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When you are experiencing the symptoms of a stroke, an emergency diagnosis must be made as quickly as possible. Time is critical in preventing further damage to your brain and in reversing the damage already done. For this reason, you should get to an emergency room as quickly as possible.

After an initial review of your symptoms and medical history, a physical exam will focus on identifying the area of your brain that is being damaged. Your condition will be stabilized. An intravenous (IV) line will be started; blood and urine tests will be collected; and you will most likely have an examination of your head by computerized imaging—either an MRI or a CT scan.

The diagnosis evaluation includes:

  • Neurological exams
  • Blood and urine tests
  • Imaging scans

If the type of stroke can be identified within 4½ hours of the beginning of your symptoms, you may be treated with IV "clot-busting" drugs to prevent worsening and possibly restore blood flow to the involved areas of your brain. If it is within approximately six hours of the onset of your symptoms, you may be treated with intra-arterial (IA) “clot busting” drugs. (These time windows will change as more research is done.)

Tests to determine the cause, location, and amount of damage include:

  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the head
  • Arteriography —a test that shows arteries in the brain after an injection of x-ray dye
  • Magnetic resonance angiography (MRA)—a test that uses a dye to show the blood vessels in the brain
  • CT angiography (CTA)—a test that uses a dye to show blood vessels using the CT machine
  • Functional MRI—a test that shows brain activity by picking up signals from oxygenated blood in the brain
  • Doppler ultrasound or carotid ultrasonography—a test that shows narrowing of the carotid arteries and vertebral arteries in the neck that supply the brain
  • Electroencephalogram (EEG)—a test that uses sensors to evaluate electrical brain activity; may be helpful to rule out other causes of symptoms that may look like a stroke
  • Lumbar puncture —a sample of the cerebrospinal fluid from the lower back; not routinely done, unless the doctor is trying to rule out a hemorrhagic stroke or an infection of the central nervous system

Many strokes are due to heart problems, so be prepared to have heart function tests, as well. Possible tests include:

  • Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle
  • Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
  • Blood tests—to look at cholesterol and factors that may make your blood more or less likely to bleed
References:

Albers GW, Amarenco P, Easton JD, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008;133(suppl 6):887S-968S.

Carpenter, C, Keim S, Milne W, Meurer W, Barsan W. Thrombolytic therapy for acute ischemic stroke beyond three hours. J Emerg Med. 2010; June 23rd [Epub ahead of print].

Neuroimaging for acute stroke. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 30, 2012. Accessed September 4, 2012.

Stroke (acute management). EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 30, 2012. Accessed September 4, 2012.

Stroke diagnosis. The Internet Stroke Center website. Available at: http://www.strokecenter.org/patients/stroke-diagnosis/lab-tests-and-procedures/. Accessed September 4, 2012.

Know stroke. Stroke National Institute of Neurological Disorders and Stroke website. Available at: http://stroke.nih.gov. Accessed September 4, 2012.

Last reviewed October 2012 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.