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. These are important tests as they help determine the best treatment to be offered to help the patient and can help distinguish between a stroke type and other treatable causes that can produce stroke-like symptoms.
- Laboratory tests: Blood work to measure 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 the 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 to 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: Magnetic resonance imaging (MRI) 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. Frequently it is used after the acute emergency or if the original CT scan is inconclusive.
- X-rays: The doctor may order a chest X-ray to make sure there is nothing wrong with the patient's 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 the patient's mental status and abilities by asking simple but very specific questions ("What day is it?" or "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 about treatment can be difficult.
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