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Tests and diagnosis

By Mayo Clinic staff

To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including:

  • Physical examination. Your doctor will ask you or a family member what symptoms you've been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present. Your doctor will want to know what medications you take and whether you have experienced any head injuries. You'll be asked about your personal and family history of heart disease, TIA or stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes.
  • Blood tests. You may have several blood tests, which give your care team important information such as how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Your blood's clotting time and levels of sugar and key chemicals must be managed as part of your stroke care. Infections also must be treated.
  • Computerized tomography (CT) scan. Brain imaging plays a key role in determining if you're having a stroke and what type of stroke you may be experiencing. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a brain hemorrhage, tumors, strokes and other conditions. Doctors may inject a dye into your blood vessels to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).
  • Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Sometimes your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography).
  • Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries.
  • Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck.
  • Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. You sometimes may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached in your throat and down into your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots.
Treatments and drugs Preparing for your appointment
References
  1. Stroke: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/stroke.htm. Accessed April 13, 2012.
  2. Oliveira-Filho J. Initial assessment and management of acute stroke. http://www.uptodate.com/index. Accessed April 13, 2012.
  3. Know stroke brochure. National Institute of Neurological Disorders and Stroke. http://stroke.nih.gov/materials/actintime.htm. Accessed April 13, 2012.
  4. Roger V, et al. Heart disease and stroke statistics - 2012 update: A report from the American Heart Association. Circulation. 2012;125:e2.
  5. Warning signs of a stroke. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=SYMP. Accessed April 13, 2012.
  6. Caplan LR. Overview of the evaluation of stroke. http://www.uptodate.com/index. Accessed April 13, 2012.
  7. Caplan LR. Etiology and classification of stroke. http://www.uptodate.com/index. Accessed April 13, 2012.
  8. Ischemic stroke (clots). American Stroke Association. http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/IschemicClots/Ischemic-Strokes-Clots_UCM_310939_Article.jsp. Accessed April 27, 2012.
  9. Cerebral aneurysms fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/cerebral_aneurysm/cerebral_aneurysms.htm. Accessed April 27, 2012.
  10. Furie KL, et al. Etiology and clinical manifestations of transient ischemic attack. http://www.uptodate.com/index. Accessed April 27, 2012.
  11. Effects of stroke. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=EFFECT. Accessed April 27, 2012.
  12. Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm?css=print. Accessed May 7, 2012.
  13. What is echocardiography? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/echo/. Accessed May 15, 2012.
  14. Samuels OB. Intravenous fibrinolytic (thrombolytic) therapy in acute ischemic stroke: Therapeutic use. http://www.uptodate.com/index. Accessed April 27, 2012.
  15. Oliveira-Filho J. Reperfusion therapy for acute ischemic stroke. http://www.uptodate.com/index. Accessed April 27, 2012.
  16. Cucchiara BL, et al. Antiplatelet therapy for secondary prevention of stroke. http://www.uptodate.com/index. Accessed April 27, 2012.
  17. Questions and answers about carotid endarterectomy. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/carotid_endarterectomy_backgrounder.htm. Accessed May 15, 2012.
  18. Mohler ER, et al. Carotid endarterectomy. http://www.uptodate.com/index. Accessed May 15, 2012.
  19. Greelish JP, et al. Carotid artery stenting and its complications. http://www.uptodate.com/index. Accessed May 15, 2012.
  20. Rordorf G, et al. Spontaneous intracerebral hemorrhage: Prognosis and treatment. http://www.uptodate.com/index. Accessed May 15, 2012.
  21. Arteriovenous malformations and other vascular lesions of the central nervous system fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/avms/avms.htm. Accessed May 15, 2012.
  22. Recovery and rehabilitation. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=REHABT. Accessed May 15, 2012.
  23. Recovery after stroke — Coping with emotions. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=Recov_factsheets. Accessed April 27, 2012.
  24. Recovery after stroke — Social support. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=Recov_factsheets. Accessed April 27, 2012.
  25. Recovery after stroke — Thinking and cognition. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=Recov_factsheets. Accessed April 27, 2012.
  26. Controllable risk factors — High blood pressure (hypertension). National Stroke Association. http://www.stroke.org/site/PageServer?pagename=Recov_factsheets. Accessed April 27, 2012.
  27. STARS — Steps against recurrent stroke. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=STARS. Accessed May 15, 2012.
  28. Physical activity and healthy diet. National Stroke Association. http://www.stroke.org/site/PageServer?pagename=eathealthy. Accessed May 15, 2012.
  29. Furie KL. Secondary prevention of stroke: Risk factor reduction. http://www.uptodate.com/index. Accessed May 15, 2012.
  30. Oliveira-Filho J, et al. Antithrombotic treatment of acute ischemic stroke. http://www.uptodate.com/index. Accessed May 15, 2012.
  31. Brown RD (expert opinion). Mayo Clinic, Rochester, Minn. June 10, 2012.
DS00150 July 3, 2012

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