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Tests and diagnosis
By Mayo Clinic staffIf you've had a previous stroke or TIA or think you're at risk of stroke, talk with your doctor about screening tests.
Before treating a stroke, your doctor 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 tumor, also need to be ruled out as a cause.
The following are most often used as screening tools to determine your risk, but they may also be used as diagnostic tools if you're having a stroke:
- Physical examination and tests. Your doctor may check for risk factors of stroke, including high blood pressure, high cholesterol levels, diabetes and high levels of the amino acid homocysteine. Your doctor may also use a stethoscope to listen for a whooshing sound (bruit) over your arteries that may indicate atherosclerosis.
- Carotid ultrasound. In this procedure, a wand-like device (transducer) sends high-frequency sound waves into your neck. The sound waves pass through tissue and then return, creating on-screen images that show any narrowing or clotting in your carotid arteries.
- 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.
- Computerized tomography (CT). In computerized tomographic angiography (CTA), 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 without as much detailed information about the blood vessels.
- Magnetic resonance imaging (MRI). Using a strong magnetic field, an MRI can generate a 3-D view of your brain. This test can detect brain tissue damaged by an ischemic stroke. Magnetic resonance angiography (MRA) uses the magnetic field and a dye injected into your veins to evaluate arteries in your neck and brain.
- Echocardiography. Your doctor can use this ultrasound technology to make images of your heart to see if an embolus from your heart has 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, which might not be seen clearly in a traditional echocardiography exam.
