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Tests and diagnosis

By Mayo Clinic staff

To determine the best treatment for your stroke, your emergency team must figure out what type of stroke you're having and what parts of your brain it's affecting. Other possible causes of your symptoms, such as a brain tumor or a drug reaction, also need to be ruled out. Your doctor may also use some of these tests to determine your risk of stroke.

  • 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, and then will evaluate whether these symptoms are still present. The doctor will want to know what medications you take, and whether you have experienced any head injury. The doctor will also ask 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 carotid (neck) 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. Various blood tests give your care team such important information as how fast your blood clots and 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 must also be treated.
  • Computerized tomography (CT). Brain imaging plays a key role in determining if you are having a stroke and what type. Computerized tomography angiography (CTA) is a specialized CT exam in which a dye is injected into your vein and X-ray beams create a 3-D image of the blood vessels in your neck and brain. Doctors use CTA to look for aneurysms or arteriovenous malformations and to evaluate arteries for narrowing. CT scanning, which is done without dye, can provide images of your brain and show hemorrhages, but provides less detailed information about the blood vessels.
  • Magnetic resonance imaging (MRI). In this type of imaging, a strong magnetic field and radio waves generate a 3-D view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke. Magnetic resonance angiography (MRA) uses a magnetic field, radio waves and a dye injected into your veins to evaluate arteries in your neck and brain.
  • Carotid ultrasound. This procedure can show narrowing or clotting in your carotid arteries. A wand-like device (transducer) painlessly sends high-frequency sound waves into your neck. The sound waves pass through tissue and then return, creating on-screen images.
  • Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-rays. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye through the catheter to provide X-ray images of your arteries.
  • Echocardiography. This ultrasound technology creates images of your heart, enabling your doctor to see if a clot (embolus) from your heart has traveled to your brain and caused your stroke. Your doctor may need to use transesophageal echocardiography (TEE) to see your heart clearly. During this procedure, you swallow a flexible probe with a transducer built into it. From there, the probe travels to your esophagus — the tube that connects the back of your mouth to your stomach. Because your esophagus is directly behind your heart, very clear, detailed ultrasound images can be created, allowing a better view of blood clots that might not be seen clearly in a traditional echocardiography exam.
Treatments and drugs Preparing for your appointment
References
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DS00150 July 1, 2010

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