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Stroke (cont.)

Exams and Tests

The doctor takes a medical history of the person who may have had a stroke and performs a physical examination, which includes looking at blood pressure and pulse, heart and lungs, as well as a neurologic examination. The doctor may be able to tell what is going on simply from the examination.

Most of the time, however, laboratory tests and x-rays are ordered. These may be directed at ruling out other causes of the problem (such as infection or very low blood sugar) or testing for the stroke directly.

Laboratory tests: Blood work to measure your blood sugar, kidney function, salt balance, white blood cell count (sign of infection), hematocrit (looking for anemia), and other tests the doctor feels are appropriate are conducted. There is no specific blood test available yet to detect stroke.
CT scans: The most important imaging study at this time for stroke is a CT scan of the head. This study produces a 3-dimensional picture of your brain. In areas where there is an ischemic stroke, the brain may appear abnormal. Signs of swelling may also be present. Most strokes, even big ones, do not show up on the CT scan until 12-24 hours after the onset of symptoms. Small strokes may not be visible at all. CT scans are, however, good at detecting bleeding in the brain. A CT scan can help rule out a hemorrhagic stroke.
- Other types of brain imaging: A newer technique to look at the brain is magnetic resonance imaging (MRI). It provides a more detailed and sensitive picture of the brain. It is not available at all hospitals and is usually not available on a 24-hour basis. However, these types of scans are becoming more available and can provide more information about the stroke and what is the best way to treat it.
- X-rays: The doctor may order a chest x-ray to make sure there is nothing wrong with your lungs (such as cancer or pneumonia) that might be causing the symptoms.
Common tests that are ordered include an ECG to look for heart irregularities and a urinalysis to look for kidney abnormalities and infection. A doctor may evaluate your mental status and abilities by asking questions ("What day is it?" "Who is the President?").
The emergency department doctor often consults a neurologist or member of a stroke team to help decide what treatment is best. Sometimes, because of the wide variety of symptoms that a stroke can present and the lack of a single specific test for stroke, making this decision can be difficult.