and location in the brain. These tests can include CT scans, MRIs, angiograms, and ultrasounds.
Computed tomography (CT) scans are often one of the first tests performed to evaluate a stroke. They use X-rays to capture images of the brain from multiple angles, allowing doctors to identify areas of abnormality, such as bleeding in the brain, damage to brain cells, or blockages in blood flow. CT scans can help determine if the stroke is ischemic (caused by insufficient blood flow) or hemorrhagic (caused by a ruptured blood vessel). However, CT scans may not always detect a stroke, especially in certain areas of the brain, and they can take several hours to reveal blockages.
Magnetic resonance imaging (MRI) is another powerful tool for diagnosing strokes. MRIs use magnets, radio waves, and computers to create detailed images of the brain. They can detect brain changes caused by a stroke sooner than CT scans and are more sensitive, making them excellent for detecting even tiny abnormalities. MRIs can also identify bleeding, blood flow problems, and other issues like tumors that can cause stroke-like symptoms. However, MRIs take longer than CT scans and may not be ideal in emergency situations where quick treatment is crucial.
Angiograms, specifically cerebral angiograms or CT angiography, are imaging tests that focus on the blood vessels. They can provide detailed images of the blood vessels in the head and neck, helping to diagnose blood vessel abnormalities, such as aneurysms, narrowed vessels, or blockages. During an angiogram, a contrast dye is injected into the bloodstream to enhance the visibility of blood vessels in X-ray images. Ultrasounds may also be used to visualize blood vessels and detect blood flow abnormalities.
Together, these imaging tests provide valuable information about the location and extent of a stroke, helping doctors make accurate diagnoses and determine the best course of treatment.
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Blood tests: checking glucose levels, cholesterol, clotting, and kidney function
While there is no blood test that can diagnose a stroke, doctors at the hospital may perform a series of blood tests to determine the cause of stroke symptoms and decide on the best treatment. These blood tests can include:
Blood Glucose
Blood glucose tests measure the level of sugar (glucose) in the blood. High blood sugar levels can increase the risk of stroke, and patients with diabetes are at a higher risk of having a stroke. Therefore, blood glucose tests are essential for controlling blood sugar levels and improving the chances of stroke recovery.
Cholesterol Tests
Cholesterol tests examine whether high blood cholesterol might have led to a stroke. High cholesterol is a risk factor for cerebrovascular disease, which includes strokes.
Clotting Tests
Clotting tests, also called coagulation tests or coagulation panels, measure how quickly your blood clots. If the blood clots too quickly, it could indicate a clot-caused (ischemic) stroke, whereas if it clots too slowly, it could suggest a bleeding-caused (hemorrhagic) stroke.
Renal Function Tests
Renal function tests assess kidney function by measuring how efficiently the kidneys filter toxins from the blood. Poor kidney function can lead to high blood pressure, a common risk factor for stroke.
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Frequently asked questions
If someone is suspected of having a stroke, it is important to call 911 or go to the nearest emergency room immediately. Tests for a stroke usually start in the ambulance, before reaching the hospital. The tests aim to determine whether the patient has had a stroke, what type of stroke it was, and what caused it.
The different types of strokes include an ischemic stroke, which is the most common type and happens when a blood clot blocks blood flow to the brain; a hemorrhagic stroke, which occurs when there is bleeding in the brain or a blood vessel bursts; and a transient ischemic attack (TIA or mini-stroke), where the symptoms of a stroke last for a short duration, typically less than 24 hours.
Doctors use a combination of physical exams, imaging tests, and blood tests to diagnose a stroke. The physical exam includes checking for mental alertness, coordination, balance, numbness, weakness, trouble speaking, and seeing. Imaging tests such as computed tomography (CT) scans, magnetic resonance imaging (MRI), angiograms, and electrocardiograms (ECG or EKG) are used to visualize the brain and blood vessels. Blood tests are done to check blood sugar levels, cholesterol levels, and complete blood counts to understand the cause and determine suitable treatment.
Treatments for strokes depend on the type of stroke and its underlying cause. For ischemic strokes caused by blood clots, clot-busting drugs like tPA may be administered to dissolve the clot. Alternatively, a device called a stent may be used to remove the clot mechanically. For hemorrhagic strokes caused by aneurysms, doctors may clamp the broken vessel closed or insert a tiny coil to prevent it from bursting again. Medication is also given to control high blood pressure, which is a common cause of hemorrhagic strokes.
